"Last Updated on December 4, 2023" hospital_id cpt cpt_modifier hcpcs hcpcs_modifier DRG APR-DRG Severity APC APG rev_code item_description item_setting gross_charge cash_price medicare medicaid 1199 SEIU National Benefits & Pension Plan Aetna ASA Products Aetna Commercial Aetna Medicare Advantage Affinity Child Health Plus Affinity Exchange Product Affinity Medicaid and Family Health Plus Affinity Medicare Care Connect Commercial Center's Plan For Healthy Living Commercial Centivo Commercial Cigna Commercial Emblem Health Essential Plan 1 & 2 Emblem Health Essential Plan 3 & 4 Emblem Health GHI Access Network Emblem Health GHI Commercial Emblem Health HIP HMO Emblem Health HIP PPO Emblem Health Medicaid Emblem Health Medicare Advantage Emblem Health Select Care "Empire BCBS CHP, Essential Plan 1 & 2" Empire BCBS Commercial "Empire BCBS Medicaid, FHP, Essential Plan 3 & 4" Fidelis Child Health Plus Fidelis Essential Plan Program Fidelis Exchange Fidelis Care Fidelis Medicare Healthfirst Medicare Longevity Medicare Advantage Magnacare Multiplan MVP Child Health Plus MVP Commercial "MVP Essential Plans 1, 2, 5, 6" "MVP Essential Plans 3,4" MVP Medicaid Northwell Direct Oscar Individual Oscar SG Broad Oscar SG Narrow (1000-5000 employees) Oscar SG Narrow (<1000 employees) Oxford Health Plan All Payer Partners Health Plan Medicare Advantage Triwest Veterans Plan Medicare United Healthcare Commercial United Healthcare Community VNS Medicaid Wellcare Child Health Plus "Wellcare Medicaid, Family Health Plus" Wellcare Medicare de_identified_min de_identified_max 330104 100 HC TRANSITIONAL CARE UNIT I "$2,621.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,572.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,097.20 " "$2,228.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,572.90 " "$2,228.28 " 330104 111 HC PRIVATE I "$7,634.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,107.56 " "$6,489.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " "$6,489.28 " 330104 112 HC PRIVATE MATERNITY/OB I "$7,634.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,107.56 " "$6,489.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " "$6,489.28 " 330104 114 HC PRIVATE; I "$7,634.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,107.56 " "$6,489.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,580.67 " "$6,489.28 " 330104 116 HC PRIVATE ROOM DETOX I "$4,439.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,663.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,551.54 " "$3,773.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,663.66 " "$3,773.52 " 330104 118 HC PRIVATE REHAB I "$4,439.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,663.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,551.54 " "$3,773.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,663.66 " "$3,773.52 " 330104 121 HC SEMI-PRIVATE I "$6,392.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,113.74 " "$5,433.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " "$5,433.35 " 330104 122 HC ANTIPARTUM SEMI-PRIVATE I "$6,392.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,113.74 " "$5,433.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " "$5,433.35 " 330104 123 HC PEDIATRICS SEMI PVT I "$6,392.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,113.74 " "$5,433.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " "$5,433.35 " 330104 124 HC SEMI PRIVATE. I "$6,392.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,113.74 " "$5,433.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,835.31 " "$5,433.35 " 330104 126 HC SEMI PVT STABILIZATION I "$4,365.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,619.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,492.48 " "$3,710.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,619.36 " "$3,710.76 " 330104 128 HC REHAB SEMI-PVT I "$4,365.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,619.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,492.48 " "$3,710.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,619.36 " "$3,710.76 " 330104 171 HC SEMI PRIVATE BASSINET I "$2,841.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,705.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,273.54 " "$2,415.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,780.00 " N/A N/A "$4,752.00 " N/A N/A N/A N/A N/A "$1,705.15 " "$4,752.00 " 330104 174 HC NICU-INTENSIVE I "$10,708.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,425.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,566.85 " "$9,102.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,560.00 " N/A N/A "$8,856.00 " N/A N/A N/A N/A N/A "$6,425.14 " "$9,102.28 " 330104 179 HC BOARDER BABY I "$2,841.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,705.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,273.54 " "$2,415.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,780.00 " N/A N/A "$4,752.00 " N/A N/A N/A N/A N/A "$1,705.15 " "$4,752.00 " 330104 180 HC LOA DUMMY CHARGE I N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 330104 201 HC CS INTENSIVE CARE UNIT I "$12,752.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,651.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,201.81 " "$10,839.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,651.36 " "$10,839.42 " 330104 201 HC MS / ICU I "$10,111.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,066.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,089.20 " "$8,594.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,066.90 " "$8,594.77 " 330104 202 HC ICU - MEDICAL I "$10,111.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,066.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,089.20 " "$8,594.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,066.90 " "$8,594.77 " 330104 214 HC INTERMEDIATE CARDIAC CARE UNIT I "$8,947.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,368.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,157.87 " "$7,605.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,368.40 " "$7,605.24 " 330104 T2101 999 220 HC BREAST MILK PROC/STORE/DIST O $1.07 N/A N/A $0.17 $0.54 $0.66 $0.66 N/A $0.17 N/A $0.17 N/A $0.80 N/A $0.70 $0.78 $0.20 $0.17 $0.64 $0.86 N/A $0.54 $0.17 N/A $0.70 $0.24 $0.86 $0.17 $0.17 $0.20 N/A $0.17 N/A N/A N/A $0.86 $0.91 $0.23 $0.80 $0.35 $0.23 $0.54 $0.70 $0.72 $0.72 $0.72 $0.72 N/A N/A N/A $0.71 $0.17 $0.17 N/A N/A N/A $0.17 $0.91 330104 250 HC PHARMACY W/O HCPCS O $15.00 N/A N/A N/A $7.50 $9.30 $9.30 $9.81 N/A N/A N/A N/A $11.25 $10.50 $9.75 $10.96 $5.25 $5.25 $9.00 $12.00 N/A $7.50 $5.25 N/A N/A N/A $12.00 N/A $12.00 N/A N/A $12.00 N/A N/A N/A $12.00 $12.75 $7.50 $11.25 $7.50 $7.50 N/A $9.75 $10.12 $10.12 $10.12 $10.12 N/A N/A N/A $10.01 $7.50 N/A N/A N/A N/A $5.25 $12.75 330104 250 HC NYACK CODE CART O "$1,134.00 " N/A N/A N/A $567.00 $703.08 $703.08 $741.64 N/A N/A N/A N/A $850.50 $793.80 $737.10 $828.95 $396.90 $396.90 $680.40 $907.20 N/A $567.00 $396.90 N/A N/A N/A $907.20 N/A $907.20 N/A N/A $907.20 N/A N/A N/A $907.20 $963.90 $567.00 $850.50 $567.00 $567.00 N/A $737.10 $765.45 $765.45 $765.45 $765.45 N/A N/A N/A $756.38 $567.00 N/A N/A N/A N/A $396.90 $963.90 330104 250 HC NITRIC OXIDE PER HOUR O $200.00 N/A N/A N/A $100.00 $124.00 $124.00 $130.80 N/A N/A N/A N/A $150.00 $140.00 $130.00 $146.20 $70.00 $70.00 $120.00 $160.00 N/A $100.00 $70.00 N/A N/A N/A $160.00 N/A $160.00 N/A N/A $160.00 N/A N/A N/A $160.00 $170.00 $100.00 $150.00 $100.00 $100.00 N/A $130.00 $135.00 $135.00 $135.00 $135.00 N/A N/A N/A $133.40 $100.00 N/A N/A N/A N/A $70.00 $170.00 330104 96360 5693 111 260 HC HYDRATION IV INFUSION INIT O $847.44 $247.83 $247.83 $35.00 $423.72 $525.41 $525.41 $245.35 $35.00 $470.88 $35.00 $247.83 $635.58 $272.61 $550.84 $619.48 $42.00 $35.00 $508.46 $677.95 $842.62 $423.72 $35.00 $247.83 $297.40 $49.00 $677.95 $35.00 $35.00 $42.00 $346.96 $35.00 $247.83 $247.83 $270.14 $677.95 $720.32 $35.00 $635.58 $71.75 $35.00 $423.72 $408.92 $572.02 $572.02 $572.02 $572.02 N/A $260.22 $247.83 $565.24 $35.00 $35.00 $210.66 $210.66 $247.83 $35.00 $842.62 330104 96361 5691 110 260 HC HYDRATE IV INFUSION ADD-ON O $245.03 $50.83 $50.83 $5.00 $122.52 $151.92 $151.92 $50.32 $5.00 $96.58 $5.00 $50.83 $183.77 $55.92 $159.27 $179.12 $6.00 $5.00 $147.02 $196.02 $172.83 $122.52 $5.00 $50.83 $61.00 $7.00 $196.02 $5.00 $5.00 $6.00 $71.17 $5.00 $50.83 $50.83 $55.41 $196.02 $208.28 $5.00 $183.77 $10.25 $5.00 $122.52 $83.87 $165.40 $165.40 $165.40 $165.40 N/A $53.37 $50.83 $163.44 $5.00 $5.00 $43.21 $43.21 $50.83 $5.00 $208.28 330104 96365 5693 111 260 HC THER/PROPH/DIAG IV INF INIT O "$1,356.76 " $247.83 $247.83 $35.00 $678.38 $841.19 $841.19 $245.35 $35.00 $470.88 $35.00 $247.83 "$1,017.57 " $272.61 $881.89 $991.79 $42.00 $35.00 $814.06 "$1,085.41 " $842.62 $678.38 $35.00 $247.83 $297.40 $49.00 "$1,085.41 " $35.00 $35.00 $42.00 $346.96 $35.00 $247.83 $247.83 $270.14 "$1,085.41 " "$1,153.25 " $35.00 "$1,017.57 " $71.75 $35.00 $678.38 $408.92 $915.81 $915.81 $915.81 $915.81 N/A $260.22 $247.83 $904.96 $35.00 $35.00 $210.66 $210.66 $247.83 $35.00 "$1,153.25 " 330104 96366 5691 110 260 HC THER/PROPH/DIAG IV INF ADDON O $471.87 $50.83 $50.83 $5.00 $235.94 $292.56 $292.56 $50.32 $5.00 $96.58 $5.00 $50.83 $353.90 $55.92 $306.72 $344.94 $6.00 $5.00 $283.12 $377.50 $172.83 $235.94 $5.00 $50.83 $61.00 $7.00 $377.50 $5.00 $5.00 $6.00 $71.17 $5.00 $50.83 $50.83 $55.41 $377.50 $401.09 $5.00 $353.90 $10.25 $5.00 $235.94 $83.87 $318.51 $318.51 $318.51 $318.51 N/A $53.37 $50.83 $314.74 $5.00 $5.00 $43.21 $43.21 $50.83 $5.00 $401.09 330104 96367 5692 111 260 HC TX/PROPH/DG ADDL SEQ IV INF O $511.46 $80.95 $80.95 $5.00 $255.73 $317.11 $317.11 $80.14 $5.00 $153.80 $5.00 $80.95 $383.59 $89.04 $332.45 $373.88 $6.00 $5.00 $306.88 $409.17 $275.22 $255.73 $5.00 $80.95 $97.14 $7.00 $409.17 $5.00 $5.00 $6.00 $113.33 $5.00 $80.95 $80.95 $88.23 $409.17 $434.74 $5.00 $383.59 $10.25 $5.00 $255.73 $133.56 $345.24 $345.24 $345.24 $345.24 N/A $84.99 $80.95 $341.14 $5.00 $5.00 $68.80 $68.80 $80.95 $5.00 $434.74 330104 96368 111 260 HC THER/DIAG CONCURRENT INF O $511.46 N/A N/A $5.00 $255.73 $317.11 $317.11 $23.47 $5.00 N/A $5.00 N/A $383.59 N/A $332.45 $373.88 $6.00 $5.00 $306.88 $409.17 N/A $255.73 $5.00 N/A $332.45 $7.00 $409.17 $5.00 $5.00 $6.00 N/A $5.00 N/A N/A N/A $409.17 $434.74 $6.75 $383.59 $10.25 $6.75 $255.73 $332.45 $345.24 $345.24 $345.24 $345.24 N/A N/A N/A $341.14 $5.00 $5.00 N/A N/A N/A $5.00 $434.74 330104 96371 5692 111 260 HC SC THER INFUSION RESET PUMP O "$1,218.73 " $80.95 $80.95 $19.00 $609.37 $755.61 $755.61 $80.14 $19.00 $153.80 $19.00 $80.95 $914.05 $89.04 $792.17 $890.89 $22.80 $19.00 $731.24 $974.98 $275.22 $609.37 $19.00 $80.95 $97.14 $26.60 $974.98 $19.00 $19.00 $22.80 $113.33 $19.00 $80.95 $80.95 $88.23 $974.98 "$1,035.92 " $19.00 $914.05 $38.95 $19.00 $609.37 $133.56 $822.64 $822.64 $822.64 $822.64 N/A $84.99 $80.95 $812.89 $19.00 $19.00 $68.80 $68.80 $80.95 $19.00 "$1,035.92 " 330104 96374 5693 109 260 HC THER/PROPH/DIAG INJ IV PUSH O $847.44 $247.83 $247.83 N/A $423.72 $525.41 $525.41 $245.35 N/A $470.88 N/A $247.83 $635.58 $272.61 $550.84 $619.48 N/A N/A $508.46 $677.95 $842.62 $423.72 N/A $247.83 $297.40 N/A $677.95 N/A N/A N/A $346.96 N/A $247.83 $247.83 $270.14 $677.95 $720.32 N/A $635.58 N/A N/A $423.72 $408.92 $572.02 $572.02 $572.02 $572.02 N/A $260.22 $247.83 $565.24 N/A N/A $210.66 $210.66 $247.83 $210.66 $842.62 330104 96375 5691 109 260 HC TX/PRO/DX INJ NEW DRUG ADDON O $471.87 $50.83 $50.83 N/A $235.94 $292.56 $292.56 $50.32 N/A $96.58 N/A $50.83 $353.90 $55.92 $306.72 $344.94 N/A N/A $283.12 $377.50 $172.83 $235.94 N/A $50.83 $61.00 N/A $377.50 N/A N/A N/A $71.17 N/A $50.83 $50.83 $55.41 $377.50 $401.09 N/A $353.90 N/A N/A $235.94 $83.87 $318.51 $318.51 $318.51 $318.51 N/A $53.37 $50.83 $314.74 N/A N/A $43.21 $43.21 $50.83 $43.21 $401.09 330104 96376 109 260 HC TX/PRO/DX INJ SAME DRUG ADON O $432.28 N/A N/A N/A $216.14 $268.01 $268.01 N/A N/A N/A N/A N/A $324.21 N/A $280.98 $316.00 N/A N/A $259.37 $345.82 N/A $216.14 N/A N/A $280.98 N/A $345.82 N/A N/A N/A N/A N/A N/A N/A N/A $345.82 $367.44 N/A $324.21 N/A N/A $216.14 $280.98 $291.79 $291.79 $291.79 $291.79 N/A N/A N/A $288.33 N/A N/A N/A N/A N/A $216.14 $367.44 330104 96370 5691 110 260 HC SC THER INFUSION ADDL HR O "$1,218.73 " $50.83 $50.83 $5.00 $609.37 $755.61 $755.61 $50.32 $5.00 $96.58 $5.00 $50.83 $914.05 $55.92 $792.17 $890.89 $6.00 $5.00 $731.24 $974.98 $172.83 $609.37 $5.00 $50.83 $61.00 $7.00 $974.98 $5.00 $5.00 $6.00 $71.17 $5.00 $50.83 $50.83 $55.41 $974.98 "$1,035.92 " $5.00 $914.05 $10.25 $5.00 $609.37 $83.87 $822.64 $822.64 $822.64 $822.64 N/A $53.37 $50.83 $812.89 $5.00 $5.00 $43.21 $43.21 $50.83 $5.00 "$1,035.92 " 330104 270 HC POLYSKIN 4X4 OPSITE KC6641 **NYACK ONLY O $3.00 N/A N/A N/A $1.50 $1.86 $1.86 $1.96 N/A N/A N/A N/A $2.25 $2.10 $1.95 $2.19 $1.05 $1.05 $1.80 $2.40 N/A $1.50 $1.05 N/A N/A N/A $2.40 N/A $2.40 N/A N/A $2.40 N/A N/A N/A $1.50 $1.50 $1.50 $2.25 $1.50 $1.50 N/A $1.95 $2.03 $2.03 $2.03 $2.03 N/A N/A N/A $2.00 $1.50 N/A N/A N/A N/A $1.05 $2.40 330104 270 HC VAC SIMPLACE O $131.00 N/A N/A N/A $65.50 $81.22 $81.22 $85.67 N/A N/A N/A N/A $98.25 $91.70 $85.15 $95.76 $45.85 $45.85 $78.60 $104.80 N/A $65.50 $45.85 N/A N/A N/A $104.80 N/A $104.80 N/A N/A $104.80 N/A N/A N/A $65.50 $65.50 $65.50 $98.25 $65.50 $65.50 N/A $85.15 $88.43 $88.43 $88.43 $88.43 N/A N/A N/A $87.38 $65.50 N/A N/A N/A N/A $45.85 $104.80 330104 270 HC VAC GRANULOFOAM SILVER O $43.00 N/A N/A N/A $21.50 $26.66 $26.66 $28.12 N/A N/A N/A N/A $32.25 $30.10 $27.95 $31.43 $15.05 $15.05 $25.80 $34.40 N/A $21.50 $15.05 N/A N/A N/A $34.40 N/A $34.40 N/A N/A $34.40 N/A N/A N/A $21.50 $21.50 $21.50 $32.25 $21.50 $21.50 N/A $27.95 $29.03 $29.03 $29.03 $29.03 N/A N/A N/A $28.68 $21.50 N/A N/A N/A N/A $15.05 $34.40 330104 270 HC VAC GRANULOFOAM DRESSING SMALL O $111.00 N/A N/A N/A $55.50 $68.82 $68.82 $72.59 N/A N/A N/A N/A $83.25 $77.70 $72.15 $81.14 $38.85 $38.85 $66.60 $88.80 N/A $55.50 $38.85 N/A N/A N/A $88.80 N/A $88.80 N/A N/A $88.80 N/A N/A N/A $55.50 $55.50 $55.50 $83.25 $55.50 $55.50 N/A $72.15 $74.93 $74.93 $74.93 $74.93 N/A N/A N/A $74.04 $55.50 N/A N/A N/A N/A $38.85 $88.80 330104 270 HC VAC GRANULOFOAM DRESSING MEDIUM O $124.00 N/A N/A N/A $62.00 $76.88 $76.88 $81.10 N/A N/A N/A N/A $93.00 $86.80 $80.60 $90.64 $43.40 $43.40 $74.40 $99.20 N/A $62.00 $43.40 N/A N/A N/A $99.20 N/A $99.20 N/A N/A $99.20 N/A N/A N/A $62.00 $62.00 $62.00 $93.00 $62.00 $62.00 N/A $80.60 $83.70 $83.70 $83.70 $83.70 N/A N/A N/A $82.71 $62.00 N/A N/A N/A N/A $43.40 $99.20 330104 270 HC VAC CANNISTERS O $106.00 N/A N/A N/A $53.00 $65.72 $65.72 $69.32 N/A N/A N/A N/A $79.50 $74.20 $68.90 $77.49 $37.10 $37.10 $63.60 $84.80 N/A $53.00 $37.10 N/A N/A N/A $84.80 N/A $84.80 N/A N/A $84.80 N/A N/A N/A $53.00 $53.00 $53.00 $79.50 $53.00 $53.00 N/A $68.90 $71.55 $71.55 $71.55 $71.55 N/A N/A N/A $70.70 $53.00 N/A N/A N/A N/A $37.10 $84.80 330104 270 HC OFF LOADING BOOTS O $86.00 N/A N/A N/A $43.00 $53.32 $53.32 $56.24 N/A N/A N/A N/A $64.50 $60.20 $55.90 $62.87 $30.10 $30.10 $51.60 $68.80 N/A $43.00 $30.10 N/A N/A N/A $68.80 N/A $68.80 N/A N/A $68.80 N/A N/A N/A $43.00 $43.00 $43.00 $64.50 $43.00 $43.00 N/A $55.90 $58.05 $58.05 $58.05 $58.05 N/A N/A N/A $57.36 $43.00 N/A N/A N/A N/A $30.10 $68.80 330104 270 HC INCENTIVE SPIROMETER O $178.00 N/A N/A N/A $89.00 $110.36 $110.36 $116.41 N/A N/A N/A N/A $133.50 $124.60 $115.70 $130.12 $62.30 $62.30 $106.80 $142.40 N/A $89.00 $62.30 N/A N/A N/A $142.40 N/A $142.40 N/A N/A $142.40 N/A N/A N/A $89.00 $89.00 $89.00 $133.50 $89.00 $89.00 N/A $115.70 $120.15 $120.15 $120.15 $120.15 N/A N/A N/A $118.73 $89.00 N/A N/A N/A N/A $62.30 $142.40 330104 270 HC THUMB ABDUCTION SPLINT O $117.00 N/A N/A N/A $58.50 $72.54 $72.54 $76.52 N/A N/A N/A N/A $87.75 $81.90 $76.05 $85.53 $40.95 $40.95 $70.20 $93.60 N/A $58.50 $40.95 N/A N/A N/A $93.60 N/A $93.60 N/A N/A $93.60 N/A N/A N/A $58.50 $58.50 $58.50 $87.75 $58.50 $58.50 N/A $76.05 $78.98 $78.98 $78.98 $78.98 N/A N/A N/A $78.04 $58.50 N/A N/A N/A N/A $40.95 $93.60 330104 270 HC SPLINT-FELT O $140.00 N/A N/A N/A $70.00 $86.80 $86.80 $91.56 N/A N/A N/A N/A $105.00 $98.00 $91.00 $102.34 $49.00 $49.00 $84.00 $112.00 N/A $70.00 $49.00 N/A N/A N/A $112.00 N/A $112.00 N/A N/A $112.00 N/A N/A N/A $70.00 $70.00 $70.00 $105.00 $70.00 $70.00 N/A $91.00 $94.50 $94.50 $94.50 $94.50 N/A N/A N/A $93.38 $70.00 N/A N/A N/A N/A $49.00 $112.00 330104 270 HC CAST:LONG LEG O $890.00 N/A N/A N/A $445.00 $551.80 $551.80 $582.06 N/A N/A N/A N/A $667.50 $623.00 $578.50 $650.59 $311.50 $311.50 $534.00 $712.00 N/A $445.00 $311.50 N/A N/A N/A $712.00 N/A $712.00 N/A N/A $712.00 N/A N/A N/A $445.00 $445.00 $445.00 $667.50 $445.00 $445.00 N/A $578.50 $600.75 $600.75 $600.75 $600.75 N/A N/A N/A $593.63 $445.00 N/A N/A N/A N/A $311.50 $712.00 330104 270 HC CAST:LONG ARM O $631.00 N/A N/A N/A $315.50 $391.22 $391.22 $412.67 N/A N/A N/A N/A $473.25 $441.70 $410.15 $461.26 $220.85 $220.85 $378.60 $504.80 N/A $315.50 $220.85 N/A N/A N/A $504.80 N/A $504.80 N/A N/A $504.80 N/A N/A N/A $315.50 $315.50 $315.50 $473.25 $315.50 $315.50 N/A $410.15 $425.93 $425.93 $425.93 $425.93 N/A N/A N/A $420.88 $315.50 N/A N/A N/A N/A $220.85 $504.80 330104 270 HC PLASTER LONG ARM CAST O $149.00 N/A N/A N/A $74.50 $92.38 $92.38 $97.45 N/A N/A N/A N/A $111.75 $104.30 $96.85 $108.92 $52.15 $52.15 $89.40 $119.20 N/A $74.50 $52.15 N/A N/A N/A $119.20 N/A $119.20 N/A N/A $119.20 N/A N/A N/A $74.50 $74.50 $74.50 $111.75 $74.50 $74.50 N/A $96.85 $100.58 $100.58 $100.58 $100.58 N/A N/A N/A $99.38 $74.50 N/A N/A N/A N/A $52.15 $119.20 330104 270 HC POLYSKIN 2X2 OPSITE KC6640 **NYACK ONLY O $1.00 N/A N/A N/A $0.50 $0.62 $0.62 $0.65 N/A N/A N/A N/A $0.75 $0.70 $0.65 $0.73 $0.35 $0.35 $0.60 $0.80 N/A $0.50 $0.35 N/A N/A N/A $0.80 N/A $0.80 N/A N/A $0.80 N/A N/A N/A $0.50 $0.50 $0.50 $0.75 $0.50 $0.50 N/A $0.65 $0.68 $0.68 $0.68 $0.68 N/A N/A N/A $0.67 $0.50 N/A N/A N/A N/A $0.35 $0.80 330104 270 HC SPLINT:THUMB SPIKA O $113.00 N/A N/A N/A $56.50 $70.06 $70.06 $73.90 N/A N/A N/A N/A $84.75 $79.10 $73.45 $82.60 $39.55 $39.55 $67.80 $90.40 N/A $56.50 $39.55 N/A N/A N/A $90.40 N/A $90.40 N/A N/A $90.40 N/A N/A N/A $56.50 $56.50 $56.50 $84.75 $56.50 $56.50 N/A $73.45 $76.28 $76.28 $76.28 $76.28 N/A N/A N/A $75.37 $56.50 N/A N/A N/A N/A $39.55 $90.40 330104 270 HC SOFT CAST O $225.00 N/A N/A N/A $112.50 $139.50 $139.50 $147.15 N/A N/A N/A N/A $168.75 $157.50 $146.25 $164.47 $78.75 $78.75 $135.00 $180.00 N/A $112.50 $78.75 N/A N/A N/A $180.00 N/A $180.00 N/A N/A $180.00 N/A N/A N/A $112.50 $112.50 $112.50 $168.75 $112.50 $112.50 N/A $146.25 $151.88 $151.88 $151.88 $151.88 N/A N/A N/A $150.08 $112.50 N/A N/A N/A N/A $78.75 $180.00 330104 270 HC AIR CAST O $274.00 N/A N/A N/A $137.00 $169.88 $169.88 $179.20 N/A N/A N/A N/A $205.50 $191.80 $178.10 $200.29 $95.90 $95.90 $164.40 $219.20 N/A $137.00 $95.90 N/A N/A N/A $219.20 N/A $219.20 N/A N/A $219.20 N/A N/A N/A $137.00 $137.00 $137.00 $205.50 $137.00 $137.00 N/A $178.10 $184.95 $184.95 $184.95 $184.95 N/A N/A N/A $182.76 $137.00 N/A N/A N/A N/A $95.90 $219.20 330104 270 HC PLASTER BELOW KNEE CAST O $174.00 N/A N/A N/A $87.00 $107.88 $107.88 $113.80 N/A N/A N/A N/A $130.50 $121.80 $113.10 $127.19 $60.90 $60.90 $104.40 $139.20 N/A $87.00 $60.90 N/A N/A N/A $139.20 N/A $139.20 N/A N/A $139.20 N/A N/A N/A $87.00 $87.00 $87.00 $130.50 $87.00 $87.00 N/A $113.10 $117.45 $117.45 $117.45 $117.45 N/A N/A N/A $116.06 $87.00 N/A N/A N/A N/A $60.90 $139.20 330104 270 HC SPLINT:MASON ALLEN O $100.00 N/A N/A N/A $50.00 $62.00 $62.00 $65.40 N/A N/A N/A N/A $75.00 $70.00 $65.00 $73.10 $35.00 $35.00 $60.00 $80.00 N/A $50.00 $35.00 N/A N/A N/A $80.00 N/A $80.00 N/A N/A $80.00 N/A N/A N/A $50.00 $50.00 $50.00 $75.00 $50.00 $50.00 N/A $65.00 $67.50 $67.50 $67.50 $67.50 N/A N/A N/A $66.70 $50.00 N/A N/A N/A N/A $35.00 $80.00 330104 270 HC JORDAN SPLINT SHORT O $210.00 N/A N/A N/A $105.00 $130.20 $130.20 $137.34 N/A N/A N/A N/A $157.50 $147.00 $136.50 $153.51 $73.50 $73.50 $126.00 $168.00 N/A $105.00 $73.50 N/A N/A N/A $168.00 N/A $168.00 N/A N/A $168.00 N/A N/A N/A $105.00 $105.00 $105.00 $157.50 $105.00 $105.00 N/A $136.50 $141.75 $141.75 $141.75 $141.75 N/A N/A N/A $140.07 $105.00 N/A N/A N/A N/A $73.50 $168.00 330104 270 HC SPLINT:FOREARM O $145.00 N/A N/A N/A $72.50 $89.90 $89.90 $94.83 N/A N/A N/A N/A $108.75 $101.50 $94.25 $106.00 $50.75 $50.75 $87.00 $116.00 N/A $72.50 $50.75 N/A N/A N/A $116.00 N/A $116.00 N/A N/A $116.00 N/A N/A N/A $72.50 $72.50 $72.50 $108.75 $72.50 $72.50 N/A $94.25 $97.88 $97.88 $97.88 $97.88 N/A N/A N/A $96.72 $72.50 N/A N/A N/A N/A $50.75 $116.00 330104 270 HC SPLINT:FINGER O $32.00 N/A N/A N/A $16.00 $19.84 $19.84 $20.93 N/A N/A N/A N/A $24.00 $22.40 $20.80 $23.39 $11.20 $11.20 $19.20 $25.60 N/A $16.00 $11.20 N/A N/A N/A $25.60 N/A $25.60 N/A N/A $25.60 N/A N/A N/A $16.00 $16.00 $16.00 $24.00 $16.00 $16.00 N/A $20.80 $21.60 $21.60 $21.60 $21.60 N/A N/A N/A $21.34 $16.00 N/A N/A N/A N/A $11.20 $25.60 330104 270 HC SPLINT:ELBOW O $168.00 N/A N/A N/A $84.00 $104.16 $104.16 $109.87 N/A N/A N/A N/A $126.00 $117.60 $109.20 $122.81 $58.80 $58.80 $100.80 $134.40 N/A $84.00 $58.80 N/A N/A N/A $134.40 N/A $134.40 N/A N/A $134.40 N/A N/A N/A $84.00 $84.00 $84.00 $126.00 $84.00 $84.00 N/A $109.20 $113.40 $113.40 $113.40 $113.40 N/A N/A N/A $112.06 $84.00 N/A N/A N/A N/A $58.80 $134.40 330104 270 HC DAILY OXYGEN ADM O $406.00 N/A N/A N/A $203.00 $251.72 $251.72 $265.52 N/A N/A N/A N/A $304.50 $284.20 $263.90 $296.79 $142.10 $142.10 $243.60 $324.80 N/A $203.00 $142.10 N/A N/A N/A $324.80 N/A $324.80 N/A N/A $324.80 N/A N/A N/A $203.00 $203.00 $203.00 $304.50 $203.00 $203.00 N/A $263.90 $274.05 $274.05 $274.05 $274.05 N/A N/A N/A $270.80 $203.00 N/A N/A N/A N/A $142.10 $324.80 330104 270 HC CART CHEST TUBE INSERTION O "$1,598.00 " N/A N/A N/A $799.00 $990.76 $990.76 "$1,045.09 " N/A N/A N/A N/A "$1,198.50 " "$1,118.60 " "$1,038.70 " "$1,168.14 " $559.30 $559.30 $958.80 "$1,278.40 " N/A $799.00 $559.30 N/A N/A N/A "$1,278.40 " N/A "$1,278.40 " N/A N/A "$1,278.40 " N/A N/A N/A $799.00 $799.00 $799.00 "$1,198.50 " $799.00 $799.00 N/A "$1,038.70 " "$1,078.65 " "$1,078.65 " "$1,078.65 " "$1,078.65 " N/A N/A N/A "$1,065.87 " $799.00 N/A N/A N/A N/A $559.30 "$1,278.40 " 330104 270 HC CART G-U O $727.00 N/A N/A N/A $363.50 $450.74 $450.74 $475.46 N/A N/A N/A N/A $545.25 $508.90 $472.55 $531.44 $254.45 $254.45 $436.20 $581.60 N/A $363.50 $254.45 N/A N/A N/A $581.60 N/A $581.60 N/A N/A $581.60 N/A N/A N/A $363.50 $363.50 $363.50 $545.25 $363.50 $363.50 N/A $472.55 $490.73 $490.73 $490.73 $490.73 N/A N/A N/A $484.91 $363.50 N/A N/A N/A N/A $254.45 $581.60 330104 270 HC SPLINT:LONG LEG O $82.00 N/A N/A N/A $41.00 $50.84 $50.84 $53.63 N/A N/A N/A N/A $61.50 $57.40 $53.30 $59.94 $28.70 $28.70 $49.20 $65.60 N/A $41.00 $28.70 N/A N/A N/A $65.60 N/A $65.60 N/A N/A $65.60 N/A N/A N/A $41.00 $41.00 $41.00 $61.50 $41.00 $41.00 N/A $53.30 $55.35 $55.35 $55.35 $55.35 N/A N/A N/A $54.69 $41.00 N/A N/A N/A N/A $28.70 $65.60 330104 270 HC PUMP FEEDING O $50.00 N/A N/A N/A $25.00 $31.00 $31.00 $32.70 N/A N/A N/A N/A $37.50 $35.00 $32.50 $36.55 $17.50 $17.50 $30.00 $40.00 N/A $25.00 $17.50 N/A N/A N/A $40.00 N/A $40.00 N/A N/A $40.00 N/A N/A N/A $25.00 $25.00 $25.00 $37.50 $25.00 $25.00 N/A $32.50 $33.75 $33.75 $33.75 $33.75 N/A N/A N/A $33.35 $25.00 N/A N/A N/A N/A $17.50 $40.00 330104 270 HC K THERMIA (MATTRESS ONLY) O $104.00 N/A N/A N/A $52.00 $64.48 $64.48 $68.02 N/A N/A N/A N/A $78.00 $72.80 $67.60 $76.02 $36.40 $36.40 $62.40 $83.20 N/A $52.00 $36.40 N/A N/A N/A $83.20 N/A $83.20 N/A N/A $83.20 N/A N/A N/A $52.00 $52.00 $52.00 $78.00 $52.00 $52.00 N/A $67.60 $70.20 $70.20 $70.20 $70.20 N/A N/A N/A $69.37 $52.00 N/A N/A N/A N/A $36.40 $83.20 330104 270 HC CAST PADDING 4 IN X 4 YD MCMW04 **NYACK ONLY O $2.00 N/A N/A N/A $1.00 $1.24 $1.24 $1.31 N/A N/A N/A N/A $1.50 $1.40 $1.30 $1.46 $0.70 $0.70 $1.20 $1.60 N/A $1.00 $0.70 N/A N/A N/A $1.60 N/A $1.60 N/A N/A $1.60 N/A N/A N/A $1.00 $1.00 $1.00 $1.50 $1.00 $1.00 N/A $1.30 $1.35 $1.35 $1.35 $1.35 N/A N/A N/A $1.33 $1.00 N/A N/A N/A N/A $0.70 $1.60 330104 270 HC CURITY ADAPTIC 3X16 DRESSING JJ6114 **NYACK ONLY O $8.00 N/A N/A N/A $4.00 $4.96 $4.96 $5.23 N/A N/A N/A N/A $6.00 $5.60 $5.20 $5.85 $2.80 $2.80 $4.80 $6.40 N/A $4.00 $2.80 N/A N/A N/A $6.40 N/A $6.40 N/A N/A $6.40 N/A N/A N/A $4.00 $4.00 $4.00 $6.00 $4.00 $4.00 N/A $5.20 $5.40 $5.40 $5.40 $5.40 N/A N/A N/A $5.34 $4.00 N/A N/A N/A N/A $2.80 $6.40 330104 270 HC DRESSING REPLICARE ULTRA 4X4 59484600 **NYACK ONLY O $10.00 N/A N/A N/A $5.00 $6.20 $6.20 $6.54 N/A N/A N/A N/A $7.50 $7.00 $6.50 $7.31 $3.50 $3.50 $6.00 $8.00 N/A $5.00 $3.50 N/A N/A N/A $8.00 N/A $8.00 N/A N/A $8.00 N/A N/A N/A $5.00 $5.00 $5.00 $7.50 $5.00 $5.00 N/A $6.50 $6.75 $6.75 $6.75 $6.75 N/A N/A N/A $6.67 $5.00 N/A N/A N/A N/A $3.50 $8.00 330104 270 HC SPLINT 5X30 OG-5PC (76530) **NYACK ONLY O $45.00 N/A N/A N/A $22.50 $27.90 $27.90 $29.43 N/A N/A N/A N/A $33.75 $31.50 $29.25 $32.89 $15.75 $15.75 $27.00 $36.00 N/A $22.50 $15.75 N/A N/A N/A $36.00 N/A $36.00 N/A N/A $36.00 N/A N/A N/A $22.50 $22.50 $22.50 $33.75 $22.50 $22.50 N/A $29.25 $30.38 $30.38 $30.38 $30.38 N/A N/A N/A $30.02 $22.50 N/A N/A N/A N/A $15.75 $36.00 330104 270 HC SPLINTS 3 X 12 OG-3PC (76312) **NYACK ONLY O $13.00 N/A N/A N/A $6.50 $8.06 $8.06 $8.50 N/A N/A N/A N/A $9.75 $9.10 $8.45 $9.50 $4.55 $4.55 $7.80 $10.40 N/A $6.50 $4.55 N/A N/A N/A $10.40 N/A $10.40 N/A N/A $10.40 N/A N/A N/A $6.50 $6.50 $6.50 $9.75 $6.50 $6.50 N/A $8.45 $8.78 $8.78 $8.78 $8.78 N/A N/A N/A $8.67 $6.50 N/A N/A N/A N/A $4.55 $10.40 330104 270 HC NITROUS OXIDE PER HOUR O $200.00 N/A N/A N/A $100.00 $124.00 $124.00 $130.80 N/A N/A N/A N/A $150.00 $140.00 $130.00 $146.20 $70.00 $70.00 $120.00 $160.00 N/A $100.00 $70.00 N/A N/A N/A $160.00 N/A $160.00 N/A N/A $160.00 N/A N/A N/A $100.00 $100.00 $100.00 $150.00 $100.00 $100.00 N/A $130.00 $135.00 $135.00 $135.00 $135.00 N/A N/A N/A $133.40 $100.00 N/A N/A N/A N/A $70.00 $160.00 330104 270 HC EPIDURAL TRAY CONT WITH DRUGS O $390.00 N/A N/A N/A $195.00 $241.80 $241.80 $255.06 N/A N/A N/A N/A $292.50 $273.00 $253.50 $285.09 $136.50 $136.50 $234.00 $312.00 N/A $195.00 $136.50 N/A N/A N/A $312.00 N/A $312.00 N/A N/A $312.00 N/A N/A N/A $195.00 $195.00 $195.00 $292.50 $195.00 $195.00 N/A $253.50 $263.25 $263.25 $263.25 $263.25 N/A N/A N/A $260.13 $195.00 N/A N/A N/A N/A $136.50 $312.00 330104 A6257 1001 270 HC TRANSPARENT FILM <= 16 SQ IN O $171.00 N/A N/A N/A $85.50 $106.02 $106.02 N/A N/A N/A N/A N/A $128.25 N/A $111.15 $125.00 N/A N/A $102.60 $136.80 N/A $85.50 N/A N/A $111.15 N/A $136.80 N/A N/A N/A N/A N/A N/A N/A N/A $85.50 $85.50 N/A $128.25 N/A N/A $85.50 $111.15 $115.43 $115.43 $115.43 $115.43 N/A N/A N/A $114.06 N/A N/A N/A N/A N/A $85.50 $136.80 330104 A6258 1001 270 HC TRANSPARENT FILM >16<=48 IN O $23.00 N/A N/A N/A $11.50 $14.26 $14.26 N/A N/A N/A N/A N/A $17.25 N/A $14.95 $16.81 N/A N/A $13.80 $18.40 N/A $11.50 N/A N/A $14.95 N/A $18.40 N/A N/A N/A N/A N/A N/A N/A N/A $11.50 $11.50 N/A $17.25 N/A N/A $11.50 $14.95 $15.53 $15.53 $15.53 $15.53 N/A N/A N/A $15.34 N/A N/A N/A N/A N/A $11.50 $18.40 330104 270 HC VAC WHITE FOAM DRESSING SMALL O $30.00 N/A N/A N/A $15.00 $18.60 $18.60 $19.62 N/A N/A N/A N/A $22.50 $21.00 $19.50 $21.93 $10.50 $10.50 $18.00 $24.00 N/A $15.00 $10.50 N/A N/A N/A $24.00 N/A $24.00 N/A N/A $24.00 N/A N/A N/A $15.00 $15.00 $15.00 $22.50 $15.00 $15.00 N/A $19.50 $20.25 $20.25 $20.25 $20.25 N/A N/A N/A $20.01 $15.00 N/A N/A N/A N/A $10.50 $24.00 330104 270 HC SPLINTS 4 X 30 OG-430PC (76430) **NYACK ONLY O $71.00 N/A N/A N/A $35.50 $44.02 $44.02 $46.43 N/A N/A N/A N/A $53.25 $49.70 $46.15 $51.90 $24.85 $24.85 $42.60 $56.80 N/A $35.50 $24.85 N/A N/A N/A $56.80 N/A $56.80 N/A N/A $56.80 N/A N/A N/A $35.50 $35.50 $35.50 $53.25 $35.50 $35.50 N/A $46.15 $47.93 $47.93 $47.93 $47.93 N/A N/A N/A $47.36 $35.50 N/A N/A N/A N/A $24.85 $56.80 330104 270 HC SLEEVES CALF ALP1 **NYACK ONLY O $33.00 N/A N/A N/A $16.50 $20.46 $20.46 $21.58 N/A N/A N/A N/A $24.75 $23.10 $21.45 $24.12 $11.55 $11.55 $19.80 $26.40 N/A $16.50 $11.55 N/A N/A N/A $26.40 N/A $26.40 N/A N/A $26.40 N/A N/A N/A $16.50 $16.50 $16.50 $24.75 $16.50 $16.50 N/A $21.45 $22.28 $22.28 $22.28 $22.28 N/A N/A N/A $22.01 $16.50 N/A N/A N/A N/A $11.55 $26.40 330104 270 HC BINDER ABDOMINAL SMALL **NYACK ONLY O $20.00 N/A N/A N/A $10.00 $12.40 $12.40 $13.08 N/A N/A N/A N/A $15.00 $14.00 $13.00 $14.62 $7.00 $7.00 $12.00 $16.00 N/A $10.00 $7.00 N/A N/A N/A $16.00 N/A $16.00 N/A N/A $16.00 N/A N/A N/A $10.00 $10.00 $10.00 $15.00 $10.00 $10.00 N/A $13.00 $13.50 $13.50 $13.50 $13.50 N/A N/A N/A $13.34 $10.00 N/A N/A N/A N/A $7.00 $16.00 330104 270 HC SPECIMEN TRAP **NYACK ONLY O $5.00 N/A N/A N/A $2.50 $3.10 $3.10 $3.27 N/A N/A N/A N/A $3.75 $3.50 $3.25 $3.65 $1.75 $1.75 $3.00 $4.00 N/A $2.50 $1.75 N/A N/A N/A $4.00 N/A $4.00 N/A N/A $4.00 N/A N/A N/A $2.50 $2.50 $2.50 $3.75 $2.50 $2.50 N/A $3.25 $3.38 $3.38 $3.38 $3.38 N/A N/A N/A $3.33 $2.50 N/A N/A N/A N/A $1.75 $4.00 330104 270 HC THORA-DRAIN **NYACK ONLY O $175.00 N/A N/A N/A $87.50 $108.50 $108.50 $114.45 N/A N/A N/A N/A $131.25 $122.50 $113.75 $127.92 $61.25 $61.25 $105.00 $140.00 N/A $87.50 $61.25 N/A N/A N/A $140.00 N/A $140.00 N/A N/A $140.00 N/A N/A N/A $87.50 $87.50 $87.50 $131.25 $87.50 $87.50 N/A $113.75 $118.13 $118.13 $118.13 $118.13 N/A N/A N/A $116.73 $87.50 N/A N/A N/A N/A $61.25 $140.00 330104 271 HC ADMIN AQUAMATIC (PAD) O $243.00 N/A N/A N/A $121.50 $150.66 $150.66 $158.92 N/A N/A N/A N/A $182.25 $170.10 $157.95 $177.63 $85.05 $85.05 $145.80 $194.40 N/A $121.50 $85.05 N/A N/A N/A $194.40 N/A $194.40 N/A N/A $194.40 N/A N/A N/A $194.40 $206.55 $121.50 $182.25 $121.50 $121.50 N/A $157.95 $164.03 $164.03 $164.03 $164.03 N/A N/A N/A $162.08 $121.50 N/A N/A N/A N/A $85.05 $206.55 330104 271 HC SCROTAL SUPPORT X-LARGE **NYACK ONLY O $38.00 N/A N/A N/A $19.00 $23.56 $23.56 $24.85 N/A N/A N/A N/A $28.50 $26.60 $24.70 $27.78 $13.30 $13.30 $22.80 $30.40 N/A $19.00 $13.30 N/A N/A N/A $30.40 N/A $30.40 N/A N/A $30.40 N/A N/A N/A $30.40 $32.30 $19.00 $28.50 $19.00 $19.00 N/A $24.70 $25.65 $25.65 $25.65 $25.65 N/A N/A N/A $25.35 $19.00 N/A N/A N/A N/A $13.30 $32.30 330104 271 HC BAG BILE **NYACK ONLY O $44.00 N/A N/A N/A $22.00 $27.28 $27.28 $28.78 N/A N/A N/A N/A $33.00 $30.80 $28.60 $32.16 $15.40 $15.40 $26.40 $35.20 N/A $22.00 $15.40 N/A N/A N/A $35.20 N/A $35.20 N/A N/A $35.20 N/A N/A N/A $35.20 $37.40 $22.00 $33.00 $22.00 $22.00 N/A $28.60 $29.70 $29.70 $29.70 $29.70 N/A N/A N/A $29.35 $22.00 N/A N/A N/A N/A $15.40 $37.40 330104 271 HC SCROTAL SUPPORT LARGE **NYACK ONLY O $41.00 N/A N/A N/A $20.50 $25.42 $25.42 $26.81 N/A N/A N/A N/A $30.75 $28.70 $26.65 $29.97 $14.35 $14.35 $24.60 $32.80 N/A $20.50 $14.35 N/A N/A N/A $32.80 N/A $32.80 N/A N/A $32.80 N/A N/A N/A $32.80 $34.85 $20.50 $30.75 $20.50 $20.50 N/A $26.65 $27.68 $27.68 $27.68 $27.68 N/A N/A N/A $27.35 $20.50 N/A N/A N/A N/A $14.35 $34.85 330104 271 HC SCROTAL SUPPORT MEDIUM **NYACK ONLY O $42.00 N/A N/A N/A $21.00 $26.04 $26.04 $27.47 N/A N/A N/A N/A $31.50 $29.40 $27.30 $30.70 $14.70 $14.70 $25.20 $33.60 N/A $21.00 $14.70 N/A N/A N/A $33.60 N/A $33.60 N/A N/A $33.60 N/A N/A N/A $33.60 $35.70 $21.00 $31.50 $21.00 $21.00 N/A $27.30 $28.35 $28.35 $28.35 $28.35 N/A N/A N/A $28.01 $21.00 N/A N/A N/A N/A $14.70 $35.70 330104 271 HC AE HOSE KNEE HI X LRG-LNG **NYACK ONLY O $17.00 N/A N/A N/A $8.50 $10.54 $10.54 $11.12 N/A N/A N/A N/A $12.75 $11.90 $11.05 $12.43 $5.95 $5.95 $10.20 $13.60 N/A $8.50 $5.95 N/A N/A N/A $13.60 N/A $13.60 N/A N/A $13.60 N/A N/A N/A $13.60 $14.45 $8.50 $12.75 $8.50 $8.50 N/A $11.05 $11.48 $11.48 $11.48 $11.48 N/A N/A N/A $11.34 $8.50 N/A N/A N/A N/A $5.95 $14.45 330104 271 HC AE HOSE THIGH HI LRG-LNG **NYACK ONLY O $21.00 N/A N/A N/A $10.50 $13.02 $13.02 $13.73 N/A N/A N/A N/A $15.75 $14.70 $13.65 $15.35 $7.35 $7.35 $12.60 $16.80 N/A $10.50 $7.35 N/A N/A N/A $16.80 N/A $16.80 N/A N/A $16.80 N/A N/A N/A $16.80 $17.85 $10.50 $15.75 $10.50 $10.50 N/A $13.65 $14.18 $14.18 $14.18 $14.18 N/A N/A N/A $14.01 $10.50 N/A N/A N/A N/A $7.35 $17.85 330104 271 HC SUCTION CATH KIT **NYACK ONLY O $11.00 N/A N/A N/A $5.50 $6.82 $6.82 $7.19 N/A N/A N/A N/A $8.25 $7.70 $7.15 $8.04 $3.85 $3.85 $6.60 $8.80 N/A $5.50 $3.85 N/A N/A N/A $8.80 N/A $8.80 N/A N/A $8.80 N/A N/A N/A $8.80 $9.35 $5.50 $8.25 $5.50 $5.50 N/A $7.15 $7.43 $7.43 $7.43 $7.43 N/A N/A N/A $7.34 $5.50 N/A N/A N/A N/A $3.85 $9.35 330104 A6212 1001 272 HC FOAM DRG <=16 SQ IN W/BORDER EACH O $40.00 N/A N/A N/A $20.00 $24.80 $24.80 N/A N/A N/A N/A N/A $30.00 N/A $26.00 $29.24 N/A N/A $24.00 $32.00 N/A $20.00 N/A N/A $26.00 N/A $32.00 N/A N/A N/A N/A N/A N/A N/A N/A $20.00 $20.00 N/A $30.00 N/A N/A $20.00 $26.00 $27.00 $27.00 $27.00 $27.00 N/A N/A N/A $26.68 N/A N/A N/A N/A N/A $20.00 $32.00 330104 A6234 1001 272 HC HYDROCOLLD DRG <=16 W/O BDR EACH O $137.00 N/A N/A N/A $68.50 $84.94 $84.94 N/A N/A N/A N/A N/A $102.75 N/A $89.05 $100.15 N/A N/A $82.20 $109.60 N/A $68.50 N/A N/A $89.05 N/A $109.60 N/A N/A N/A N/A N/A N/A N/A N/A $68.50 $68.50 N/A $102.75 N/A N/A $68.50 $89.05 $92.48 $92.48 $92.48 $92.48 N/A N/A N/A $91.38 N/A N/A N/A N/A N/A $68.50 $109.60 330104 A6223 1001 272 HC GAUZE >16<=48 NO W/SAL W/O BRDR EACH O $19.00 N/A N/A N/A $9.50 $11.78 $11.78 N/A N/A N/A N/A N/A $14.25 N/A $12.35 $13.89 N/A N/A $11.40 $15.20 N/A $9.50 N/A N/A $12.35 N/A $15.20 N/A N/A N/A N/A N/A N/A N/A N/A $9.50 $9.50 N/A $14.25 N/A N/A $9.50 $12.35 $12.83 $12.83 $12.83 $12.83 N/A N/A N/A $12.67 N/A N/A N/A N/A N/A $9.50 $15.20 330104 A6213 1001 272 HC FOAM DRG >16 <=48 SQ IN W/BDR EACH O $580.00 N/A N/A N/A $290.00 $359.60 $359.60 N/A N/A N/A N/A N/A $435.00 N/A $377.00 $423.98 N/A N/A $348.00 $464.00 N/A $290.00 N/A N/A $377.00 N/A $464.00 N/A N/A N/A N/A N/A N/A N/A N/A $290.00 $290.00 N/A $435.00 N/A N/A $290.00 $377.00 $391.50 $391.50 $391.50 $391.50 N/A N/A N/A $386.86 N/A N/A N/A N/A N/A $290.00 $464.00 330104 A6252 1001 272 HC ABSORPT DRG >16 <=48 W/O BDR O $386.00 N/A N/A N/A $193.00 $239.32 $239.32 N/A N/A N/A N/A N/A $289.50 N/A $250.90 $282.17 N/A N/A $231.60 $308.80 N/A $193.00 N/A N/A $250.90 N/A $308.80 N/A N/A N/A N/A N/A N/A N/A N/A $193.00 $193.00 N/A $289.50 N/A N/A $193.00 $250.90 $260.55 $260.55 $260.55 $260.55 N/A N/A N/A $257.46 N/A N/A N/A N/A N/A $193.00 $308.80 330104 A6209 1001 272 HC FOAM DRSG <=16 SQ IN W/O BDR EACH O $310.00 N/A N/A N/A $155.00 $192.20 $192.20 N/A N/A N/A N/A N/A $232.50 N/A $201.50 $226.61 N/A N/A $186.00 $248.00 N/A $155.00 N/A N/A $201.50 N/A $248.00 N/A N/A N/A N/A N/A N/A N/A N/A $155.00 $155.00 N/A $232.50 N/A N/A $155.00 $201.50 $209.25 $209.25 $209.25 $209.25 N/A N/A N/A $206.77 N/A N/A N/A N/A N/A $155.00 $248.00 330104 272 HC CUSTOM OPEN HEART PACK **NYACK ONLY O $637.00 N/A N/A N/A $318.50 $394.94 $394.94 $416.60 N/A N/A N/A N/A $477.75 $445.90 $414.05 $465.65 $222.95 $222.95 $382.20 $509.60 N/A $318.50 $222.95 N/A N/A N/A $509.60 N/A $509.60 N/A N/A $509.60 N/A N/A N/A $318.50 $318.50 $318.50 $477.75 $318.50 $318.50 N/A $414.05 $429.98 $429.98 $429.98 $429.98 N/A N/A N/A $424.88 $318.50 N/A N/A N/A N/A $222.95 $509.60 330104 A6021 1002 272 HC COLLAGEN DRESSING <=16 SQ IN EACH O $416.00 N/A N/A N/A $208.00 $257.92 $257.92 N/A N/A N/A N/A N/A $312.00 N/A $270.40 $304.10 N/A N/A $249.60 $332.80 N/A $208.00 N/A N/A $270.40 N/A $332.80 N/A N/A N/A N/A N/A N/A N/A N/A $208.00 $208.00 N/A $312.00 N/A N/A $208.00 $270.40 $280.80 $280.80 $280.80 $280.80 N/A N/A N/A $277.47 N/A N/A N/A N/A N/A $208.00 $332.80 330104 272 HC CUSTOM MINOR PACK **NYACK ONLY O $160.00 N/A N/A N/A $80.00 $99.20 $99.20 $104.64 N/A N/A N/A N/A $120.00 $112.00 $104.00 $116.96 $56.00 $56.00 $96.00 $128.00 N/A $80.00 $56.00 N/A N/A N/A $128.00 N/A $128.00 N/A N/A $128.00 N/A N/A N/A $80.00 $80.00 $80.00 $120.00 $80.00 $80.00 N/A $104.00 $108.00 $108.00 $108.00 $108.00 N/A N/A N/A $106.72 $80.00 N/A N/A N/A N/A $56.00 $128.00 330104 272 HC CATH FOLEY 30CC-24FR(2WAY) **NYACK ONLY O $4.00 N/A N/A N/A $2.00 $2.48 $2.48 $2.62 N/A N/A N/A N/A $3.00 $2.80 $2.60 $2.92 $1.40 $1.40 $2.40 $3.20 N/A $2.00 $1.40 N/A N/A N/A $3.20 N/A $3.20 N/A N/A $3.20 N/A N/A N/A $2.00 $2.00 $2.00 $3.00 $2.00 $2.00 N/A $2.60 $2.70 $2.70 $2.70 $2.70 N/A N/A N/A $2.67 $2.00 N/A N/A N/A N/A $1.40 $3.20 330104 272 HC CUSTOM HIP PACK **NYACK ONLY O $427.00 N/A N/A N/A $213.50 $264.74 $264.74 $279.26 N/A N/A N/A N/A $320.25 $298.90 $277.55 $312.14 $149.45 $149.45 $256.20 $341.60 N/A $213.50 $149.45 N/A N/A N/A $341.60 N/A $341.60 N/A N/A $341.60 N/A N/A N/A $213.50 $213.50 $213.50 $320.25 $213.50 $213.50 N/A $277.55 $288.23 $288.23 $288.23 $288.23 N/A N/A N/A $284.81 $213.50 N/A N/A N/A N/A $149.45 $341.60 330104 272 HC CATH COUDE 5CC 20FR **NYACK ONLY O $5.00 N/A N/A N/A $2.50 $3.10 $3.10 $3.27 N/A N/A N/A N/A $3.75 $3.50 $3.25 $3.65 $1.75 $1.75 $3.00 $4.00 N/A $2.50 $1.75 N/A N/A N/A $4.00 N/A $4.00 N/A N/A $4.00 N/A N/A N/A $2.50 $2.50 $2.50 $3.75 $2.50 $2.50 N/A $3.25 $3.38 $3.38 $3.38 $3.38 N/A N/A N/A $3.33 $2.50 N/A N/A N/A N/A $1.75 $4.00 330104 A6449 1001 272 "HC LT COMPRES BAND >=3"" <5""/YD" O $5.00 N/A N/A N/A $2.50 $3.10 $3.10 N/A N/A N/A N/A N/A $3.75 N/A $3.25 $3.65 N/A N/A $3.00 $4.00 N/A $2.50 N/A N/A $3.25 N/A $4.00 N/A N/A N/A N/A N/A N/A N/A N/A $2.50 $2.50 N/A $3.75 N/A N/A $2.50 $3.25 $3.38 $3.38 $3.38 $3.38 N/A N/A N/A $3.33 N/A N/A N/A N/A N/A $2.50 $4.00 330104 A6196 1001 272 HC ALGINATE DRESSING <=16 SQ IN EACH O $22.00 N/A N/A N/A $11.00 $13.64 $13.64 N/A N/A N/A N/A N/A $16.50 N/A $14.30 $16.08 N/A N/A $13.20 $17.60 N/A $11.00 N/A N/A $14.30 N/A $17.60 N/A N/A N/A N/A N/A N/A N/A N/A $11.00 $11.00 N/A $16.50 N/A N/A $11.00 $14.30 $14.85 $14.85 $14.85 $14.85 N/A N/A N/A $14.67 N/A N/A N/A N/A N/A $11.00 $17.60 330104 C1769 2006 272 HC COAXIAL MICROINDUCER KIT O $96.00 N/A N/A N/A $48.00 $59.52 $59.52 $62.78 N/A N/A N/A N/A $72.00 N/A $62.40 $70.18 N/A N/A $57.60 $76.80 N/A $48.00 N/A N/A N/A N/A $76.80 N/A N/A N/A N/A N/A N/A N/A N/A $48.00 $48.00 N/A $72.00 N/A N/A $48.00 $62.40 $64.80 $64.80 $64.80 $64.80 N/A N/A N/A $64.03 N/A N/A N/A N/A N/A $48.00 $76.80 330104 A4346 1001 272 HC CATH FOLEY 5CC-24FR(2WAY) **NYACK ONLY O $3.00 N/A N/A N/A $1.50 $1.86 $1.86 N/A N/A N/A N/A N/A $2.25 N/A $1.95 $2.19 N/A N/A $1.80 $2.40 N/A $1.50 N/A N/A $1.95 N/A $2.40 N/A N/A N/A N/A N/A N/A N/A N/A $1.50 $1.50 N/A $2.25 N/A N/A $1.50 $1.95 $2.03 $2.03 $2.03 $2.03 N/A N/A N/A $2.00 N/A N/A N/A N/A N/A $1.50 $2.40 330104 272 HC CUSTOM HIP PINNING PACK **NYACK ONLY O $279.00 N/A N/A N/A $139.50 $172.98 $172.98 $182.47 N/A N/A N/A N/A $209.25 $195.30 $181.35 $203.95 $97.65 $97.65 $167.40 $223.20 N/A $139.50 $97.65 N/A N/A N/A $223.20 N/A $223.20 N/A N/A $223.20 N/A N/A N/A $139.50 $139.50 $139.50 $209.25 $139.50 $139.50 N/A $181.35 $188.33 $188.33 $188.33 $188.33 N/A N/A N/A $186.09 $139.50 N/A N/A N/A N/A $97.65 $223.20 330104 272 HC CUSTOM ARTHROSCOPY PACK **NYACK ONLY O $199.00 N/A N/A N/A $99.50 $123.38 $123.38 $130.15 N/A N/A N/A N/A $149.25 $139.30 $129.35 $145.47 $69.65 $69.65 $119.40 $159.20 N/A $99.50 $69.65 N/A N/A N/A $159.20 N/A $159.20 N/A N/A $159.20 N/A N/A N/A $99.50 $99.50 $99.50 $149.25 $99.50 $99.50 N/A $129.35 $134.33 $134.33 $134.33 $134.33 N/A N/A N/A $132.73 $99.50 N/A N/A N/A N/A $69.65 $159.20 330104 272 HC CUSTOM NEURO PACK **NYACK ONLY O $251.00 N/A N/A N/A $125.50 $155.62 $155.62 $164.15 N/A N/A N/A N/A $188.25 $175.70 $163.15 $183.48 $87.85 $87.85 $150.60 $200.80 N/A $125.50 $87.85 N/A N/A N/A $200.80 N/A $200.80 N/A N/A $200.80 N/A N/A N/A $125.50 $125.50 $125.50 $188.25 $125.50 $125.50 N/A $163.15 $169.43 $169.43 $169.43 $169.43 N/A N/A N/A $167.42 $125.50 N/A N/A N/A N/A $87.85 $200.80 330104 272 HC CATH TRAY ADD A FOLEY **NYACK ONLY O $13.00 N/A N/A N/A $6.50 $8.06 $8.06 $8.50 N/A N/A N/A N/A $9.75 $9.10 $8.45 $9.50 $4.55 $4.55 $7.80 $10.40 N/A $6.50 $4.55 N/A N/A N/A $10.40 N/A $10.40 N/A N/A $10.40 N/A N/A N/A $6.50 $6.50 $6.50 $9.75 $6.50 $6.50 N/A $8.45 $8.78 $8.78 $8.78 $8.78 N/A N/A N/A $8.67 $6.50 N/A N/A N/A N/A $4.55 $10.40 330104 272 HC CANNULA TRACH INNER SZ 4 **NYACK ONLY O $105.00 N/A N/A N/A $52.50 $65.10 $65.10 $68.67 N/A N/A N/A N/A $78.75 $73.50 $68.25 $76.75 $36.75 $36.75 $63.00 $84.00 N/A $52.50 $36.75 N/A N/A N/A $84.00 N/A $84.00 N/A N/A $84.00 N/A N/A N/A $52.50 $52.50 $52.50 $78.75 $52.50 $52.50 N/A $68.25 $70.88 $70.88 $70.88 $70.88 N/A N/A N/A $70.04 $52.50 N/A N/A N/A N/A $36.75 $84.00 330104 272 HC SKIN STAPLES **NYACK ONLY O $35.00 N/A N/A N/A $17.50 $21.70 $21.70 $22.89 N/A N/A N/A N/A $26.25 $24.50 $22.75 $25.59 $12.25 $12.25 $21.00 $28.00 N/A $17.50 $12.25 N/A N/A N/A $28.00 N/A $28.00 N/A N/A $28.00 N/A N/A N/A $17.50 $17.50 $17.50 $26.25 $17.50 $17.50 N/A $22.75 $23.62 $23.62 $23.62 $23.62 N/A N/A N/A $23.35 $17.50 N/A N/A N/A N/A $12.25 $28.00 330104 272 HC TRACH TUBE CUFFED SIZE 8 505080 **NYACK ONLY O $109.00 N/A N/A N/A $54.50 $67.58 $67.58 $71.29 N/A N/A N/A N/A $81.75 $76.30 $70.85 $79.68 $38.15 $38.15 $65.40 $87.20 N/A $54.50 $38.15 N/A N/A N/A $87.20 N/A $87.20 N/A N/A $87.20 N/A N/A N/A $54.50 $54.50 $54.50 $81.75 $54.50 $54.50 N/A $70.85 $73.58 $73.58 $73.58 $73.58 N/A N/A N/A $72.70 $54.50 N/A N/A N/A N/A $38.15 $87.20 330104 272 HC URINE METER FOLEY TRAY 16FR KC7006LL **NYACK ONLY O $39.00 N/A N/A N/A $19.50 $24.18 $24.18 $25.51 N/A N/A N/A N/A $29.25 $27.30 $25.35 $28.51 $13.65 $13.65 $23.40 $31.20 N/A $19.50 $13.65 N/A N/A N/A $31.20 N/A $31.20 N/A N/A $31.20 N/A N/A N/A $19.50 $19.50 $19.50 $29.25 $19.50 $19.50 N/A $25.35 $26.33 $26.33 $26.33 $26.33 N/A N/A N/A $26.01 $19.50 N/A N/A N/A N/A $13.65 $31.20 330104 272 HC URINE METER FOLEY TRAY 18 **NYACK ONLY O $34.00 N/A N/A N/A $17.00 $21.08 $21.08 $22.24 N/A N/A N/A N/A $25.50 $23.80 $22.10 $24.85 $11.90 $11.90 $20.40 $27.20 N/A $17.00 $11.90 N/A N/A N/A $27.20 N/A $27.20 N/A N/A $27.20 N/A N/A N/A $17.00 $17.00 $17.00 $25.50 $17.00 $17.00 N/A $22.10 $22.95 $22.95 $22.95 $22.95 N/A N/A N/A $22.68 $17.00 N/A N/A N/A N/A $11.90 $27.20 330104 272 HC SPLINTS 4 X 15 OG-4PC (76415) **NYACK ONLY O $18.00 N/A N/A N/A $9.00 $11.16 $11.16 $11.77 N/A N/A N/A N/A $13.50 $12.60 $11.70 $13.16 $6.30 $6.30 $10.80 $14.40 N/A $9.00 $6.30 N/A N/A N/A $14.40 N/A $14.40 N/A N/A $14.40 N/A N/A N/A $9.00 $9.00 $9.00 $13.50 $9.00 $9.00 N/A $11.70 $12.15 $12.15 $12.15 $12.15 N/A N/A N/A $12.01 $9.00 N/A N/A N/A N/A $6.30 $14.40 330104 272 HB KIT MULTI-LUMEN CATH ARROW GUARD O $353.00 N/A N/A N/A $176.50 $218.86 $218.86 $230.86 N/A N/A N/A N/A $264.75 $247.10 $229.45 $258.04 $123.55 $123.55 $211.80 $282.40 N/A $176.50 $123.55 N/A N/A N/A $282.40 N/A $282.40 N/A N/A $282.40 N/A N/A N/A $176.50 $176.50 $176.50 $264.75 $176.50 $176.50 N/A $229.45 $238.28 $238.28 $238.28 $238.28 N/A N/A N/A $235.45 $176.50 N/A N/A N/A N/A $123.55 $282.40 330104 272 HC GASTRIC TUBING O $51.90 N/A N/A N/A $25.95 $32.18 $32.18 $33.94 N/A N/A N/A N/A $38.92 $36.33 $33.73 $37.94 $18.16 $18.16 $31.14 $41.52 N/A $25.95 $18.16 N/A N/A N/A $41.52 N/A $41.52 N/A N/A $41.52 N/A N/A N/A $25.95 $25.95 $25.95 $38.92 $25.95 $25.95 N/A $33.73 $35.03 $35.03 $35.03 $35.03 N/A N/A N/A $34.62 $25.95 N/A N/A N/A N/A $18.16 $41.52 330104 272 HC ADHESIVE SKIN DERMABOND O $55.00 N/A N/A N/A $27.50 $34.10 $34.10 $35.97 N/A N/A N/A N/A $41.25 $38.50 $35.75 $40.20 $19.25 $19.25 $33.00 $44.00 N/A $27.50 $19.25 N/A N/A N/A $44.00 N/A $44.00 N/A N/A $44.00 N/A N/A N/A $27.50 $27.50 $27.50 $41.25 $27.50 $27.50 N/A $35.75 $37.12 $37.12 $37.12 $37.12 N/A N/A N/A $36.69 $27.50 N/A N/A N/A N/A $19.25 $44.00 330104 272 HC CATH FOLEY 5CC-22FR(2WAY) **NYACK ONLY O $25.00 N/A N/A N/A $12.50 $15.50 $15.50 $16.35 N/A N/A N/A N/A $18.75 $17.50 $16.25 $18.27 $8.75 $8.75 $15.00 $20.00 N/A $12.50 $8.75 N/A N/A N/A $20.00 N/A $20.00 N/A N/A $20.00 N/A N/A N/A $12.50 $12.50 $12.50 $18.75 $12.50 $12.50 N/A $16.25 $16.88 $16.88 $16.88 $16.88 N/A N/A N/A $16.68 $12.50 N/A N/A N/A N/A $8.75 $20.00 330104 272 HC CUSTOM MAJOR PACK **NYACK ONLY O $325.00 N/A N/A N/A $162.50 $201.50 $201.50 $212.55 N/A N/A N/A N/A $243.75 $227.50 $211.25 $237.57 $113.75 $113.75 $195.00 $260.00 N/A $162.50 $113.75 N/A N/A N/A $260.00 N/A $260.00 N/A N/A $260.00 N/A N/A N/A $162.50 $162.50 $162.50 $243.75 $162.50 $162.50 N/A $211.25 $219.38 $219.38 $219.38 $219.38 N/A N/A N/A $216.78 $162.50 N/A N/A N/A N/A $113.75 $260.00 330104 272 HC CATH FOLEY 5CC-14FR(2WAY) **NYACK ONLY O $3.00 N/A N/A N/A $1.50 $1.86 $1.86 $1.96 N/A N/A N/A N/A $2.25 $2.10 $1.95 $2.19 $1.05 $1.05 $1.80 $2.40 N/A $1.50 $1.05 N/A N/A N/A $2.40 N/A $2.40 N/A N/A $2.40 N/A N/A N/A $1.50 $1.50 $1.50 $2.25 $1.50 $1.50 N/A $1.95 $2.03 $2.03 $2.03 $2.03 N/A N/A N/A $2.00 $1.50 N/A N/A N/A N/A $1.05 $2.40 330104 272 HC MULTI LUMEN CATHETER AK-45703-ASK **NYACK ONLY O $413.00 N/A N/A N/A $206.50 $256.06 $256.06 $270.10 N/A N/A N/A N/A $309.75 $289.10 $268.45 $301.90 $144.55 $144.55 $247.80 $330.40 N/A $206.50 $144.55 N/A N/A N/A $330.40 N/A $330.40 N/A N/A $330.40 N/A N/A N/A $206.50 $206.50 $206.50 $309.75 $206.50 $206.50 N/A $268.45 $278.78 $278.78 $278.78 $278.78 N/A N/A N/A $275.47 $206.50 N/A N/A N/A N/A $144.55 $330.40 330104 272 HC FULLER SHIELD **NYACK ONLY O $57.00 N/A N/A N/A $28.50 $35.34 $35.34 $37.28 N/A N/A N/A N/A $42.75 $39.90 $37.05 $41.67 $19.95 $19.95 $34.20 $45.60 N/A $28.50 $19.95 N/A N/A N/A $45.60 N/A $45.60 N/A N/A $45.60 N/A N/A N/A $28.50 $28.50 $28.50 $42.75 $28.50 $28.50 N/A $37.05 $38.48 $38.48 $38.48 $38.48 N/A N/A N/A $38.02 $28.50 N/A N/A N/A N/A $19.95 $45.60 330104 272 HC MOLDED CERVICAL COLLAR O $70.00 N/A N/A N/A $35.00 $43.40 $43.40 $45.78 N/A N/A N/A N/A $52.50 $49.00 $45.50 $51.17 $24.50 $24.50 $42.00 $56.00 N/A $35.00 $24.50 N/A N/A N/A $56.00 N/A $56.00 N/A N/A $56.00 N/A N/A N/A $35.00 $35.00 $35.00 $52.50 $35.00 $35.00 N/A $45.50 $47.25 $47.25 $47.25 $47.25 N/A N/A N/A $46.69 $35.00 N/A N/A N/A N/A $24.50 $56.00 330104 272 HC CELERO-INTRO-12 O $64.00 N/A N/A N/A $32.00 $39.68 $39.68 $41.86 N/A N/A N/A N/A $48.00 $44.80 $41.60 $46.78 $22.40 $22.40 $38.40 $51.20 N/A $32.00 $22.40 N/A N/A N/A $51.20 N/A $51.20 N/A N/A $51.20 N/A N/A N/A $32.00 $32.00 $32.00 $48.00 $32.00 $32.00 N/A $41.60 $43.20 $43.20 $43.20 $43.20 N/A N/A N/A $42.69 $32.00 N/A N/A N/A N/A $22.40 $51.20 330104 272 HC CELERO-12 O $755.00 N/A N/A N/A $377.50 $468.10 $468.10 $493.77 N/A N/A N/A N/A $566.25 $528.50 $490.75 $551.90 $264.25 $264.25 $453.00 $604.00 N/A $377.50 $264.25 N/A N/A N/A $604.00 N/A $604.00 N/A N/A $604.00 N/A N/A N/A $377.50 $377.50 $377.50 $566.25 $377.50 $377.50 N/A $490.75 $509.63 $509.63 $509.63 $509.63 N/A N/A N/A $503.59 $377.50 N/A N/A N/A N/A $264.25 $604.00 330104 272 HC EVIVA NGO9L - NEEDLE GUIDE O $32.00 N/A N/A N/A $16.00 $19.84 $19.84 $20.93 N/A N/A N/A N/A $24.00 $22.40 $20.80 $23.39 $11.20 $11.20 $19.20 $25.60 N/A $16.00 $11.20 N/A N/A N/A $25.60 N/A $25.60 N/A N/A $25.60 N/A N/A N/A $16.00 $16.00 $16.00 $24.00 $16.00 $16.00 N/A $20.80 $21.60 $21.60 $21.60 $21.60 N/A N/A N/A $21.34 $16.00 N/A N/A N/A N/A $11.20 $25.60 330104 272 HC EVIVA HANDPIECE 913-12/20 O $808.00 N/A N/A N/A $404.00 $500.96 $500.96 $528.43 N/A N/A N/A N/A $606.00 $565.60 $525.20 $590.65 $282.80 $282.80 $484.80 $646.40 N/A $404.00 $282.80 N/A N/A N/A $646.40 N/A $646.40 N/A N/A $646.40 N/A N/A N/A $404.00 $404.00 $404.00 $606.00 $404.00 $404.00 N/A $525.20 $545.40 $545.40 $545.40 $545.40 N/A N/A N/A $538.94 $404.00 N/A N/A N/A N/A $282.80 $646.40 330104 272 HC PYNSINC VIAL ADAPTER 13MM O $11.00 N/A N/A N/A $5.50 $6.82 $6.82 $7.19 N/A N/A N/A N/A $8.25 $7.70 $7.15 $8.04 $3.85 $3.85 $6.60 $8.80 N/A $5.50 $3.85 N/A N/A N/A $8.80 N/A $8.80 N/A N/A $8.80 N/A N/A N/A $5.50 $5.50 $5.50 $8.25 $5.50 $5.50 N/A $7.15 $7.43 $7.43 $7.43 $7.43 N/A N/A N/A $7.34 $5.50 N/A N/A N/A N/A $3.85 $8.80 330104 272 HC BAG LEG URIN DRAIN(DISP) **NYACK ONLY O $9.00 N/A N/A N/A $4.50 $5.58 $5.58 $5.89 N/A N/A N/A N/A $6.75 $6.30 $5.85 $6.58 $3.15 $3.15 $5.40 $7.20 N/A $4.50 $3.15 N/A N/A N/A $7.20 N/A $7.20 N/A N/A $7.20 N/A N/A N/A $4.50 $4.50 $4.50 $6.75 $4.50 $4.50 N/A $5.85 $6.08 $6.08 $6.08 $6.08 N/A N/A N/A $6.00 $4.50 N/A N/A N/A N/A $3.15 $7.20 330104 272 HC M MARK STOPLIGHT O $450.00 N/A N/A N/A $225.00 $279.00 $279.00 $294.30 N/A N/A N/A N/A $337.50 $315.00 $292.50 $328.95 $157.50 $157.50 $270.00 $360.00 N/A $225.00 $157.50 N/A N/A N/A $360.00 N/A $360.00 N/A N/A $360.00 N/A N/A N/A $225.00 $225.00 $225.00 $337.50 $225.00 $225.00 N/A $292.50 $303.75 $303.75 $303.75 $303.75 N/A N/A N/A $300.15 $225.00 N/A N/A N/A N/A $157.50 $360.00 330104 272 HC MRI NEEDLS LOC 18G-100G O $204.00 N/A N/A N/A $102.00 $126.48 $126.48 $133.42 N/A N/A N/A N/A $153.00 $142.80 $132.60 $149.12 $71.40 $71.40 $122.40 $163.20 N/A $102.00 $71.40 N/A N/A N/A $163.20 N/A $163.20 N/A N/A $163.20 N/A N/A N/A $102.00 $102.00 $102.00 $153.00 $102.00 $102.00 N/A $132.60 $137.70 $137.70 $137.70 $137.70 N/A N/A N/A $136.07 $102.00 N/A N/A N/A N/A $71.40 $163.20 330104 272 HC MRI - COLD SPOT -70MM X 70MM O $6.00 N/A N/A N/A $3.00 $3.72 $3.72 $3.92 N/A N/A N/A N/A $4.50 $4.20 $3.90 $4.39 $2.10 $2.10 $3.60 $4.80 N/A $3.00 $2.10 N/A N/A N/A $4.80 N/A $4.80 N/A N/A $4.80 N/A N/A N/A $3.00 $3.00 $3.00 $4.50 $3.00 $3.00 N/A $3.90 $4.05 $4.05 $4.05 $4.05 N/A N/A N/A $4.00 $3.00 N/A N/A N/A N/A $2.10 $4.80 330104 272 HC MRI NEEDLE BIOPSY PETITE -9GX14X12 ATEC O $990.00 N/A N/A N/A $495.00 $613.80 $613.80 $647.46 N/A N/A N/A N/A $742.50 $693.00 $643.50 $723.69 $346.50 $346.50 $594.00 $792.00 N/A $495.00 $346.50 N/A N/A N/A $792.00 N/A $792.00 N/A N/A $792.00 N/A N/A N/A $495.00 $495.00 $495.00 $742.50 $495.00 $495.00 N/A $643.50 $668.25 $668.25 $668.25 $668.25 N/A N/A N/A $660.33 $495.00 N/A N/A N/A N/A $346.50 $792.00 330104 272 HC MRI INTRODUCER PETITE 9G ILS 0914-12 O $570.00 N/A N/A N/A $285.00 $353.40 $353.40 $372.78 N/A N/A N/A N/A $427.50 $399.00 $370.50 $416.67 $199.50 $199.50 $342.00 $456.00 N/A $285.00 $199.50 N/A N/A N/A $456.00 N/A $456.00 N/A N/A $456.00 N/A N/A N/A $285.00 $285.00 $285.00 $427.50 $285.00 $285.00 N/A $370.50 $384.75 $384.75 $384.75 $384.75 N/A N/A N/A $380.19 $285.00 N/A N/A N/A N/A $199.50 $456.00 330104 272 HC VERAFLO VERALINK O $172.00 N/A N/A N/A $86.00 $106.64 $106.64 $112.49 N/A N/A N/A N/A $129.00 $120.40 $111.80 $125.73 $60.20 $60.20 $103.20 $137.60 N/A $86.00 $60.20 N/A N/A N/A $137.60 N/A $137.60 N/A N/A $137.60 N/A N/A N/A $86.00 $86.00 $86.00 $129.00 $86.00 $86.00 N/A $111.80 $116.10 $116.10 $116.10 $116.10 N/A N/A N/A $114.72 $86.00 N/A N/A N/A N/A $60.20 $137.60 330104 272 HC VERAFLO GRANUFOAM O $431.00 N/A N/A N/A $215.50 $267.22 $267.22 $281.87 N/A N/A N/A N/A $323.25 $301.70 $280.15 $315.06 $150.85 $150.85 $258.60 $344.80 N/A $215.50 $150.85 N/A N/A N/A $344.80 N/A $344.80 N/A N/A $344.80 N/A N/A N/A $215.50 $215.50 $215.50 $323.25 $215.50 $215.50 N/A $280.15 $290.93 $290.93 $290.93 $290.93 N/A N/A N/A $287.48 $215.50 N/A N/A N/A N/A $150.85 $344.80 330104 272 HC VERAFLO CLEANSE FOAM O $359.00 N/A N/A N/A $179.50 $222.58 $222.58 $234.79 N/A N/A N/A N/A $269.25 $251.30 $233.35 $262.43 $125.65 $125.65 $215.40 $287.20 N/A $179.50 $125.65 N/A N/A N/A $287.20 N/A $287.20 N/A N/A $287.20 N/A N/A N/A $179.50 $179.50 $179.50 $269.25 $179.50 $179.50 N/A $233.35 $242.33 $242.33 $242.33 $242.33 N/A N/A N/A $239.45 $179.50 N/A N/A N/A N/A $125.65 $287.20 330104 272 HC FOLEY TRAY CATH 14 FR O $28.00 N/A N/A N/A $14.00 $17.36 $17.36 $18.31 N/A N/A N/A N/A $21.00 $19.60 $18.20 $20.47 $9.80 $9.80 $16.80 $22.40 N/A $14.00 $9.80 N/A N/A N/A $22.40 N/A $22.40 N/A N/A $22.40 N/A N/A N/A $14.00 $14.00 $14.00 $21.00 $14.00 $14.00 N/A $18.20 $18.90 $18.90 $18.90 $18.90 N/A N/A N/A $18.68 $14.00 N/A N/A N/A N/A $9.80 $22.40 330104 272 HC INTRAUTERINE CATHOTIP TRN O $178.00 N/A N/A N/A $89.00 $110.36 $110.36 $116.41 N/A N/A N/A N/A $133.50 $124.60 $115.70 $130.12 $62.30 $62.30 $106.80 $142.40 N/A $89.00 $62.30 N/A N/A N/A $142.40 N/A $142.40 N/A N/A $142.40 N/A N/A N/A $89.00 $89.00 $89.00 $133.50 $89.00 $89.00 N/A $115.70 $120.15 $120.15 $120.15 $120.15 N/A N/A N/A $118.73 $89.00 N/A N/A N/A N/A $62.30 $142.40 330104 272 HC VACUUM EXTRACTOR SILICUP O $90.00 N/A N/A N/A $45.00 $55.80 $55.80 $58.86 N/A N/A N/A N/A $67.50 $63.00 $58.50 $65.79 $31.50 $31.50 $54.00 $72.00 N/A $45.00 $31.50 N/A N/A N/A $72.00 N/A $72.00 N/A N/A $72.00 N/A N/A N/A $45.00 $45.00 $45.00 $67.50 $45.00 $45.00 N/A $58.50 $60.75 $60.75 $60.75 $60.75 N/A N/A N/A $60.03 $45.00 N/A N/A N/A N/A $31.50 $72.00 330104 272 HC BAIR HUGGER O $14.00 N/A N/A N/A $7.00 $8.68 $8.68 $9.16 N/A N/A N/A N/A $10.50 $9.80 $9.10 $10.23 $4.90 $4.90 $8.40 $11.20 N/A $7.00 $4.90 N/A N/A N/A $11.20 N/A $11.20 N/A N/A $11.20 N/A N/A N/A $7.00 $7.00 $7.00 $10.50 $7.00 $7.00 N/A $9.10 $9.45 $9.45 $9.45 $9.45 N/A N/A N/A $9.34 $7.00 N/A N/A N/A N/A $4.90 $11.20 330104 272 HC SPINAL ANES TRY WHITACRE O $66.00 N/A N/A N/A $33.00 $40.92 $40.92 $43.16 N/A N/A N/A N/A $49.50 $46.20 $42.90 $48.25 $23.10 $23.10 $39.60 $52.80 N/A $33.00 $23.10 N/A N/A N/A $52.80 N/A $52.80 N/A N/A $52.80 N/A N/A N/A $33.00 $33.00 $33.00 $49.50 $33.00 $33.00 N/A $42.90 $44.55 $44.55 $44.55 $44.55 N/A N/A N/A $44.02 $33.00 N/A N/A N/A N/A $23.10 $52.80 330104 272 HC CVP KIT O $326.00 N/A N/A N/A $163.00 $202.12 $202.12 $213.20 N/A N/A N/A N/A $244.50 $228.20 $211.90 $238.31 $114.10 $114.10 $195.60 $260.80 N/A $163.00 $114.10 N/A N/A N/A $260.80 N/A $260.80 N/A N/A $260.80 N/A N/A N/A $163.00 $163.00 $163.00 $244.50 $163.00 $163.00 N/A $211.90 $220.05 $220.05 $220.05 $220.05 N/A N/A N/A $217.44 $163.00 N/A N/A N/A N/A $114.10 $260.80 330104 C1756 2006 272 HC CATH THERACATH EPIDUR ARROW 20GEC-5000 O $57.00 N/A N/A N/A $28.50 $35.34 $35.34 $37.28 N/A N/A N/A N/A $42.75 N/A $37.05 $41.67 N/A N/A $34.20 $45.60 N/A $28.50 N/A N/A N/A N/A $45.60 N/A N/A N/A N/A N/A N/A N/A N/A $28.50 $28.50 N/A $42.75 N/A N/A $28.50 $37.05 $38.48 $38.48 $38.48 $38.48 N/A N/A N/A $38.02 N/A N/A N/A N/A N/A $28.50 $45.60 330104 272 HC BRONCH CATH WITH CPAP O $252.00 N/A N/A N/A $126.00 $156.24 $156.24 $164.81 N/A N/A N/A N/A $189.00 $176.40 $163.80 $184.21 $88.20 $88.20 $151.20 $201.60 N/A $126.00 $88.20 N/A N/A N/A $201.60 N/A $201.60 N/A N/A $201.60 N/A N/A N/A $126.00 $126.00 $126.00 $189.00 $126.00 $126.00 N/A $163.80 $170.10 $170.10 $170.10 $170.10 N/A N/A N/A $168.08 $126.00 N/A N/A N/A N/A $88.20 $201.60 330104 272 HC SPINAL ANESTHESIA TRAY O $194.00 N/A N/A N/A $97.00 $120.28 $120.28 $126.88 N/A N/A N/A N/A $145.50 $135.80 $126.10 $141.81 $67.90 $67.90 $116.40 $155.20 N/A $97.00 $67.90 N/A N/A N/A $155.20 N/A $155.20 N/A N/A $155.20 N/A N/A N/A $97.00 $97.00 $97.00 $145.50 $97.00 $97.00 N/A $126.10 $130.95 $130.95 $130.95 $130.95 N/A N/A N/A $129.40 $97.00 N/A N/A N/A N/A $67.90 $155.20 330104 272 HC BLOOD COLLECTION SET O $134.00 N/A N/A N/A $67.00 $83.08 $83.08 $87.64 N/A N/A N/A N/A $100.50 $93.80 $87.10 $97.95 $46.90 $46.90 $80.40 $107.20 N/A $67.00 $46.90 N/A N/A N/A $107.20 N/A $107.20 N/A N/A $107.20 N/A N/A N/A $67.00 $67.00 $67.00 $100.50 $67.00 $67.00 N/A $87.10 $90.45 $90.45 $90.45 $90.45 N/A N/A N/A $89.38 $67.00 N/A N/A N/A N/A $46.90 $107.20 330104 272 HC MEDICAL/SURGICAL SUPPLIES - STERILE O $390.00 N/A N/A N/A $195.00 $241.80 $241.80 $255.06 N/A N/A N/A N/A $292.50 $273.00 $253.50 $285.09 $136.50 $136.50 $234.00 $312.00 N/A $195.00 $136.50 N/A N/A N/A $312.00 N/A $312.00 N/A N/A $312.00 N/A N/A N/A $195.00 $195.00 $195.00 $292.50 $195.00 $195.00 N/A $253.50 $263.25 $263.25 $263.25 $263.25 N/A N/A N/A $260.13 $195.00 N/A N/A N/A N/A $136.50 $312.00 330104 C1751 2006 272 HC BARD ACCESS PICC 5.0FR O $750.00 N/A N/A N/A $375.00 $465.00 $465.00 $490.50 N/A N/A N/A N/A $562.50 N/A $487.50 $548.25 N/A N/A $450.00 $600.00 N/A $375.00 N/A N/A N/A N/A $600.00 N/A N/A N/A N/A N/A N/A N/A N/A $375.00 $375.00 N/A $562.50 N/A N/A $375.00 $487.50 $506.25 $506.25 $506.25 $506.25 N/A N/A N/A $500.25 N/A N/A N/A N/A N/A $375.00 $600.00 330104 272 HC TRIPLE LUMEN CATHETER #16 O $327.00 N/A N/A N/A $163.50 $202.74 $202.74 $213.86 N/A N/A N/A N/A $245.25 $228.90 $212.55 $239.04 $114.45 $114.45 $196.20 $261.60 N/A $163.50 $114.45 N/A N/A N/A $261.60 N/A $261.60 N/A N/A $261.60 N/A N/A N/A $163.50 $163.50 $163.50 $245.25 $163.50 $163.50 N/A $212.55 $220.73 $220.73 $220.73 $220.73 N/A N/A N/A $218.11 $163.50 N/A N/A N/A N/A $114.45 $261.60 330104 272 HC ESOPHAGEAL STETHOSCOPE O $7.00 N/A N/A N/A $3.50 $4.34 $4.34 $4.58 N/A N/A N/A N/A $5.25 $4.90 $4.55 $5.12 $2.45 $2.45 $4.20 $5.60 N/A $3.50 $2.45 N/A N/A N/A $5.60 N/A $5.60 N/A N/A $5.60 N/A N/A N/A $3.50 $3.50 $3.50 $5.25 $3.50 $3.50 N/A $4.55 $4.73 $4.73 $4.73 $4.73 N/A N/A N/A $4.67 $3.50 N/A N/A N/A N/A $2.45 $5.60 330104 272 HC TEMNO 14G - 16G O $165.00 N/A N/A N/A $82.50 $102.30 $102.30 $107.91 N/A N/A N/A N/A $123.75 $115.50 $107.25 $120.61 $57.75 $57.75 $99.00 $132.00 N/A $82.50 $57.75 N/A N/A N/A $132.00 N/A $132.00 N/A N/A $132.00 N/A N/A N/A $82.50 $82.50 $82.50 $123.75 $82.50 $82.50 N/A $107.25 $111.38 $111.38 $111.38 $111.38 N/A N/A N/A $110.06 $82.50 N/A N/A N/A N/A $57.75 $132.00 330104 272 HC SPINAL ANESTHESIA TRAY O $73.00 N/A N/A N/A $36.50 $45.26 $45.26 $47.74 N/A N/A N/A N/A $54.75 $51.10 $47.45 $53.36 $25.55 $25.55 $43.80 $58.40 N/A $36.50 $25.55 N/A N/A N/A $58.40 N/A $58.40 N/A N/A $58.40 N/A N/A N/A $36.50 $36.50 $36.50 $54.75 $36.50 $36.50 N/A $47.45 $49.28 $49.28 $49.28 $49.28 N/A N/A N/A $48.69 $36.50 N/A N/A N/A N/A $25.55 $58.40 330104 272 HC MARKER SKIN MRI 1.5CM #122 O $8.00 N/A N/A N/A $4.00 $4.96 $4.96 $5.23 N/A N/A N/A N/A $6.00 $5.60 $5.20 $5.85 $2.80 $2.80 $4.80 $6.40 N/A $4.00 $2.80 N/A N/A N/A $6.40 N/A $6.40 N/A N/A $6.40 N/A N/A N/A $4.00 $4.00 $4.00 $6.00 $4.00 $4.00 N/A $5.20 $5.40 $5.40 $5.40 $5.40 N/A N/A N/A $5.34 $4.00 N/A N/A N/A N/A $2.80 $6.40 330104 272 HC CART BRONCHOSCOPY O "$1,050.00 " N/A N/A N/A $525.00 $651.00 $651.00 $686.70 N/A N/A N/A N/A $787.50 $735.00 $682.50 $767.55 $367.50 $367.50 $630.00 $840.00 N/A $525.00 $367.50 N/A N/A N/A $840.00 N/A $840.00 N/A N/A $840.00 N/A N/A N/A $525.00 $525.00 $525.00 $787.50 $525.00 $525.00 N/A $682.50 $708.75 $708.75 $708.75 $708.75 N/A N/A N/A $700.35 $525.00 N/A N/A N/A N/A $367.50 $840.00 330104 272 HC BIOPSY TRAY BASIC **NYACK ONLY O $29.00 N/A N/A N/A $14.50 $17.98 $17.98 $18.97 N/A N/A N/A N/A $21.75 $20.30 $18.85 $21.20 $10.15 $10.15 $17.40 $23.20 N/A $14.50 $10.15 N/A N/A N/A $23.20 N/A $23.20 N/A N/A $23.20 N/A N/A N/A $14.50 $14.50 $14.50 $21.75 $14.50 $14.50 N/A $18.85 $19.58 $19.58 $19.58 $19.58 N/A N/A N/A $19.34 $14.50 N/A N/A N/A N/A $10.15 $23.20 330104 272 HC LUMBAR PUNCTURE TRAY AD **NYACK ONLY O $33.00 N/A N/A N/A $16.50 $20.46 $20.46 $21.58 N/A N/A N/A N/A $24.75 $23.10 $21.45 $24.12 $11.55 $11.55 $19.80 $26.40 N/A $16.50 $11.55 N/A N/A N/A $26.40 N/A $26.40 N/A N/A $26.40 N/A N/A N/A $16.50 $16.50 $16.50 $24.75 $16.50 $16.50 N/A $21.45 $22.28 $22.28 $22.28 $22.28 N/A N/A N/A $22.01 $16.50 N/A N/A N/A N/A $11.55 $26.40 330104 272 HC TROCAR CATH 24 FR **NYACK ONLY O $46.00 N/A N/A N/A $23.00 $28.52 $28.52 $30.08 N/A N/A N/A N/A $34.50 $32.20 $29.90 $33.63 $16.10 $16.10 $27.60 $36.80 N/A $23.00 $16.10 N/A N/A N/A $36.80 N/A $36.80 N/A N/A $36.80 N/A N/A N/A $23.00 $23.00 $23.00 $34.50 $23.00 $23.00 N/A $29.90 $31.05 $31.05 $31.05 $31.05 N/A N/A N/A $30.68 $23.00 N/A N/A N/A N/A $16.10 $36.80 330104 272 HC TRACH TUBE 7.0MM 513070 FENEST **NYACK ONLY O $95.00 N/A N/A N/A $47.50 $58.90 $58.90 $62.13 N/A N/A N/A N/A $71.25 $66.50 $61.75 $69.44 $33.25 $33.25 $57.00 $76.00 N/A $47.50 $33.25 N/A N/A N/A $76.00 N/A $76.00 N/A N/A $76.00 N/A N/A N/A $47.50 $47.50 $47.50 $71.25 $47.50 $47.50 N/A $61.75 $64.12 $64.12 $64.12 $64.12 N/A N/A N/A $63.37 $47.50 N/A N/A N/A N/A $33.25 $76.00 330104 272 HC PERI GYN PACK **NYACK ONLY O $22.00 N/A N/A N/A $11.00 $13.64 $13.64 $14.39 N/A N/A N/A N/A $16.50 $15.40 $14.30 $16.08 $7.70 $7.70 $13.20 $17.60 N/A $11.00 $7.70 N/A N/A N/A $17.60 N/A $17.60 N/A N/A $17.60 N/A N/A N/A $11.00 $11.00 $11.00 $16.50 $11.00 $11.00 N/A $14.30 $14.85 $14.85 $14.85 $14.85 N/A N/A N/A $14.67 $11.00 N/A N/A N/A N/A $7.70 $17.60 330104 272 HC CYSTO PACK **NYACK ONLY O $82.00 N/A N/A N/A $41.00 $50.84 $50.84 $53.63 N/A N/A N/A N/A $61.50 $57.40 $53.30 $59.94 $28.70 $28.70 $49.20 $65.60 N/A $41.00 $28.70 N/A N/A N/A $65.60 N/A $65.60 N/A N/A $65.60 N/A N/A N/A $41.00 $41.00 $41.00 $61.50 $41.00 $41.00 N/A $53.30 $55.35 $55.35 $55.35 $55.35 N/A N/A N/A $54.69 $41.00 N/A N/A N/A N/A $28.70 $65.60 330104 272 HC BASIC PACK **NYACK ONLY O $23.00 N/A N/A N/A $11.50 $14.26 $14.26 $15.04 N/A N/A N/A N/A $17.25 $16.10 $14.95 $16.81 $8.05 $8.05 $13.80 $18.40 N/A $11.50 $8.05 N/A N/A N/A $18.40 N/A $18.40 N/A N/A $18.40 N/A N/A N/A $11.50 $11.50 $11.50 $17.25 $11.50 $11.50 N/A $14.95 $15.53 $15.53 $15.53 $15.53 N/A N/A N/A $15.34 $11.50 N/A N/A N/A N/A $8.05 $18.40 330104 272 HC HEAD AND NECK PACK **NYACK ONLY O $93.00 N/A N/A N/A $46.50 $57.66 $57.66 $60.82 N/A N/A N/A N/A $69.75 $65.10 $60.45 $67.98 $32.55 $32.55 $55.80 $74.40 N/A $46.50 $32.55 N/A N/A N/A $74.40 N/A $74.40 N/A N/A $74.40 N/A N/A N/A $46.50 $46.50 $46.50 $69.75 $46.50 $46.50 N/A $60.45 $62.78 $62.78 $62.78 $62.78 N/A N/A N/A $62.03 $46.50 N/A N/A N/A N/A $32.55 $74.40 330104 272 HC CHLORAPREP APPLICATOR 10 ML O $10.00 N/A N/A N/A $5.00 $6.20 $6.20 $6.54 N/A N/A N/A N/A $7.50 $7.00 $6.50 $7.31 $3.50 $3.50 $6.00 $8.00 N/A $5.00 $3.50 N/A N/A N/A $8.00 N/A $8.00 N/A N/A $8.00 N/A N/A N/A $5.00 $5.00 $5.00 $7.50 $5.00 $5.00 N/A $6.50 $6.75 $6.75 $6.75 $6.75 N/A N/A N/A $6.67 $5.00 N/A N/A N/A N/A $3.50 $8.00 330104 272 HC SANDEL SKIN MARKER O $42.00 N/A N/A N/A $21.00 $26.04 $26.04 $27.47 N/A N/A N/A N/A $31.50 $29.40 $27.30 $30.70 $14.70 $14.70 $25.20 $33.60 N/A $21.00 $14.70 N/A N/A N/A $33.60 N/A $33.60 N/A N/A $33.60 N/A N/A N/A $21.00 $21.00 $21.00 $31.50 $21.00 $21.00 N/A $27.30 $28.35 $28.35 $28.35 $28.35 N/A N/A N/A $28.01 $21.00 N/A N/A N/A N/A $14.70 $33.60 330104 272 HC SITE RITE PROBE COVER KIT W/ GEL O $21.00 N/A N/A N/A $10.50 $13.02 $13.02 $13.73 N/A N/A N/A N/A $15.75 $14.70 $13.65 $15.35 $7.35 $7.35 $12.60 $16.80 N/A $10.50 $7.35 N/A N/A N/A $16.80 N/A $16.80 N/A N/A $16.80 N/A N/A N/A $10.50 $10.50 $10.50 $15.75 $10.50 $10.50 N/A $13.65 $14.18 $14.18 $14.18 $14.18 N/A N/A N/A $14.01 $10.50 N/A N/A N/A N/A $7.35 $16.80 330104 272 HC TRAY THOROCENTESIS O $468.00 N/A N/A N/A $234.00 $290.16 $290.16 $306.07 N/A N/A N/A N/A $351.00 $327.60 $304.20 $342.11 $163.80 $163.80 $280.80 $374.40 N/A $234.00 $163.80 N/A N/A N/A $374.40 N/A $374.40 N/A N/A $374.40 N/A N/A N/A $234.00 $234.00 $234.00 $351.00 $234.00 $234.00 N/A $304.20 $315.90 $315.90 $315.90 $315.90 N/A N/A N/A $312.16 $234.00 N/A N/A N/A N/A $163.80 $374.40 330104 272 HC TRAY INTUBATION O $112.00 N/A N/A N/A $56.00 $69.44 $69.44 $73.25 N/A N/A N/A N/A $84.00 $78.40 $72.80 $81.87 $39.20 $39.20 $67.20 $89.60 N/A $56.00 $39.20 N/A N/A N/A $89.60 N/A $89.60 N/A N/A $89.60 N/A N/A N/A $56.00 $56.00 $56.00 $84.00 $56.00 $56.00 N/A $72.80 $75.60 $75.60 $75.60 $75.60 N/A N/A N/A $74.70 $56.00 N/A N/A N/A N/A $39.20 $89.60 330104 272 HC TRAY CUT DOWN O $308.00 N/A N/A N/A $154.00 $190.96 $190.96 $201.43 N/A N/A N/A N/A $231.00 $215.60 $200.20 $225.15 $107.80 $107.80 $184.80 $246.40 N/A $154.00 $107.80 N/A N/A N/A $246.40 N/A $246.40 N/A N/A $246.40 N/A N/A N/A $154.00 $154.00 $154.00 $231.00 $154.00 $154.00 N/A $200.20 $207.90 $207.90 $207.90 $207.90 N/A N/A N/A $205.44 $154.00 N/A N/A N/A N/A $107.80 $246.40 330104 272 HC ELECTRODE QUADTRODE ECG STAND 9303N O $19.00 N/A N/A N/A $9.50 $11.78 $11.78 $12.43 N/A N/A N/A N/A $14.25 $13.30 $12.35 $13.89 $6.65 $6.65 $11.40 $15.20 N/A $9.50 $6.65 N/A N/A N/A $15.20 N/A $15.20 N/A N/A $15.20 N/A N/A N/A $9.50 $9.50 $9.50 $14.25 $9.50 $9.50 N/A $12.35 $12.83 $12.83 $12.83 $12.83 N/A N/A N/A $12.67 $9.50 N/A N/A N/A N/A $6.65 $15.20 330104 272 HC CONTINUOUS BLOCK KIT O $319.00 N/A N/A N/A $159.50 $197.78 $197.78 $208.63 N/A N/A N/A N/A $239.25 $223.30 $207.35 $233.19 $111.65 $111.65 $191.40 $255.20 N/A $159.50 $111.65 N/A N/A N/A $255.20 N/A $255.20 N/A N/A $255.20 N/A N/A N/A $159.50 $159.50 $159.50 $239.25 $159.50 $159.50 N/A $207.35 $215.33 $215.33 $215.33 $215.33 N/A N/A N/A $212.77 $159.50 N/A N/A N/A N/A $111.65 $255.20 330104 272 HC MEDELA BREAST PUMP HARMONY MAN 67186S O $43.00 N/A N/A N/A $21.50 $26.66 $26.66 $28.12 N/A N/A N/A N/A $32.25 $30.10 $27.95 $31.43 $15.05 $15.05 $25.80 $34.40 N/A $21.50 $15.05 N/A N/A N/A $34.40 N/A $34.40 N/A N/A $34.40 N/A N/A N/A $21.50 $21.50 $21.50 $32.25 $21.50 $21.50 N/A $27.95 $29.03 $29.03 $29.03 $29.03 N/A N/A N/A $28.68 $21.50 N/A N/A N/A N/A $15.05 $34.40 330104 272 HC MEDELA NIPPLE SHIELD 20MM 89907S O $12.00 N/A N/A N/A $6.00 $7.44 $7.44 $7.85 N/A N/A N/A N/A $9.00 $8.40 $7.80 $8.77 $4.20 $4.20 $7.20 $9.60 N/A $6.00 $4.20 N/A N/A N/A $9.60 N/A $9.60 N/A N/A $9.60 N/A N/A N/A $6.00 $6.00 $6.00 $9.00 $6.00 $6.00 N/A $7.80 $8.10 $8.10 $8.10 $8.10 N/A N/A N/A $8.00 $6.00 N/A N/A N/A N/A $4.20 $9.60 330104 272 HC CERVICAL RIPENING BALLOON W/STYLET O $131.00 N/A N/A N/A $65.50 $81.22 $81.22 $85.67 N/A N/A N/A N/A $98.25 $91.70 $85.15 $95.76 $45.85 $45.85 $78.60 $104.80 N/A $65.50 $45.85 N/A N/A N/A $104.80 N/A $104.80 N/A N/A $104.80 N/A N/A N/A $65.50 $65.50 $65.50 $98.25 $65.50 $65.50 N/A $85.15 $88.43 $88.43 $88.43 $88.43 N/A N/A N/A $87.38 $65.50 N/A N/A N/A N/A $45.85 $104.80 330104 272 HC NOVII PATCH FETAL MONITOR 107-PT-004-50 O $111.00 N/A N/A N/A $55.50 $68.82 $68.82 $72.59 N/A N/A N/A N/A $83.25 $77.70 $72.15 $81.14 $38.85 $38.85 $66.60 $88.80 N/A $55.50 $38.85 N/A N/A N/A $88.80 N/A $88.80 N/A N/A $88.80 N/A N/A N/A $55.50 $55.50 $55.50 $83.25 $55.50 $55.50 N/A $72.15 $74.93 $74.93 $74.93 $74.93 N/A N/A N/A $74.04 $55.50 N/A N/A N/A N/A $38.85 $88.80 330104 272 HC PUMP FLANGES O $17.00 N/A N/A N/A $8.50 $10.54 $10.54 $11.12 N/A N/A N/A N/A $12.75 $11.90 $11.05 $12.43 $5.95 $5.95 $10.20 $13.60 N/A $8.50 $5.95 N/A N/A N/A $13.60 N/A $13.60 N/A N/A $13.60 N/A N/A N/A $8.50 $8.50 $8.50 $12.75 $8.50 $8.50 N/A $11.05 $11.48 $11.48 $11.48 $11.48 N/A N/A N/A $11.34 $8.50 N/A N/A N/A N/A $5.95 $13.60 330104 272 HC SINGLE KIT WITH MANUAL PUMP O $58.00 N/A N/A N/A $29.00 $35.96 $35.96 $37.93 N/A N/A N/A N/A $43.50 $40.60 $37.70 $42.40 $20.30 $20.30 $34.80 $46.40 N/A $29.00 $20.30 N/A N/A N/A $46.40 N/A $46.40 N/A N/A $46.40 N/A N/A N/A $29.00 $29.00 $29.00 $43.50 $29.00 $29.00 N/A $37.70 $39.15 $39.15 $39.15 $39.15 N/A N/A N/A $38.69 $29.00 N/A N/A N/A N/A $20.30 $46.40 330104 272 HC DOUBLE PUMP KIT O $26.00 N/A N/A N/A $13.00 $16.12 $16.12 $17.00 N/A N/A N/A N/A $19.50 $18.20 $16.90 $19.01 $9.10 $9.10 $15.60 $20.80 N/A $13.00 $9.10 N/A N/A N/A $20.80 N/A $20.80 N/A N/A $20.80 N/A N/A N/A $13.00 $13.00 $13.00 $19.50 $13.00 $13.00 N/A $16.90 $17.55 $17.55 $17.55 $17.55 N/A N/A N/A $17.34 $13.00 N/A N/A N/A N/A $9.10 $20.80 330104 272 HC CIVCO NEEDLE GUIDE COVERS O $65.00 N/A N/A N/A $32.50 $40.30 $40.30 $42.51 N/A N/A N/A N/A $48.75 $45.50 $42.25 $47.52 $22.75 $22.75 $39.00 $52.00 N/A $32.50 $22.75 N/A N/A N/A $52.00 N/A $52.00 N/A N/A $52.00 N/A N/A N/A $32.50 $32.50 $32.50 $48.75 $32.50 $32.50 N/A $42.25 $43.88 $43.88 $43.88 $43.88 N/A N/A N/A $43.36 $32.50 N/A N/A N/A N/A $22.75 $52.00 330104 272 HC SINGLE PUMP KIT O $15.00 N/A N/A N/A $7.50 $9.30 $9.30 $9.81 N/A N/A N/A N/A $11.25 $10.50 $9.75 $10.96 $5.25 $5.25 $9.00 $12.00 N/A $7.50 $5.25 N/A N/A N/A $12.00 N/A $12.00 N/A N/A $12.00 N/A N/A N/A $7.50 $7.50 $7.50 $11.25 $7.50 $7.50 N/A $9.75 $10.12 $10.12 $10.12 $10.12 N/A N/A N/A $10.01 $7.50 N/A N/A N/A N/A $5.25 $12.00 330104 272 HC BASIC DIALYSIS CATH. #20 O $383.00 N/A N/A N/A $191.50 $237.46 $237.46 $250.48 N/A N/A N/A N/A $287.25 $268.10 $248.95 $279.97 $134.05 $134.05 $229.80 $306.40 N/A $191.50 $134.05 N/A N/A N/A $306.40 N/A $306.40 N/A N/A $306.40 N/A N/A N/A $191.50 $191.50 $191.50 $287.25 $191.50 $191.50 N/A $248.95 $258.53 $258.53 $258.53 $258.53 N/A N/A N/A $255.46 $191.50 N/A N/A N/A N/A $134.05 $306.40 330104 272 HC BARD ACCESS PICC 4.0FR O $627.00 N/A N/A N/A $313.50 $388.74 $388.74 $410.06 N/A N/A N/A N/A $470.25 $438.90 $407.55 $458.34 $219.45 $219.45 $376.20 $501.60 N/A $313.50 $219.45 N/A N/A N/A $501.60 N/A $501.60 N/A N/A $501.60 N/A N/A N/A $313.50 $313.50 $313.50 $470.25 $313.50 $313.50 N/A $407.55 $423.23 $423.23 $423.23 $423.23 N/A N/A N/A $418.21 $313.50 N/A N/A N/A N/A $219.45 $501.60 330104 272 HC MRI CLIP V SHAPE STMK14GSS O $301.00 N/A N/A N/A $150.50 $186.62 $186.62 $196.85 N/A N/A N/A N/A $225.75 $210.70 $195.65 $220.03 $105.35 $105.35 $180.60 $240.80 N/A $150.50 $105.35 N/A N/A N/A $240.80 N/A $240.80 N/A N/A $240.80 N/A N/A N/A $150.50 $150.50 $150.50 $225.75 $150.50 $150.50 N/A $195.65 $203.18 $203.18 $203.18 $203.18 N/A N/A N/A $200.77 $150.50 N/A N/A N/A N/A $105.35 $240.80 330104 272 HC MRI SITE MARKER WING BARD O $189.00 N/A N/A N/A $94.50 $117.18 $117.18 $123.61 N/A N/A N/A N/A $141.75 $132.30 $122.85 $138.16 $66.15 $66.15 $113.40 $151.20 N/A $94.50 $66.15 N/A N/A N/A $151.20 N/A $151.20 N/A N/A $151.20 N/A N/A N/A $94.50 $94.50 $94.50 $141.75 $94.50 $94.50 N/A $122.85 $127.58 $127.58 $127.58 $127.58 N/A N/A N/A $126.06 $94.50 N/A N/A N/A N/A $66.15 $151.20 330104 272 HC NEEDLE BRST BLOCK MRI 9896-032-03481 O $20.00 N/A N/A N/A $10.00 $12.40 $12.40 $13.08 N/A N/A N/A N/A $15.00 $14.00 $13.00 $14.62 $7.00 $7.00 $12.00 $16.00 N/A $10.00 $7.00 N/A N/A N/A $16.00 N/A $16.00 N/A N/A $16.00 N/A N/A N/A $10.00 $10.00 $10.00 $15.00 $10.00 $10.00 N/A $13.00 $13.50 $13.50 $13.50 $13.50 N/A N/A N/A $13.34 $10.00 N/A N/A N/A N/A $7.00 $16.00 330104 272 HC ENT CART O $162.00 N/A N/A N/A $81.00 $100.44 $100.44 $105.95 N/A N/A N/A N/A $121.50 $113.40 $105.30 $118.42 $56.70 $56.70 $97.20 $129.60 N/A $81.00 $56.70 N/A N/A N/A $129.60 N/A $129.60 N/A N/A $129.60 N/A N/A N/A $81.00 $81.00 $81.00 $121.50 $81.00 $81.00 N/A $105.30 $109.35 $109.35 $109.35 $109.35 N/A N/A N/A $108.05 $81.00 N/A N/A N/A N/A $56.70 $129.60 330104 L3260 1001 274 HC AMBULATORY SURGICAL BOOT EAC O $24.00 N/A N/A N/A $4.44 $19.20 $19.20 $15.70 N/A N/A N/A N/A N/A $12.00 $15.60 $17.54 N/A N/A $14.40 $19.20 N/A $12.00 N/A N/A N/A $12.00 $7.92 $12.00 N/A N/A N/A N/A N/A N/A N/A $19.20 $20.40 N/A $9.12 N/A N/A $12.00 $15.60 $16.20 $16.20 $16.20 $16.20 $9.60 $12.00 N/A $9.60 N/A $12.00 $12.00 $12.00 N/A $4.44 $20.40 330104 Q4195 455 278 HC PURAPLY (5X5) 25 SQ CM O $155.00 N/A N/A N/A $28.68 $124.00 $124.00 N/A N/A N/A N/A N/A N/A $77.50 $100.75 $113.30 N/A N/A $93.00 $124.00 N/A $77.50 N/A N/A $100.75 $77.50 $51.15 $77.50 N/A N/A N/A N/A N/A N/A N/A $124.00 $131.75 N/A $58.90 N/A N/A $77.50 $100.75 $104.62 $104.62 $104.62 $104.62 $62.00 $77.50 N/A $62.00 N/A $77.50 $77.50 $77.50 N/A $28.68 $131.75 330104 C1751 2006 278 HC BARD MIDLINE KIT 4F O $400.00 N/A N/A N/A $74.00 $320.00 $320.00 $261.60 N/A N/A N/A N/A N/A $200.00 $260.00 $292.40 N/A N/A $240.00 $320.00 N/A $200.00 N/A N/A N/A $200.00 $132.00 $200.00 N/A N/A N/A N/A N/A N/A N/A $320.00 $340.00 N/A $152.00 N/A N/A $200.00 $260.00 $270.00 $270.00 $270.00 $270.00 $160.00 $200.00 N/A $160.00 N/A $200.00 $200.00 $200.00 N/A $74.00 $340.00 330104 Q4158 455 278 HC MARIGEN O $703.00 N/A N/A N/A $130.06 $562.40 $562.40 N/A N/A N/A N/A N/A N/A $351.50 $456.95 $513.89 N/A N/A $421.80 $562.40 N/A $351.50 N/A N/A $456.95 $351.50 $231.99 $351.50 N/A N/A N/A N/A N/A N/A N/A $562.40 $597.55 N/A $267.14 N/A N/A $351.50 $456.95 $474.53 $474.53 $474.53 $474.53 $281.20 $351.50 N/A $281.20 N/A $351.50 $351.50 $351.50 N/A $130.06 $597.55 330104 A4648 2006 278 HC IMPLANTABLE TISSUE MARKER O $252.00 N/A N/A N/A $46.62 $201.60 $201.60 N/A N/A N/A N/A N/A N/A $126.00 $163.80 $184.21 N/A N/A $151.20 $201.60 N/A $126.00 N/A N/A $163.80 $126.00 $83.16 $126.00 N/A N/A N/A N/A N/A N/A N/A $201.60 $214.20 N/A $95.76 N/A N/A $126.00 $163.80 $170.10 $170.10 $170.10 $170.10 $100.80 $126.00 N/A $100.80 N/A $126.00 $126.00 $126.00 N/A $46.62 $214.20 330104 C2639 2639 335 278 HC BRACHYTX NON-STRANDEDI-125 RADONC O $300.00 $42.36 $42.36 $997.14 $55.50 $240.00 $240.00 $41.94 $997.14 $80.49 $997.14 $42.36 N/A $150.00 $195.00 $219.30 "$1,196.57 " $997.14 $180.00 $240.00 $144.03 $150.00 $997.14 $42.36 $50.84 $150.00 $99.00 $150.00 $997.14 "$1,196.57 " $59.31 $997.14 $42.36 $42.36 $46.18 $240.00 $255.00 $997.14 $114.00 "$2,044.14 " $997.14 $150.00 $69.90 $202.50 $202.50 $202.50 $202.50 $120.00 $150.00 $42.36 $120.00 $997.14 $150.00 $150.00 $150.00 $42.36 $41.94 "$2,044.14 " 330104 Q4195 455 278 HC PURAPLY (2X4) 8 SQ CM O $356.00 N/A N/A N/A $65.86 $284.80 $284.80 N/A N/A N/A N/A N/A N/A $178.00 $231.40 $260.24 N/A N/A $213.60 $284.80 N/A $178.00 N/A N/A $231.40 $178.00 $117.48 $178.00 N/A N/A N/A N/A N/A N/A N/A $284.80 $302.60 N/A $135.28 N/A N/A $178.00 $231.40 $240.30 $240.30 $240.30 $240.30 $142.40 $178.00 N/A $142.40 N/A $178.00 $178.00 $178.00 N/A $65.86 $302.60 330104 Q4196 455 278 HC PURAPLY AM (5X5) 25 SQ CM O $155.00 N/A N/A N/A $28.68 $124.00 $124.00 N/A N/A N/A N/A N/A N/A $77.50 $100.75 $113.30 N/A N/A $93.00 $124.00 N/A $77.50 N/A N/A $100.75 $77.50 $51.15 $77.50 N/A N/A N/A N/A N/A N/A N/A $124.00 $131.75 N/A $58.90 N/A N/A $77.50 $100.75 $104.62 $104.62 $104.62 $104.62 $62.00 $77.50 N/A $62.00 N/A $77.50 $77.50 $77.50 N/A $28.68 $131.75 330104 A4648 2006 278 HC IMPLANTABLE TISSUE MARKER EACH O $189.00 N/A N/A N/A $34.96 $151.20 $151.20 N/A N/A N/A N/A N/A N/A $94.50 $122.85 $138.16 N/A N/A $113.40 $151.20 N/A $94.50 N/A N/A $122.85 $94.50 $62.37 $94.50 N/A N/A N/A N/A N/A N/A N/A $151.20 $160.65 N/A $71.82 N/A N/A $94.50 $122.85 $127.58 $127.58 $127.58 $127.58 $75.60 $94.50 N/A $75.60 N/A $94.50 $94.50 $94.50 N/A $34.96 $160.65 330104 Q4101 455 278 HC APLIGRAF O $185.00 N/A N/A N/A $34.23 $148.00 $148.00 N/A N/A N/A N/A N/A N/A $92.50 $120.25 $135.23 N/A N/A $111.00 $148.00 N/A $92.50 N/A N/A $120.25 $92.50 $61.05 $92.50 N/A N/A N/A N/A N/A N/A N/A $148.00 $157.25 N/A $70.30 N/A N/A $92.50 $120.25 $124.88 $124.88 $124.88 $124.88 $74.00 $92.50 N/A $74.00 N/A $92.50 $92.50 $92.50 N/A $34.23 $157.25 330104 Q4150 455 278 HC ALLOWRAP DS OR DRY O "$3,150.00 " N/A N/A N/A $582.75 "$2,520.00 " "$2,520.00 " N/A N/A N/A N/A N/A N/A "$1,575.00 " "$2,047.50 " "$2,302.65 " N/A N/A "$1,890.00 " "$2,520.00 " N/A "$1,575.00 " N/A N/A "$2,047.50 " "$1,575.00 " "$1,039.50 " "$1,575.00 " N/A N/A N/A N/A N/A N/A N/A "$2,520.00 " "$2,677.50 " N/A "$1,197.00 " N/A N/A "$1,575.00 " "$2,047.50 " "$2,126.25 " "$2,126.25 " "$2,126.25 " "$2,126.25 " "$1,260.00 " "$1,575.00 " N/A "$1,260.00 " N/A "$1,575.00 " "$1,575.00 " "$1,575.00 " N/A $582.75 "$2,677.50 " 330104 Q4196 455 278 HC PURAPLY AM 1.6 CM DISC O $675.00 N/A N/A N/A $124.88 $540.00 $540.00 N/A N/A N/A N/A N/A N/A $337.50 $438.75 $493.43 N/A N/A $405.00 $540.00 N/A $337.50 N/A N/A $438.75 $337.50 $222.75 $337.50 N/A N/A N/A N/A N/A N/A N/A $540.00 $573.75 N/A $256.50 N/A N/A $337.50 $438.75 $455.63 $455.63 $455.63 $455.63 $270.00 $337.50 N/A $270.00 N/A $337.50 $337.50 $337.50 N/A $124.88 $573.75 330104 Q4196 455 278 HC PURAPLY AM (2X4) 8 SQ CM O $356.00 N/A N/A N/A $65.86 $284.80 $284.80 N/A N/A N/A N/A N/A N/A $178.00 $231.40 $260.24 N/A N/A $213.60 $284.80 N/A $178.00 N/A N/A $231.40 $178.00 $117.48 $178.00 N/A N/A N/A N/A N/A N/A N/A $284.80 $302.60 N/A $135.28 N/A N/A $178.00 $231.40 $240.30 $240.30 $240.30 $240.30 $142.40 $178.00 N/A $142.40 N/A $178.00 $178.00 $178.00 N/A $65.86 $302.60 330104 Q4196 455 278 HC PURAPLY AM (3X4) 12 SQ CM O $110.00 N/A N/A N/A $20.35 $88.00 $88.00 N/A N/A N/A N/A N/A N/A $55.00 $71.50 $80.41 N/A N/A $66.00 $88.00 N/A $55.00 N/A N/A $71.50 $55.00 $36.30 $55.00 N/A N/A N/A N/A N/A N/A N/A $88.00 $93.50 N/A $41.80 N/A N/A $55.00 $71.50 $74.25 $74.25 $74.25 $74.25 $44.00 $55.00 N/A $44.00 N/A $55.00 $55.00 $55.00 N/A $20.35 $93.50 330104 Q4196 455 278 HC PURAPLY AM (4X4) 16 SQ CM O $108.00 N/A N/A N/A $19.98 $86.40 $86.40 N/A N/A N/A N/A N/A N/A $54.00 $70.20 $78.95 N/A N/A $64.80 $86.40 N/A $54.00 N/A N/A $70.20 $54.00 $35.64 $54.00 N/A N/A N/A N/A N/A N/A N/A $86.40 $91.80 N/A $41.04 N/A N/A $54.00 $70.20 $72.90 $72.90 $72.90 $72.90 $43.20 $54.00 N/A $43.20 N/A $54.00 $54.00 $54.00 N/A $19.98 $91.80 330104 C1713 2006 278 HC LINER LONGEVITY 36X62 O "$5,160.00 " N/A N/A N/A $954.60 "$4,128.00 " "$4,128.00 " "$3,374.64 " N/A N/A N/A N/A N/A "$2,580.00 " "$3,354.00 " "$3,771.96 " N/A N/A "$3,096.00 " "$4,128.00 " N/A "$2,580.00 " N/A N/A N/A "$2,580.00 " "$1,702.80 " "$2,580.00 " N/A N/A N/A N/A N/A N/A N/A "$4,128.00 " "$4,386.00 " N/A "$1,960.80 " N/A N/A "$2,580.00 " "$3,354.00 " "$3,483.00 " "$3,483.00 " "$3,483.00 " "$3,483.00 " "$2,064.00 " "$2,580.00 " N/A "$2,064.00 " N/A "$2,580.00 " "$2,580.00 " "$2,580.00 " N/A $954.60 "$4,386.00 " 330104 C2639 2639 335 278 HC BRACHYTX NON-STRANDEDI-125 O $225.00 $42.36 $42.36 $997.14 $41.62 $180.00 $180.00 $41.94 $997.14 $80.49 $997.14 $42.36 N/A $112.50 $146.25 $164.47 "$1,196.57 " $997.14 $135.00 $180.00 $144.03 $112.50 $997.14 $42.36 $50.84 $112.50 $74.25 $112.50 $997.14 "$1,196.57 " $59.31 $997.14 $42.36 $42.36 $46.18 $180.00 $191.25 $997.14 $85.50 "$2,044.14 " $997.14 $112.50 $69.90 $151.88 $151.88 $151.88 $151.88 $90.00 $112.50 $42.36 $90.00 $997.14 $112.50 $112.50 $112.50 $42.36 $41.62 "$2,044.14 " 330104 C2638 2638 335 278 HC BRACHYTX STRANDED I-125 O $115.00 $45.77 $45.77 $997.14 $21.27 $92.00 $92.00 $45.31 $997.14 $86.96 $997.14 $45.77 N/A $57.50 $74.75 $84.06 "$1,196.57 " $997.14 $69.00 $92.00 $155.62 $57.50 $997.14 $45.77 $54.92 $57.50 $37.95 $57.50 $997.14 "$1,196.57 " $64.08 $997.14 $45.77 $45.77 $49.89 $92.00 $97.75 $997.14 $43.70 "$2,044.14 " $997.14 $57.50 $75.52 $77.62 $77.62 $77.62 $77.62 $46.00 $57.50 $45.77 $46.00 $997.14 $57.50 $57.50 $57.50 $45.77 $21.27 "$2,044.14 " 330104 C2628 2006 278 HC CATHETER OCCLUSION O $780.00 N/A N/A N/A $144.30 $624.00 $624.00 $510.12 N/A N/A N/A N/A N/A $390.00 $507.00 $570.18 N/A N/A $468.00 $624.00 N/A $390.00 N/A N/A N/A $390.00 $257.40 $390.00 N/A N/A N/A N/A N/A N/A N/A $624.00 $663.00 N/A $296.40 N/A N/A $390.00 $507.00 $526.50 $526.50 $526.50 $526.50 $312.00 $390.00 N/A $312.00 N/A $390.00 $390.00 $390.00 N/A $144.30 $663.00 330104 Q4196 455 278 HC PURAPLY AM (2X2) 4 SQ CM O $563.00 N/A N/A N/A $104.16 $450.40 $450.40 N/A N/A N/A N/A N/A N/A $281.50 $365.95 $411.55 N/A N/A $337.80 $450.40 N/A $281.50 N/A N/A $365.95 $281.50 $185.79 $281.50 N/A N/A N/A N/A N/A N/A N/A $450.40 $478.55 N/A $213.94 N/A N/A $281.50 $365.95 $380.03 $380.03 $380.03 $380.03 $225.20 $281.50 N/A $225.20 N/A $281.50 $281.50 $281.50 N/A $104.16 $478.55 330104 Q4106 455 278 HC DERMAGRAFT O $99.00 N/A N/A N/A $18.32 $79.20 $79.20 N/A N/A N/A N/A N/A N/A $49.50 $64.35 $72.37 N/A N/A $59.40 $79.20 N/A $49.50 N/A N/A $64.35 $49.50 $32.67 $49.50 N/A N/A N/A N/A N/A N/A N/A $79.20 $84.15 N/A $37.62 N/A N/A $49.50 $64.35 $66.83 $66.83 $66.83 $66.83 $39.60 $49.50 N/A $39.60 N/A $49.50 $49.50 $49.50 N/A $18.32 $84.15 330104 0708T 111 280 HC INTRADERMAL CANCER IMMNTX PREP & 1ST INJECTION O $107.00 N/A N/A $271.09 $53.50 $66.34 $66.34 N/A $271.09 N/A $271.09 N/A $80.25 N/A $69.55 $78.22 $325.31 $271.09 $64.20 $85.60 N/A $53.50 $271.09 N/A $69.55 $379.53 $85.60 $271.09 $271.09 $325.31 N/A $271.09 N/A N/A N/A $85.60 $90.95 $365.97 $80.25 $555.74 $365.97 $53.50 $69.55 $72.23 $72.23 $72.23 $72.23 N/A N/A N/A $71.37 $271.09 $271.09 N/A N/A N/A $53.50 $555.74 330104 E0779 1002 291 HC INFUSE PUMP O $29.96 N/A N/A N/A $14.98 $18.58 $18.58 $19.59 N/A N/A N/A N/A $22.47 N/A $19.47 $21.90 N/A N/A $17.98 $23.97 N/A $14.98 N/A N/A N/A N/A $23.97 N/A N/A N/A N/A N/A N/A N/A N/A $23.97 $25.47 N/A $22.47 N/A N/A $14.98 $19.47 $20.22 $20.22 $20.22 $20.22 N/A N/A N/A $19.98 N/A N/A N/A N/A N/A $14.98 $25.47 330104 81003 410 300 HC URINALYSIS AUTO W/O SCOPE O $112.35 $2.25 $2.25 $2.00 $56.17 N/A N/A N/A $2.00 $4.27 $2.00 $2.25 $84.26 $2.48 $70.78 $82.13 $2.40 $2.00 $67.41 $89.88 $7.65 $12.83 $2.00 $2.25 $73.03 $2.80 $89.88 $2.00 $2.00 $2.40 $3.15 $2.00 $2.25 $2.25 $2.45 $89.88 $95.50 $2.70 $84.26 $4.10 $2.70 $56.17 $73.03 $3.16 $3.16 $3.16 $3.16 $3.79 $2.36 $2.25 $3.79 $2.00 $2.00 $1.69 $1.69 $1.69 $1.69 $95.50 330104 81002 410 300 HC URINALYSIS NONAUTO W/O SCOPE O $192.60 $3.48 $3.48 $2.00 $96.30 N/A N/A N/A $2.00 $6.61 $2.00 $3.48 $144.45 $3.83 $121.34 $140.79 $2.40 $2.00 $115.56 $154.08 $11.83 $19.84 $2.00 $3.48 $125.19 $2.80 $154.08 $2.00 $2.00 $2.40 $4.87 $2.00 $3.48 $3.48 $3.79 $154.08 $163.71 $2.70 $144.45 $4.10 $2.70 $96.30 $125.19 $4.89 $4.89 $4.89 $4.89 $4.32 $3.65 $3.48 $4.32 $2.00 $2.00 $2.61 $2.61 $2.61 $2.00 $163.71 330104 81001 410 300 HC URINALYSIS AUTO W/SCOPE O $42.80 $3.17 $3.17 $3.17 $21.40 N/A N/A N/A $3.17 $6.02 $3.17 $3.17 $32.10 $3.49 $26.96 $31.29 $3.80 $3.17 $25.68 $34.24 $10.78 $18.07 $3.17 $3.17 $27.82 $4.44 $34.24 $3.17 $3.17 $3.80 $4.44 $3.17 $3.17 $3.17 $3.46 $34.24 $36.38 $4.28 $32.10 $6.50 $4.28 $21.40 $27.82 $4.45 $4.45 $4.45 $4.45 $5.34 $3.33 $3.17 $5.34 $3.17 $3.17 $2.38 $2.38 $2.38 $2.38 $36.38 330104 80365 2040 300 HC OXYCODONE O $151.94 $114.43 $114.43 $5.00 $75.97 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $113.95 $125.87 $95.72 $111.07 $6.00 $5.00 $91.16 $121.55 $389.06 $652.25 $5.00 $114.43 $98.76 $7.00 $121.55 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $121.55 $129.15 $6.75 $113.95 $10.25 $6.75 $75.97 $98.76 $160.77 $160.77 $160.77 $160.77 $31.91 $120.15 $114.43 $31.91 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 81025 410 300 HC URINE PREGNANCY TEST O $54.57 $8.61 $8.61 $2.00 $27.29 N/A N/A N/A $2.00 $16.36 $2.00 $8.61 $40.93 $9.47 $34.38 $39.89 $2.40 $2.00 $32.74 $43.66 $29.27 $49.08 $2.00 $8.61 $35.47 $2.80 $43.66 $2.00 $2.00 $2.40 $12.05 $2.00 $8.61 $8.61 $9.38 $43.66 $46.38 $2.70 $40.93 $4.10 $2.70 $27.29 $35.47 $12.10 $12.10 $12.10 $12.10 $10.68 $9.04 $8.61 $10.68 $2.00 $2.00 $6.46 $6.46 $6.46 $2.00 $49.08 330104 80361 2040 300 HC OPIATES 1 OR MORE O $208.65 $114.43 $114.43 $5.00 $104.33 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $156.49 $125.87 $131.45 $152.52 $6.00 $5.00 $125.19 $166.92 $389.06 $652.25 $5.00 $114.43 $135.62 $7.00 $166.92 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $166.92 $177.35 $6.75 $156.49 $10.25 $6.75 $104.33 $135.62 $160.77 $160.77 $160.77 $160.77 $41.98 $120.15 $114.43 $41.98 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80358 2040 300 HC METHADONE SERUM O $205.44 $114.43 $114.43 $5.00 $102.72 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $154.08 $125.87 $129.43 $150.18 $6.00 $5.00 $123.26 $164.35 $389.06 $652.25 $5.00 $114.43 $133.54 $7.00 $164.35 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $164.35 $174.62 $6.75 $154.08 $10.25 $6.75 $102.72 $133.54 $160.77 $160.77 $160.77 $160.77 $26.66 $120.15 $114.43 $26.66 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80353 2040 300 HC COCAINE O $219.35 $114.43 $114.43 $5.00 $109.67 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $164.51 $125.87 $138.19 $160.34 $6.00 $5.00 $131.61 $175.48 $389.06 $652.25 $5.00 $114.43 $142.58 $7.00 $175.48 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $175.48 $186.45 $6.75 $164.51 $10.25 $6.75 $109.67 $142.58 $160.77 $160.77 $160.77 $160.77 $24.74 $120.15 $114.43 $24.74 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80349 2040 300 HC CANNABINOIDS NATURAL O $208.65 $114.43 $114.43 $5.00 $104.33 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $156.49 $125.87 $131.45 $152.52 $6.00 $5.00 $125.19 $166.92 $389.06 $652.25 $5.00 $114.43 $135.62 $7.00 $166.92 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $166.92 $177.35 $6.75 $156.49 $10.25 $6.75 $104.33 $135.62 $160.77 $160.77 $160.77 $160.77 $29.32 $120.15 $114.43 $29.32 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80347 2040 300 HC BENZODIAZEPINES; 13 OR MORE O $121.98 $114.43 $114.43 $5.00 $60.99 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $91.48 $125.87 $76.85 $89.17 $6.00 $5.00 $73.19 $97.58 $389.06 $652.25 $5.00 $114.43 $79.29 $7.00 $97.58 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $97.58 $103.68 $6.75 $91.48 $10.25 $6.75 $60.99 $79.29 $160.77 $160.77 $160.77 $160.77 $32.33 $120.15 $114.43 $32.33 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 36415 304 300 HC ROUTINE VENIPUNCTURE O $21.40 $8.57 $8.57 N/A $10.70 N/A N/A N/A N/A $16.28 N/A $8.57 $16.05 $9.43 $13.48 $15.64 N/A N/A $12.84 $17.12 $29.14 $48.85 N/A $8.57 $13.91 N/A $17.12 N/A N/A N/A $12.00 N/A $8.57 $8.57 $9.34 $17.12 $18.19 N/A $16.05 N/A N/A $10.70 $13.91 $12.04 $12.04 $12.04 $12.04 $3.60 $9.00 $8.57 $3.60 N/A N/A $6.43 $6.43 $6.43 $3.60 $48.85 330104 80345 2040 300 HC BARBITURATES O $466.52 $114.43 $114.43 $5.00 $233.26 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $349.89 $125.87 $293.91 $341.03 $6.00 $5.00 $279.91 $373.22 $389.06 $652.25 $5.00 $114.43 $303.24 $7.00 $373.22 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $373.22 $396.54 $6.75 $349.89 $10.25 $6.75 $233.26 $303.24 $160.77 $160.77 $160.77 $160.77 $18.70 $120.15 $114.43 $18.70 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80332 2041 300 HC IMIPRAMINE- O $202.23 $114.43 $114.43 N/A $101.11 N/A N/A N/A N/A $217.42 N/A $114.43 $151.67 $125.87 $127.40 $147.83 N/A N/A $121.34 $161.78 $389.06 $652.25 N/A $114.43 $131.45 N/A $161.78 N/A N/A N/A $160.20 N/A $114.43 $114.43 $124.73 $161.78 $171.90 N/A $151.67 N/A N/A $101.11 $131.45 $160.77 $160.77 $160.77 $160.77 $29.32 $120.15 $114.43 $29.32 N/A N/A $85.82 $85.82 $85.82 $29.32 $652.25 330104 80329 2040 300 HC ACETAMINOPHEN- O $182.97 $114.43 $114.43 N/A $91.48 N/A N/A N/A N/A $217.42 N/A $114.43 $137.23 $125.87 $115.27 $133.75 N/A N/A $109.78 $146.38 $389.06 $652.25 N/A $114.43 $118.93 N/A $146.38 N/A N/A N/A $160.20 N/A $114.43 $114.43 $124.73 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 $160.77 $160.77 $160.77 $160.77 $33.05 $120.15 $114.43 $33.05 N/A N/A $85.82 $85.82 $85.82 $33.05 $652.25 330104 80326 2040 300 HC AMPHETAMINES; 5 OR MORE O $364.87 N/A N/A $5.00 $182.44 N/A N/A N/A $5.00 N/A $5.00 N/A $273.65 N/A $229.87 $266.72 $6.00 $5.00 $218.92 $291.90 N/A N/A $5.00 N/A $237.17 $7.00 $291.90 $5.00 $5.00 $6.00 N/A $5.00 N/A N/A N/A $291.90 $310.14 $6.75 $273.65 $10.25 $6.75 $182.44 $237.17 N/A N/A N/A N/A $25.38 N/A N/A $25.38 $5.00 $5.00 N/A N/A N/A $5.00 $310.14 330104 0097U 388 300 "HC GI PROFILE, STOOL, PCR" O $303.88 N/A N/A N/A $151.94 N/A N/A $198.74 N/A N/A N/A N/A $227.91 N/A $191.44 $222.14 N/A N/A $182.33 $243.10 N/A N/A N/A N/A N/A N/A $243.10 N/A N/A N/A N/A N/A N/A N/A N/A $243.10 $258.30 N/A $227.91 N/A N/A $151.94 $197.52 N/A N/A N/A N/A N/A N/A N/A $202.69 N/A N/A N/A N/A N/A $151.94 $258.30 330104 G2023 304 300 HC SPECIMEN COLLECT COVID-19 O $84.53 $23.46 $23.46 $23.46 $42.27 $3.59 $3.25 $2.85 $23.46 $44.57 $23.46 $23.46 $63.40 $25.81 $53.25 $61.79 $28.15 $23.46 $50.72 $67.62 $79.76 $133.72 $23.46 $23.46 $54.94 $32.84 $67.62 $23.46 $23.46 $28.15 $32.84 $23.46 $23.46 $23.46 $25.57 $67.62 $71.85 $31.67 $63.40 $48.09 $31.67 $42.27 $54.94 $32.96 $32.96 $32.96 $32.96 N/A $24.63 $23.46 $56.38 $23.46 $23.46 $17.59 $17.59 $17.59 $2.85 $133.72 330104 0241U 388 300 HC NFCT DS RNA 4 TARGETS UPPER RESPIRATORY SPECIMEN O $449.40 $142.63 $142.63 N/A $224.70 N/A N/A $293.91 N/A $271.00 N/A $142.63 $337.05 $156.89 $283.12 $328.51 N/A N/A $269.64 $359.52 $484.94 $812.99 N/A $142.63 N/A N/A $359.52 N/A N/A N/A $199.68 N/A $142.63 $142.63 $155.47 $359.52 $381.99 N/A $337.05 N/A N/A $224.70 $292.11 $200.40 $200.40 $200.40 $200.40 N/A $149.76 $142.63 $299.75 N/A N/A $106.97 $106.97 $106.97 $106.97 $812.99 330104 81311 386 300 HC NRAS GENE VARIANTS EXON 2&3 O "$1,274.37 " $295.79 $295.79 $177.47 $637.18 N/A N/A N/A $177.47 $562.00 $177.47 $295.79 $955.78 $325.37 $802.85 $931.56 $212.96 $177.47 $764.62 "$1,019.50 " "$1,005.69 " "$1,686.00 " $177.47 $295.79 $828.34 $248.46 "$1,019.50 " $177.47 $177.47 $212.96 $414.11 $177.47 $295.79 $295.79 $322.41 "$1,019.50 " "$1,083.21 " $239.58 $955.78 $363.81 $239.58 $637.18 $828.34 $415.58 $415.58 $415.58 $415.58 $354.95 $310.58 $295.79 $354.95 $177.47 $177.47 $221.84 $221.84 $221.84 $177.47 "$1,686.00 " 330104 80201 405 300 HC ASSAY OF TOPIRAMATE O $151.94 $11.92 $11.92 N/A $75.97 N/A N/A N/A N/A $22.65 N/A $11.92 $113.95 $13.11 $95.72 $111.07 N/A N/A $91.16 $121.55 $40.53 $67.94 N/A $11.92 $98.76 N/A $121.55 N/A N/A N/A $16.69 N/A $11.92 $11.92 $12.99 $121.55 $129.15 N/A $113.95 N/A N/A $75.97 $98.76 $16.75 $16.75 $16.75 $16.75 $20.14 $12.52 $11.92 $20.14 N/A N/A $8.94 $8.94 $8.94 $8.94 $129.15 330104 80346 2040 300 HC BENZODIAZEPINES- O $208.65 $114.43 $114.43 $5.00 $104.33 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $156.49 $125.87 $131.45 $152.52 $6.00 $5.00 $125.19 $166.92 $389.06 $652.25 $5.00 $114.43 $135.62 $7.00 $166.92 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $166.92 $177.35 $6.75 $156.49 $10.25 $6.75 $104.33 $135.62 $160.77 $160.77 $160.77 $160.77 $32.33 $120.15 $114.43 $32.33 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 81364 386 300 HC HBB FULL GENE SEQUENCE O "$1,213.38 " $324.58 $324.58 N/A $606.69 N/A N/A N/A N/A $616.70 N/A $324.58 $910.04 $357.04 $764.43 $886.98 N/A N/A $728.03 $970.70 "$1,103.57 " "$1,850.11 " N/A $324.58 $788.70 N/A $970.70 N/A N/A N/A $454.41 N/A $324.58 $324.58 $353.79 $970.70 "$1,031.37 " N/A $910.04 N/A N/A $606.69 $788.70 $456.03 $456.03 $456.03 $456.03 $389.50 $340.81 $324.58 $389.50 N/A N/A $243.44 $243.44 $243.44 $243.44 "$1,850.11 " 330104 86870 5673 2043 300 HC RBC ANTIBODY IDENTIFICATION O "$1,308.61 " $388.85 $388.85 $14.10 $654.30 N/A N/A $384.96 $14.10 $738.81 $14.10 $388.85 $981.46 $427.73 $824.42 $956.59 $16.92 $14.10 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $14.10 $388.85 $466.62 $19.74 "$1,046.89 " $14.10 $14.10 $16.92 $544.39 $14.10 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $14.10 $981.46 $28.90 $14.10 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $30.10 $408.29 $388.85 $30.10 $14.10 $14.10 $291.64 $291.64 $291.64 $14.10 "$2,216.43 " 330104 81511 386 300 HC FETAL CONGENITAL ABNOR ASSAY FOUR ANAL O $606.69 $153.50 $153.50 $42.87 $303.35 N/A N/A N/A $42.87 $291.65 $42.87 $153.50 $455.02 $168.85 $382.21 $443.49 $51.44 $42.87 $364.01 $485.35 $521.90 $874.95 $42.87 $153.50 $394.35 $60.02 $485.35 $42.87 $42.87 $51.44 $214.90 $42.87 $153.50 $153.50 $167.32 $485.35 $515.69 $57.87 $455.02 $87.88 $57.87 $303.35 $394.35 $215.67 $215.67 $215.67 $215.67 $184.20 $161.18 $153.50 $184.20 $42.87 $42.87 $115.12 $115.12 $115.12 $42.87 $874.95 330104 81455 2045 300 HC TARGETED GENOMIC SEQ ANALYS O "$10,630.45 " "$2,919.60 " "$2,919.60 " N/A "$5,315.23 " N/A N/A N/A N/A "$5,547.24 " N/A "$2,919.60 " "$7,972.84 " "$3,211.56 " "$6,697.18 " "$7,770.86 " N/A N/A "$6,378.27 " "$8,504.36 " "$9,926.64 " "$16,641.72 " N/A "$2,919.60 " "$6,909.79 " N/A "$8,504.36 " N/A N/A N/A "$4,087.44 " N/A "$2,919.60 " "$2,919.60 " "$3,182.36 " "$8,504.36 " "$9,035.88 " N/A "$7,972.84 " N/A N/A "$5,315.23 " "$6,909.79 " "$4,102.04 " "$4,102.04 " "$4,102.04 " "$4,102.04 " "$3,503.52 " "$3,065.58 " "$2,919.60 " "$3,503.52 " N/A N/A "$2,189.70 " "$2,189.70 " "$2,189.70 " "$2,189.70 " "$16,641.72 " 330104 87209 396 300 HC SMEAR COMPLEX STAIN O $283.55 $17.98 $17.98 $5.85 $141.78 N/A N/A N/A $5.85 $34.16 $5.85 $17.98 $212.66 $19.78 $178.64 $207.28 $7.02 $5.85 $170.13 $226.84 $61.13 $102.49 $5.85 $17.98 $184.31 $8.19 $226.84 $5.85 $5.85 $7.02 $25.17 $5.85 $17.98 $17.98 $19.60 $226.84 $241.02 $7.90 $212.66 $11.99 $7.90 $141.78 $184.31 $25.26 $25.26 $25.26 $25.26 $30.35 $18.88 $17.98 $30.35 $5.85 $5.85 $13.48 $13.48 $13.48 $5.85 $241.02 330104 87210 396 300 HC SMEAR WET MOUNT SALINE/INK O $151.94 $5.82 $5.82 $3.40 $75.97 N/A N/A N/A $3.40 $11.06 $3.40 $5.82 $113.95 $6.40 $95.72 $111.07 $4.08 $3.40 $91.16 $121.55 $19.79 $33.17 $3.40 $5.82 $98.76 $4.76 $121.55 $3.40 $3.40 $4.08 $8.15 $3.40 $5.82 $5.82 $6.34 $121.55 $129.15 $4.59 $113.95 $6.97 $4.59 $75.97 $98.76 $8.18 $8.18 $8.18 $8.18 $7.21 $6.11 $5.82 $7.21 $3.40 $3.40 $4.37 $4.37 $4.37 $3.40 $129.15 330104 87301 396 300 HC IAAD IA ADENOVIRUS ENTERIC TYP 40/41 O $185.11 $11.98 $11.98 $8.03 $92.56 N/A N/A N/A $8.03 $22.76 $8.03 $11.98 $138.83 $13.18 $116.62 $135.32 $9.64 $8.03 $111.07 $148.09 $40.73 $68.29 $8.03 $11.98 $120.32 $11.24 $148.09 $8.03 $8.03 $9.64 $16.77 $8.03 $11.98 $11.98 $13.06 $148.09 $157.34 $10.84 $138.83 $16.46 $10.84 $92.56 $120.32 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $8.03 $8.03 $8.98 $8.98 $8.98 $8.03 $157.34 330104 87498 397 300 HC ENTEROVIRUS PROBE&REVRS TRNS O $359.52 $35.09 $35.09 $21.43 $179.76 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $269.64 $38.60 $226.50 $262.81 $25.72 $21.43 $215.71 $287.62 $119.31 $200.01 $21.43 $35.09 $233.69 $30.00 $287.62 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $287.62 $305.59 $28.93 $269.64 $43.93 $28.93 $179.76 $233.69 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $305.59 330104 87502 388 300 HC INFLUENZA DNA AMP PROBE O $909.50 $95.80 $95.80 $53.45 $454.75 N/A N/A N/A $53.45 $182.02 $53.45 $95.80 $682.12 $105.38 $572.99 $664.84 $64.14 $53.45 $545.70 $727.60 $325.72 $546.06 $53.45 $95.80 $591.18 $74.83 $727.60 $53.45 $53.45 $64.14 $134.12 $53.45 $95.80 $95.80 $104.42 $727.60 $773.07 $72.16 $682.12 $109.57 $72.16 $454.75 $591.18 $134.60 $134.60 $134.60 $134.60 $143.70 $100.59 $95.80 $143.70 $53.45 $53.45 $71.85 $71.85 $71.85 $53.45 $773.07 330104 87503 397 300 HC INFLUENZA DNA AMP PROB ADDL O $218.28 $29.22 $29.22 $21.43 $109.14 N/A N/A N/A $21.43 $55.52 $21.43 $29.22 $163.71 $32.14 $137.52 $159.56 $25.72 $21.43 $130.97 $174.62 $99.35 $166.55 $21.43 $29.22 $141.88 $30.00 $174.62 $21.43 $21.43 $25.72 $40.91 $21.43 $29.22 $29.22 $31.85 $174.62 $185.54 $28.93 $163.71 $43.93 $28.93 $109.14 $141.88 $41.05 $41.05 $41.05 $41.05 $35.06 $30.68 $29.22 $35.06 $21.43 $21.43 $21.91 $21.91 $21.91 $21.43 $185.54 330104 87532 397 300 HC HHV-6 DNA AMP PROBE O $704.06 $35.09 $35.09 N/A $352.03 N/A N/A N/A N/A $66.67 N/A $35.09 $528.04 $38.60 $443.56 $514.67 N/A N/A $422.44 $563.25 $119.31 $200.01 N/A $35.09 $457.64 N/A $563.25 N/A N/A N/A $49.13 N/A $35.09 $35.09 $38.25 $563.25 $598.45 N/A $528.04 N/A N/A $352.03 $457.64 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 N/A N/A $26.32 $26.32 $26.32 $26.32 $598.45 330104 87593 397 300 HC IADNA ORTHOPOXVIRUS AMPLIFIED PROBE TECHNIQUE EA O $95.23 N/A N/A $51.31 $47.62 N/A N/A N/A $51.31 N/A $51.31 N/A $71.42 N/A $59.99 $69.61 $61.57 $51.31 $57.14 $76.18 N/A N/A $51.31 N/A $61.90 $71.83 $76.18 $51.31 $51.31 $61.57 N/A $51.31 N/A N/A N/A $76.18 $80.95 $69.27 $71.42 $105.19 $69.27 $47.62 $61.90 N/A N/A N/A N/A N/A N/A N/A $63.52 $51.31 $51.31 N/A N/A N/A $47.62 $105.19 330104 87633 388 300 HC RESP VIRUS 12-25 TARGETS O "$1,820.07 " $416.78 $416.78 $61.77 $910.03 N/A N/A N/A $61.77 $791.88 $61.77 $416.78 "$1,365.05 " $458.46 "$1,146.64 " "$1,330.47 " $74.12 $61.77 "$1,092.04 " "$1,456.06 " "$1,417.05 " "$2,375.65 " $61.77 $416.78 "$1,183.05 " $86.47 "$1,456.06 " $61.77 $61.77 $74.12 $583.49 $61.77 $416.78 $416.78 $454.29 "$1,456.06 " "$1,547.06 " $83.38 "$1,365.05 " $126.62 $83.38 $910.03 "$1,183.05 " $585.58 $585.58 $585.58 $585.58 $687.49 $437.62 $416.78 $687.49 $61.77 $61.77 $312.58 $312.58 $312.58 $61.77 "$2,375.65 " 330104 86901 5732 486 300 HC BLOOD TYPING RH (D) O $155.15 $40.74 $40.74 $2.99 $77.58 N/A N/A $40.34 $2.99 $77.41 $2.99 $40.74 $116.36 $44.82 $97.74 $113.41 $3.59 $2.99 $93.09 $124.12 $138.53 $232.24 $2.99 $40.74 $48.89 $4.19 $124.12 $2.99 $2.99 $3.59 $57.04 $2.99 $40.74 $40.74 $44.41 $124.12 $131.88 $2.99 $116.36 $6.13 $2.99 $77.58 $109.60 $57.24 $57.24 $57.24 $57.24 $5.04 $42.78 $40.74 $5.04 $2.99 $2.99 $30.56 $30.56 $30.56 $2.99 $232.24 330104 89051 390 300 HC BODY FLUID CELL COUNT O $54.57 $5.60 $5.60 $2.80 $27.29 N/A N/A N/A $2.80 $10.64 $2.80 $5.60 $40.93 $6.16 $34.38 $39.89 $3.36 $2.80 $32.74 $43.66 $19.04 $31.92 $2.80 $5.60 $35.47 $3.92 $43.66 $2.80 $2.80 $3.36 $7.84 $2.80 $5.60 $5.60 $6.10 $43.66 $46.38 $3.78 $40.93 $5.74 $3.78 $27.29 $35.47 $7.87 $7.87 $7.87 $7.87 $9.30 $5.88 $5.60 $9.30 $2.80 $2.80 $4.20 $4.20 $4.20 $2.80 $46.38 330104 89310 390 300 HC SPERM PRESENCE/MOTILITY O $142.31 $8.61 $8.61 N/A $71.16 N/A N/A N/A N/A $16.36 N/A $8.61 $106.73 $9.47 $89.66 $104.03 N/A N/A $85.39 $113.85 $29.27 $49.08 N/A $8.61 $92.50 N/A $113.85 N/A N/A N/A $12.05 N/A $8.61 $8.61 $9.38 $113.85 $120.96 N/A $106.73 N/A N/A $71.16 $92.50 $12.10 $12.10 $12.10 $12.10 $14.53 $9.04 $8.61 $14.53 N/A N/A $6.46 $6.46 $6.46 $6.46 $120.96 330104 89320 390 300 HC SEMEN ANAL VOL/COUNT/MOT O $306.02 $12.31 $12.31 N/A $153.01 N/A N/A N/A N/A $23.39 N/A $12.31 $229.51 $13.54 $192.79 $223.70 N/A N/A $183.61 $244.82 $41.85 $70.17 N/A $12.31 $198.91 N/A $244.82 N/A N/A N/A $17.23 N/A $12.31 $12.31 $13.42 $244.82 $260.12 N/A $229.51 N/A N/A $153.01 $198.91 $17.30 $17.30 $17.30 $17.30 $20.35 $12.93 $12.31 $20.35 N/A N/A $9.23 $9.23 $9.23 $9.23 $260.12 330104 99437 260 300 HC CHRONIC CARE MGMT SVC PHYS EA ADDL 30 MIN CAL MNTH O $258.94 N/A N/A N/A $129.47 $73.13 $66.11 $57.92 N/A N/A N/A N/A $194.20 N/A $163.13 $189.29 N/A N/A $155.36 $207.15 N/A N/A N/A N/A $168.31 N/A $207.15 N/A N/A N/A N/A N/A N/A N/A N/A $207.15 $220.10 N/A $194.20 N/A N/A $129.47 $168.31 N/A N/A N/A N/A N/A N/A N/A $172.71 N/A N/A N/A N/A N/A $57.92 $220.10 330104 86200 394 300 HC CCP ANTIBODY O $207.58 $12.95 $12.95 N/A $103.79 N/A N/A N/A N/A $24.60 N/A $12.95 $155.69 $14.25 $130.78 $151.74 N/A N/A $124.55 $166.06 $44.03 $73.81 N/A $12.95 $134.93 N/A $166.06 N/A N/A N/A $18.13 N/A $12.95 $12.95 $14.12 $166.06 $176.44 N/A $155.69 N/A N/A $103.79 $134.93 $18.19 $18.19 $18.19 $18.19 $21.86 $13.60 $12.95 $21.86 N/A N/A $9.71 $9.71 $9.71 $9.71 $176.44 330104 86580 5731 394 300 HC TB INTRADERMAL TEST O $20.33 $29.95 $29.95 $5.00 $10.16 $15.87 $14.34 $29.65 $5.00 $56.90 $5.00 $29.95 $15.25 $32.94 $12.81 $14.86 $6.00 $5.00 $12.20 $16.26 $101.81 $170.69 $5.00 $29.95 $35.93 $7.00 $16.26 $5.00 $5.00 $6.00 $41.92 $5.00 $29.95 $29.95 $32.64 $16.26 $17.28 $5.00 $15.25 $10.25 $5.00 $10.16 $80.55 $42.07 $42.07 $42.07 $42.07 $6.68 $31.44 $29.95 $6.68 $5.00 $5.00 $22.46 $22.46 $22.46 $5.00 $170.69 330104 87207 396 300 HC SMEAR SPECIAL STAIN O $276.06 $5.99 $5.99 $5.99 $138.03 N/A N/A N/A $5.99 $11.38 $5.99 $5.99 $207.05 $6.59 $173.92 $201.80 $7.19 $5.99 $165.64 $220.85 $20.37 $34.14 $5.99 $5.99 $179.44 $8.39 $220.85 $5.99 $5.99 $7.19 $8.39 $5.99 $5.99 $5.99 $6.53 $220.85 $234.65 $8.09 $207.05 $12.28 $8.09 $138.03 $179.44 $8.42 $8.42 $8.42 $8.42 $10.13 $6.29 $5.99 $10.13 $5.99 $5.99 $4.49 $4.49 $4.49 $4.49 $234.65 330104 86355 395 300 HC B CELLS TOTAL COUNT O $590.64 $37.73 $37.73 $23.17 $295.32 N/A N/A N/A $23.17 $71.69 $23.17 $37.73 $442.98 $41.50 $372.10 $431.76 $27.80 $23.17 $354.38 $472.51 $128.28 $215.06 $23.17 $37.73 $383.92 $32.44 $472.51 $23.17 $23.17 $27.80 $52.82 $23.17 $37.73 $37.73 $41.13 $472.51 $502.04 $31.28 $442.98 $47.50 $31.28 $295.32 $383.92 $53.01 $53.01 $53.01 $53.01 $63.70 $39.62 $37.73 $63.70 $23.17 $23.17 $28.30 $28.30 $28.30 $23.17 $502.04 330104 86357 395 300 HC NK CELLS TOTAL COUNT O $400.18 $37.73 $37.73 $23.17 $200.09 N/A N/A N/A $23.17 $71.69 $23.17 $37.73 $300.13 $41.50 $252.11 $292.53 $27.80 $23.17 $240.11 $320.14 $128.28 $215.06 $23.17 $37.73 $260.12 $32.44 $320.14 $23.17 $23.17 $27.80 $52.82 $23.17 $37.73 $37.73 $41.13 $320.14 $340.15 $31.28 $300.13 $47.50 $31.28 $200.09 $260.12 $53.01 $53.01 $53.01 $53.01 $63.70 $39.62 $37.73 $63.70 $23.17 $23.17 $28.30 $28.30 $28.30 $23.17 $340.15 330104 80335 2040 300 HC NORTRIPYLINE- O $311.37 $114.43 $114.43 $5.00 $155.69 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $233.53 $125.87 $196.16 $227.61 $6.00 $5.00 $186.82 $249.10 $389.06 $652.25 $5.00 $114.43 $202.39 $7.00 $249.10 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $249.10 $264.66 $6.75 $233.53 $10.25 $6.75 $155.69 $202.39 $160.77 $160.77 $160.77 $160.77 $29.23 $120.15 $114.43 $29.23 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 80320 2041 300 HC ALCOHOL ETHYL- O $208.65 $114.43 $114.43 $5.00 $104.33 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $156.49 $125.87 $131.45 $152.52 $6.00 $5.00 $125.19 $166.92 $389.06 $652.25 $5.00 $114.43 $135.62 $7.00 $166.92 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $166.92 $177.35 $6.75 $156.49 $10.25 $6.75 $104.33 $135.62 $160.77 $160.77 $160.77 $160.77 $28.22 $120.15 $114.43 $28.22 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 89060 390 300 HC EXAM SYNOVIAL FLUID CRYSTALS O $208.65 $7.33 $7.33 $6.00 $104.33 N/A N/A N/A $6.00 $13.93 $6.00 $7.33 $156.49 $8.06 $131.45 $152.52 $7.20 $6.00 $125.19 $166.92 $24.92 $41.78 $6.00 $7.33 $135.62 $8.40 $166.92 $6.00 $6.00 $7.20 $10.26 $6.00 $7.33 $7.33 $7.99 $166.92 $177.35 $8.10 $156.49 $12.30 $8.10 $104.33 $135.62 $10.30 $10.30 $10.30 $10.30 $12.07 $7.70 $7.33 $12.07 $6.00 $6.00 $5.50 $5.50 $5.50 $5.50 $177.35 330104 86900 5734 486 300 HC BLOOD TYPING ABO O "$1,395.28 " $139.30 $139.30 $2.99 $697.64 N/A N/A $137.91 $2.99 $264.67 $2.99 $139.30 "$1,046.46 " $153.23 $879.03 "$1,019.95 " $3.59 $2.99 $837.17 "$1,116.22 " $473.63 $794.02 $2.99 $139.30 $167.16 $4.19 "$1,116.22 " $2.99 $2.99 $3.59 $195.02 $2.99 $139.30 $139.30 $151.84 "$1,116.22 " "$1,185.99 " $2.99 "$1,046.46 " $6.13 $2.99 $697.64 $374.72 $195.72 $195.72 $195.72 $195.72 $5.04 $146.27 $139.30 $5.04 $2.99 $2.99 $104.48 $104.48 $104.48 $2.99 "$1,185.99 " 330104 86921 5672 2043 300 HC COMPATIBILITY TESTINCUB TECH O $800.36 $188.66 $188.66 N/A $400.18 N/A N/A $186.77 N/A $358.45 N/A $188.66 $600.27 $207.53 $504.23 $585.06 N/A N/A $480.22 $640.29 $641.44 "$1,075.36 " N/A $188.66 $226.39 N/A $640.29 N/A N/A N/A $264.12 N/A $188.66 $188.66 $205.64 $640.29 $680.31 N/A $600.27 N/A N/A $400.18 $507.49 $265.07 $265.07 $265.07 $265.07 $17.92 $198.09 $188.66 $17.92 N/A N/A $141.49 $141.49 $141.49 $17.92 "$1,075.36 " 330104 86860 5672 2043 300 HC RBC ANTIBODY ELUTION O "$1,357.83 " $188.66 $188.66 $11.70 $678.91 N/A N/A $186.77 $11.70 $358.45 $11.70 $188.66 "$1,018.37 " $207.53 $855.43 $992.57 $14.04 $11.70 $814.70 "$1,086.26 " $641.44 "$1,075.36 " $11.70 $188.66 $226.39 $16.38 "$1,086.26 " $11.70 $11.70 $14.04 $264.12 $11.70 $188.66 $188.66 $205.64 "$1,086.26 " "$1,154.16 " $11.70 "$1,018.37 " $23.98 $11.70 $678.91 $507.49 $265.07 $265.07 $265.07 $265.07 $30.10 $198.09 $188.66 $30.10 $11.70 $11.70 $141.49 $141.49 $141.49 $11.70 "$1,154.16 " 330104 82017 400 300 HC ACYLCARNITINES QUANT O $227.91 $16.87 $16.87 $16.87 $113.95 N/A N/A N/A $16.87 $32.05 $16.87 $16.87 $170.93 $18.56 $143.58 $166.60 $20.24 $16.87 $136.75 $182.33 $57.36 $96.16 $16.87 $16.87 $148.14 $23.62 $182.33 $16.87 $16.87 $20.24 $23.62 $16.87 $16.87 $16.87 $18.39 $182.33 $193.72 $22.77 $170.93 $34.58 $22.77 $113.95 $148.14 $23.70 $23.70 $23.70 $23.70 $28.49 $17.71 $16.87 $28.49 $16.87 $16.87 $12.65 $12.65 $12.65 $12.65 $193.72 330104 82270 402 300 HC OCCULT BLOOD FECES O $121.98 $4.38 $4.38 $3.40 $60.99 N/A N/A N/A $3.40 $8.32 $3.40 $4.38 $91.48 $4.82 $76.85 $89.17 $4.08 $3.40 $73.19 $97.58 $14.89 $24.97 $3.40 $4.38 $79.29 $4.76 $97.58 $3.40 $3.40 $4.08 $6.13 $3.40 $4.38 $4.38 $4.77 $97.58 $103.68 $4.59 $91.48 $6.97 $4.59 $60.99 $79.29 $6.15 $6.15 $6.15 $6.15 $5.50 $4.60 $4.38 $5.50 $3.40 $3.40 $3.29 $3.29 $3.29 $3.29 $103.68 330104 82803 401 300 HC BLOOD GASES ANY COMBINATION O $836.74 $26.07 $26.07 $16.20 $418.37 N/A N/A N/A $16.20 $49.53 $16.20 $26.07 $627.56 $28.68 $527.15 $611.66 $19.44 $16.20 $502.04 $669.39 $88.64 $148.60 $16.20 $26.07 $543.88 $22.68 $669.39 $16.20 $16.20 $19.44 $36.50 $16.20 $26.07 $26.07 $28.42 $669.39 $711.23 $21.87 $627.56 $33.21 $21.87 $418.37 $543.88 $36.63 $36.63 $36.63 $36.63 $32.66 $27.37 $26.07 $32.66 $16.20 $16.20 $19.55 $19.55 $19.55 $16.20 $711.23 330104 82950 402 300 HC GLUCOSE TEST O $162.64 $4.75 $4.75 $4.75 $81.32 N/A N/A N/A $4.75 $9.03 $4.75 $4.75 $121.98 $5.23 $102.46 $118.89 $5.70 $4.75 $97.58 $130.11 $16.15 $27.07 $4.75 $4.75 $105.72 $6.65 $130.11 $4.75 $4.75 $5.70 $6.65 $4.75 $4.75 $4.75 $5.18 $130.11 $138.24 $6.41 $121.98 $9.74 $6.41 $81.32 $105.72 $6.67 $6.67 $6.67 $6.67 $8.02 $4.99 $4.75 $8.02 $4.75 $4.75 $3.56 $3.56 $3.56 $3.56 $138.24 330104 84081 400 300 HC PHOSPHATI DYLGLYCEROL AMN O $262.15 $16.52 $16.52 $7.97 $131.07 N/A N/A N/A $7.97 $31.39 $7.97 $16.52 $196.61 $18.17 $165.15 $191.63 $9.56 $7.97 $157.29 $209.72 $56.17 $94.16 $7.97 $16.52 $170.40 $11.16 $209.72 $7.97 $7.97 $9.56 $23.13 $7.97 $16.52 $16.52 $18.01 $209.72 $222.83 $10.76 $196.61 $16.34 $10.76 $131.07 $170.40 $23.21 $23.21 $23.21 $23.21 $27.90 $17.35 $16.52 $27.90 $7.97 $7.97 $12.39 $12.39 $12.39 $7.97 $222.83 330104 85046 408 300 HC RETICULOCYTE COUNT AUTO W CELL PARAM O $58.15 $5.57 $5.57 $1.43 $29.08 N/A N/A N/A $1.43 $10.58 $1.43 $5.57 $43.62 $6.13 $36.64 $42.51 $1.72 $1.43 $34.89 $46.52 $18.94 $31.75 $1.43 $5.57 $37.80 $2.00 $46.52 $1.43 $1.43 $1.72 $7.80 $1.43 $5.57 $5.57 $6.07 $46.52 $49.43 $1.93 $43.62 $2.93 $1.93 $29.08 $37.80 $7.83 $7.83 $7.83 $7.83 $9.42 $5.85 $5.57 $9.42 $1.43 $1.43 $4.18 $4.18 $4.18 $1.43 $49.43 330104 85347 406 300 HC COAGULATION TIME ACTIVATED O $129.47 $4.28 $4.28 $4.28 $64.73 N/A N/A N/A $4.28 $8.13 $4.28 $4.28 $97.10 $4.71 $81.57 $94.64 $5.14 $4.28 $77.68 $103.58 $14.55 $24.40 $4.28 $4.28 $84.16 $5.99 $103.58 $4.28 $4.28 $5.14 $5.99 $4.28 $4.28 $4.28 $4.67 $103.58 $110.05 $5.78 $97.10 $8.77 $5.78 $64.73 $84.16 $6.01 $6.01 $6.01 $6.01 $7.19 $4.49 $4.28 $7.19 $4.28 $4.28 $3.21 $3.21 $3.21 $3.21 $110.05 330104 85420 406 300 HC FIBRINOLYTIC PLASMINOGEN O $103.79 $6.53 $6.53 N/A $51.90 N/A N/A N/A N/A $12.41 N/A $6.53 $77.84 $7.18 $65.39 $75.87 N/A N/A $62.27 $83.03 $22.20 $37.22 N/A $6.53 $67.46 N/A $83.03 N/A N/A N/A $9.14 N/A $6.53 $6.53 $7.12 $83.03 $88.22 N/A $77.84 N/A N/A $51.90 $67.46 $9.17 $9.17 $9.17 $9.17 $11.04 $6.86 $6.53 $11.04 N/A N/A $4.90 $4.90 $4.90 $4.90 $88.22 330104 86880 5733 486 300 HC COOMBS TEST DIRECT O $358.45 $68.96 $68.96 $4.69 $179.22 N/A N/A $68.27 $4.69 $131.03 $4.69 $68.96 $268.84 $75.86 $225.82 $262.03 $5.63 $4.69 $215.07 $286.76 $234.47 $393.08 $4.69 $68.96 $82.75 $6.57 $286.76 $4.69 $4.69 $5.63 $96.55 $4.69 $68.96 $68.96 $75.17 $286.76 $304.68 $4.69 $268.84 $9.61 $4.69 $179.22 $185.51 $96.89 $96.89 $96.89 $96.89 $9.07 $72.41 $68.96 $9.07 $4.69 $4.69 $51.72 $51.72 $51.72 $4.69 $393.08 330104 86359 395 300 HC T CELLS TOTAL COUNT O $590.64 $37.73 $37.73 $23.17 $295.32 N/A N/A N/A $23.17 $71.69 $23.17 $37.73 $442.98 $41.50 $372.10 $431.76 $27.80 $23.17 $354.38 $472.51 $128.28 $215.06 $23.17 $37.73 $383.92 $32.44 $472.51 $23.17 $23.17 $27.80 $52.82 $23.17 $37.73 $37.73 $41.13 $472.51 $502.04 $31.28 $442.98 $47.50 $31.28 $295.32 $383.92 $53.01 $53.01 $53.01 $53.01 $63.70 $39.62 $37.73 $63.70 $23.17 $23.17 $28.30 $28.30 $28.30 $23.17 $502.04 330104 86361 395 300 HC T CELL ABSOLUTE COUNT O $739.37 $26.78 $26.78 $23.17 $369.69 N/A N/A N/A $23.17 $50.88 $23.17 $26.78 $554.53 $29.46 $465.80 $540.48 $27.80 $23.17 $443.62 $591.50 $91.05 $152.65 $23.17 $26.78 $480.59 $32.44 $591.50 $23.17 $23.17 $27.80 $37.49 $23.17 $26.78 $26.78 $29.19 $591.50 $628.46 $31.28 $554.53 $47.50 $31.28 $369.69 $480.59 $37.63 $37.63 $37.63 $37.63 $45.20 $28.12 $26.78 $45.20 $23.17 $23.17 $20.09 $20.09 $20.09 $20.09 $628.46 330104 86341 394 300 HC ISLET CELL ANTIBODY O $311.37 $23.57 $23.57 $12.50 $155.69 N/A N/A N/A $12.50 $44.78 $12.50 $23.57 $233.53 $25.93 $196.16 $227.61 $15.00 $12.50 $186.82 $249.10 $80.14 $134.35 $12.50 $23.57 $202.39 $17.50 $249.10 $12.50 $12.50 $15.00 $33.00 $12.50 $23.57 $23.57 $25.69 $249.10 $264.66 $16.88 $233.53 $25.62 $16.88 $155.69 $202.39 $33.12 $33.12 $33.12 $33.12 $33.42 $24.75 $23.57 $33.42 $12.50 $12.50 $17.68 $17.68 $17.68 $12.50 $264.66 330104 86480 395 300 HC TB TEST CELL IMMUN MEASURE O $817.48 $61.98 $61.98 $50.00 $408.74 N/A N/A N/A $50.00 $117.76 $50.00 $61.98 $613.11 $68.18 $515.01 $597.58 $60.00 $50.00 $490.49 $653.98 $210.73 $353.29 $50.00 $61.98 $531.36 $70.00 $653.98 $50.00 $50.00 $60.00 $86.77 $50.00 $61.98 $61.98 $67.56 $653.98 $694.86 $67.50 $613.11 $102.50 $67.50 $408.74 $531.36 $87.08 $87.08 $87.08 $87.08 $104.66 $65.08 $61.98 $104.66 $50.00 $50.00 $46.48 $46.48 $46.48 $46.48 $694.86 330104 86850 5671 486 300 HC RBC ANTIBODY SCREEN O $348.82 $60.15 $60.15 $5.55 $174.41 N/A N/A $59.55 $5.55 $114.29 $5.55 $60.15 $261.62 $66.17 $219.76 $254.99 $6.66 $5.55 $209.29 $279.06 $204.53 $342.88 $5.55 $60.15 $72.19 $7.77 $279.06 $5.55 $5.55 $6.66 $84.22 $5.55 $60.15 $60.15 $65.57 $279.06 $296.50 $5.55 $261.62 $11.38 $5.55 $174.41 $161.82 $84.52 $84.52 $84.52 $84.52 $17.92 $63.16 $60.15 $17.92 $5.55 $5.55 $45.12 $45.12 $45.12 $5.55 $342.88 330104 86403 394 300 HC PARTICLE AGGLUT ANTBDY SCRN O $121.98 $11.54 $11.54 $3.75 $60.99 N/A N/A N/A $3.75 $21.93 $3.75 $11.54 $91.48 $12.69 $76.85 $89.17 $4.50 $3.75 $73.19 $97.58 $39.24 $65.78 $3.75 $11.54 $79.29 $5.25 $97.58 $3.75 $3.75 $4.50 $16.16 $3.75 $11.54 $11.54 $12.58 $97.58 $103.68 $5.06 $91.48 $7.69 $5.06 $60.99 $79.29 $16.21 $16.21 $16.21 $16.21 $17.21 $12.12 $11.54 $17.21 $3.75 $3.75 $8.65 $8.65 $8.65 $3.75 $103.68 330104 86702 394 300 HC HIV-2 ANTIBODY O $218.28 $13.52 $13.52 $13.52 $109.14 N/A N/A N/A $13.52 $25.69 $13.52 $13.52 $163.71 $14.87 $137.52 $159.56 $16.22 $13.52 $130.97 $174.62 $45.97 $77.06 $13.52 $13.52 $141.88 $18.93 $174.62 $13.52 $13.52 $16.22 $18.93 $13.52 $13.52 $13.52 $14.74 $174.62 $185.54 $18.25 $163.71 $27.72 $18.25 $109.14 $141.88 $19.00 $19.00 $19.00 $19.00 $22.84 $14.20 $13.52 $22.84 $13.52 $13.52 $10.14 $10.14 $10.14 $10.14 $185.54 330104 86701 394 300 HC HIV-1ANTIBODY O $372.36 $8.89 $8.89 $8.89 $186.18 N/A N/A N/A $8.89 $16.89 $8.89 $8.89 $279.27 $9.78 $234.59 $272.20 $10.67 $8.89 $223.42 $297.89 $30.23 $50.67 $8.89 $8.89 $242.03 $12.45 $297.89 $8.89 $8.89 $10.67 $12.45 $8.89 $8.89 $8.89 $9.69 $297.89 $316.51 $12.00 $279.27 $18.22 $12.00 $186.18 $242.03 $12.49 $12.49 $12.49 $12.49 $15.00 $9.33 $8.89 $15.00 $8.89 $8.89 $6.67 $6.67 $6.67 $6.67 $316.51 330104 86696 394 300 HC HERPES SIMPLEX TYPE 2 TEST O $613.11 $19.35 $19.35 $14.50 $306.56 N/A N/A N/A $14.50 $36.77 $14.50 $19.35 $459.83 $21.29 $386.26 $448.18 $17.40 $14.50 $367.87 $490.49 $65.79 $110.30 $14.50 $19.35 $398.52 $20.30 $490.49 $14.50 $14.50 $17.40 $27.09 $14.50 $19.35 $19.35 $21.09 $490.49 $521.14 $19.58 $459.83 $29.72 $19.58 $306.56 $398.52 $27.19 $27.19 $27.19 $27.19 $32.68 $20.32 $19.35 $32.68 $14.50 $14.50 $14.51 $14.51 $14.51 $14.50 $521.14 330104 86769 394 300 HC ANTIBODY; SEVERE ACUTE RESP SYND CORONA 2 (SARS-COV-2) ( COVID-19) O $174.41 $42.13 $42.13 $42.13 $87.20 N/A N/A N/A $42.13 $80.05 $42.13 $42.13 $130.81 $46.34 $109.88 $127.49 $50.56 $42.13 $104.65 $139.53 $143.24 $240.14 $42.13 $42.13 $113.37 $58.98 $139.53 $42.13 $42.13 $50.56 $58.98 $42.13 $42.13 $42.13 $45.92 $139.53 $148.25 $56.88 $130.81 $86.37 $56.88 $87.20 $113.37 $59.19 $59.19 $59.19 $59.19 N/A $44.24 $42.13 $116.33 $42.13 $42.13 $31.60 $31.60 $31.60 $31.60 $240.14 330104 86658 394 300 HC ENTEROVIRUS ANTIBODY O $716.90 $13.03 $13.03 $8.03 $358.45 N/A N/A N/A $8.03 $24.76 $8.03 $13.03 $537.67 $14.33 $451.65 $524.05 $9.64 $8.03 $430.14 $573.52 $44.30 $74.27 $8.03 $13.03 $465.99 $11.24 $573.52 $8.03 $8.03 $9.64 $18.24 $8.03 $13.03 $13.03 $14.20 $573.52 $609.37 $10.84 $537.67 $16.46 $10.84 $358.45 $465.99 $18.31 $18.31 $18.31 $18.31 $22.01 $13.68 $13.03 $22.01 $8.03 $8.03 $9.77 $9.77 $9.77 $8.03 $609.37 330104 86602 394 300 HC ANTINOMYCES ANTIBODY O $277.13 $10.18 $10.18 $8.03 $138.56 N/A N/A N/A $8.03 $19.34 $8.03 $10.18 $207.85 $11.20 $174.59 $202.58 $9.64 $8.03 $166.28 $221.70 $34.61 $58.03 $8.03 $10.18 $180.13 $11.24 $221.70 $8.03 $8.03 $9.64 $14.25 $8.03 $10.18 $10.18 $11.10 $221.70 $235.56 $10.84 $207.85 $16.46 $10.84 $138.56 $180.13 $14.30 $14.30 $14.30 $14.30 $17.18 $10.69 $10.18 $17.18 $8.03 $8.03 $7.63 $7.63 $7.63 $7.63 $235.56 330104 86593 394 300 HC SYPHILIS TEST NON-TREP QUANT O $237.54 $4.40 $4.40 $3.70 $118.77 N/A N/A N/A $3.70 $8.36 $3.70 $4.40 $178.16 $4.84 $149.65 $173.64 $4.44 $3.70 $142.52 $190.03 $14.96 $25.08 $3.70 $4.40 $154.40 $5.18 $190.03 $3.70 $3.70 $4.44 $6.16 $3.70 $4.40 $4.40 $4.80 $190.03 $201.91 $5.00 $178.16 $7.58 $5.00 $118.77 $154.40 $6.18 $6.18 $6.18 $6.18 $7.43 $4.62 $4.40 $7.43 $3.70 $3.70 $3.30 $3.30 $3.30 $3.30 $201.91 330104 86592 394 300 HC SYPHILIS TEST NON-TREP QUAL O $151.94 $4.27 $4.27 $3.27 $75.97 N/A N/A N/A $3.27 $8.11 $3.27 $4.27 $113.95 $4.70 $95.72 $111.07 $3.92 $3.27 $91.16 $121.55 $14.52 $24.34 $3.27 $4.27 $98.76 $4.58 $121.55 $3.27 $3.27 $3.92 $5.98 $3.27 $4.27 $4.27 $4.65 $121.55 $129.15 $4.41 $113.95 $6.70 $4.41 $75.97 $98.76 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 $3.27 $3.27 $3.20 $3.20 $3.20 $3.20 $129.15 330104 86682 394 300 HC HELMINTH NOT ELSEWHERE SPECIFIED O $121.98 $13.01 $13.01 N/A $60.99 N/A N/A N/A N/A $24.72 N/A $13.01 $91.48 $14.31 $76.85 $89.17 N/A N/A $73.19 $97.58 $44.23 $74.16 N/A $13.01 $79.29 N/A $97.58 N/A N/A N/A $18.21 N/A $13.01 $13.01 $14.18 $97.58 $103.68 N/A $91.48 N/A N/A $60.99 $79.29 $18.28 $18.28 $18.28 $18.28 $21.97 $13.66 $13.01 $21.97 N/A N/A $9.76 $9.76 $9.76 $9.76 $103.68 330104 80324 2040 300 HC AMPHETAMINES; 1 OR 2 O $245.03 $114.43 $114.43 $5.00 $122.52 N/A N/A N/A $5.00 $217.42 $5.00 $114.43 $183.77 $125.87 $154.37 $179.12 $6.00 $5.00 $147.02 $196.02 $389.06 $652.25 $5.00 $114.43 $159.27 $7.00 $196.02 $5.00 $5.00 $6.00 $160.20 $5.00 $114.43 $114.43 $124.73 $196.02 $208.28 $6.75 $183.77 $10.25 $6.75 $122.52 $159.27 $160.77 $160.77 $160.77 $160.77 $25.38 $120.15 $114.43 $25.38 $5.00 $5.00 $85.82 $85.82 $85.82 $5.00 $652.25 330104 83704 401 301 HC LIPOPROTEIN BLOOD QUAN NUMBERS AND SUBCLASSES O $112.35 $34.19 $34.19 N/A $56.17 N/A N/A N/A N/A $64.96 N/A $34.19 $84.26 $37.61 $70.78 $82.13 N/A N/A $67.41 $89.88 $116.25 $194.88 N/A $34.19 $73.03 N/A $89.88 N/A N/A N/A $47.87 N/A $34.19 $34.19 $37.27 $89.88 $95.50 N/A $84.26 N/A N/A $56.17 $73.03 $48.04 $48.04 $48.04 $48.04 $53.28 $35.90 $34.19 $53.28 N/A N/A $25.64 $25.64 $25.64 $25.64 $194.88 330104 83718 402 301 HC ASSAY OF LIPOPROTEIN O $182.97 $8.19 $8.19 $5.03 $91.48 N/A N/A N/A $5.03 $15.56 $5.03 $8.19 $137.23 $9.01 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $27.85 $46.68 $5.03 $8.19 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $11.47 $5.03 $8.19 $8.19 $8.93 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $11.51 $11.51 $11.51 $11.51 $13.82 $8.60 $8.19 $13.82 $5.03 $5.03 $6.14 $6.14 $6.14 $5.03 $155.52 330104 83721 402 301 HC ASSAY OF BLOOD LIPOPROTEIN O $176.55 $10.50 $10.50 N/A $88.28 N/A N/A N/A N/A $19.95 N/A $10.50 $132.41 $11.55 $111.23 $129.06 N/A N/A $105.93 $141.24 $35.70 $59.85 N/A $10.50 $114.76 N/A $141.24 N/A N/A N/A $14.70 N/A $10.50 $10.50 $11.45 $141.24 $150.07 N/A $132.41 N/A N/A $88.28 $114.76 $14.75 $14.75 $14.75 $14.75 $16.10 $11.03 $10.50 $16.10 N/A N/A $7.88 $7.88 $7.88 $7.88 $150.07 330104 83735 402 301 HC ASSAY OF MAGNESIUM O $182.97 $6.70 $6.70 $5.03 $91.48 N/A N/A N/A $5.03 $12.73 $5.03 $6.70 $137.23 $7.37 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $22.78 $38.19 $5.03 $6.70 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $9.38 $5.03 $6.70 $6.70 $7.30 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $9.41 $9.41 $9.41 $9.41 $11.32 $7.04 $6.70 $11.32 $5.03 $5.03 $5.03 $5.03 $5.03 $5.03 $155.52 330104 83825 404 301 HC ASSAY OF MERCURY O $527.51 $16.26 $16.26 $16.26 $263.75 N/A N/A N/A $16.26 $30.89 $16.26 $16.26 $395.63 $17.89 $332.33 $385.61 $19.51 $16.26 $316.51 $422.01 $55.28 $92.68 $16.26 $16.26 $342.88 $22.76 $422.01 $16.26 $16.26 $19.51 $22.76 $16.26 $16.26 $16.26 $17.72 $422.01 $448.38 $21.95 $395.63 $33.33 $21.95 $263.75 $342.88 $22.85 $22.85 $22.85 $22.85 $27.46 $17.07 $16.26 $27.46 $16.26 $16.26 $12.20 $12.20 $12.20 $12.20 $448.38 330104 83835 398 301 HC ASSAY OF METANEPHRINES O $548.91 $16.94 $16.94 $16.94 $274.45 N/A N/A N/A $16.94 $32.19 $16.94 $16.94 $411.68 $18.63 $345.81 $401.25 $20.33 $16.94 $329.35 $439.13 $57.60 $96.56 $16.94 $16.94 $356.79 $23.72 $439.13 $16.94 $16.94 $20.33 $23.72 $16.94 $16.94 $16.94 $18.46 $439.13 $466.57 $22.87 $411.68 $34.73 $22.87 $274.45 $356.79 $23.80 $23.80 $23.80 $23.80 $28.61 $17.79 $16.94 $28.61 $16.94 $16.94 $12.71 $12.71 $12.71 $12.71 $466.57 330104 82565 402 301 HC ASSAY OF CREATININE O $42.80 $5.12 $5.12 $5.03 $21.40 N/A N/A N/A $5.03 $9.73 $5.03 $5.12 $32.10 $5.63 $26.96 $31.29 $6.04 $5.03 $25.68 $34.24 $17.41 $29.18 $5.03 $5.12 $27.82 $7.04 $34.24 $5.03 $5.03 $6.04 $7.17 $5.03 $5.12 $5.12 $5.58 $34.24 $36.38 $6.79 $32.10 $10.31 $6.79 $21.40 $27.82 $7.19 $7.19 $7.19 $7.19 $8.66 $5.38 $5.12 $8.66 $5.03 $5.03 $3.84 $3.84 $3.84 $3.84 $36.38 330104 83690 402 301 HC ASSAY OF LIPASE O $182.97 $6.89 $6.89 $5.75 $91.48 N/A N/A N/A $5.75 $13.09 $5.75 $6.89 $137.23 $7.58 $115.27 $133.75 $6.90 $5.75 $109.78 $146.38 $23.43 $39.27 $5.75 $6.89 $118.93 $8.05 $146.38 $5.75 $5.75 $6.90 $9.65 $5.75 $6.89 $6.89 $7.51 $146.38 $155.52 $7.76 $137.23 $11.79 $7.76 $91.48 $118.93 $9.68 $9.68 $9.68 $9.68 $11.63 $7.23 $6.89 $11.63 $5.75 $5.75 $5.17 $5.17 $5.17 $5.17 $155.52 330104 82638 400 301 HC ASSAY OF DIBUCAINE NUMBER O $404.46 $12.25 $12.25 N/A $202.23 N/A N/A N/A N/A $23.27 N/A $12.25 $303.34 $13.48 $254.81 $295.66 N/A N/A $242.68 $323.57 $41.65 $69.83 N/A $12.25 $262.90 N/A $323.57 N/A N/A N/A $17.15 N/A $12.25 $12.25 $13.35 $323.57 $343.79 N/A $303.34 N/A N/A $202.23 $262.90 $17.21 $17.21 $17.21 $17.21 $20.68 $12.86 $12.25 $20.68 N/A N/A $9.19 $9.19 $9.19 $9.19 $343.79 330104 82652 401 301 HC VIT D 1 25-DIHYDROXY O $610.97 $38.50 $38.50 N/A $305.49 N/A N/A N/A N/A $73.15 N/A $38.50 $458.23 $42.35 $384.91 $446.62 N/A N/A $366.58 $488.78 $130.90 $219.45 N/A $38.50 $397.13 N/A $488.78 N/A N/A N/A $53.90 N/A $38.50 $38.50 $41.97 $488.78 $519.32 N/A $458.23 N/A N/A $305.49 $397.13 $54.09 $54.09 $54.09 $54.09 $65.02 $40.43 $38.50 $65.02 N/A N/A $28.88 $28.88 $28.88 $28.88 $519.32 330104 82656 400 301 HC PANCREATIC ELASTASE FECAL O $73.83 $11.53 $11.53 $5.20 $36.91 N/A N/A N/A $5.20 $21.91 $5.20 $11.53 $55.37 $12.68 $46.51 $53.97 $6.24 $5.20 $44.30 $59.06 $39.20 $65.72 $5.20 $11.53 $47.99 $7.28 $59.06 $5.20 $5.20 $6.24 $16.14 $5.20 $11.53 $11.53 $12.57 $59.06 $62.76 $7.02 $55.37 $10.66 $7.02 $36.91 $47.99 $16.20 $16.20 $16.20 $16.20 $19.49 $12.11 $11.53 $19.49 $5.20 $5.20 $8.65 $8.65 $8.65 $5.20 $65.72 330104 82668 400 301 HC ASSAY OF ERYTHROPOIETIN O $527.51 $18.79 $18.79 $17.06 $263.75 N/A N/A N/A $17.06 $35.70 $17.06 $18.79 $395.63 $20.67 $332.33 $385.61 $20.47 $17.06 $316.51 $422.01 $63.89 $107.10 $17.06 $18.79 $342.88 $23.88 $422.01 $17.06 $17.06 $20.47 $26.31 $17.06 $18.79 $18.79 $20.48 $422.01 $448.38 $23.03 $395.63 $34.97 $23.03 $263.75 $342.88 $26.40 $26.40 $26.40 $26.40 $31.75 $19.73 $18.79 $31.75 $17.06 $17.06 $14.09 $14.09 $14.09 $14.09 $448.38 330104 82670 398 301 HC ASSAY OF ESTRADIOL O $588.50 $27.94 $27.94 $27.94 $294.25 N/A N/A N/A $27.94 $53.09 $27.94 $27.94 $441.38 $30.73 $370.75 $430.19 $33.53 $27.94 $353.10 $470.80 $95.00 $159.26 $27.94 $27.94 $382.53 $39.12 $470.80 $27.94 $27.94 $33.53 $39.12 $27.94 $27.94 $27.94 $30.45 $470.80 $500.22 $37.72 $441.38 $57.28 $37.72 $294.25 $382.53 $39.26 $39.26 $39.26 $39.26 $47.18 $29.34 $27.94 $47.18 $27.94 $27.94 $20.96 $20.96 $20.96 $20.96 $500.22 330104 82672 398 301 HC ASSAY OF ESTROGEN TOTAL O $572.45 $21.70 $21.70 $21.70 $286.23 N/A N/A N/A $21.70 $41.23 $21.70 $21.70 $429.34 $23.87 $360.64 $418.46 $26.04 $21.70 $343.47 $457.96 $73.78 $123.69 $21.70 $21.70 $372.09 $30.38 $457.96 $21.70 $21.70 $26.04 $30.38 $21.70 $21.70 $21.70 $23.65 $457.96 $486.58 $29.30 $429.34 $44.48 $29.30 $286.23 $372.09 $30.49 $30.49 $30.49 $30.49 $36.64 $22.79 $21.70 $36.64 $21.70 $21.70 $16.27 $16.27 $16.27 $16.27 $486.58 330104 82677 398 301 HC ASSAY OF ESTRIOL O $387.34 $24.18 $24.18 $17.50 $193.67 N/A N/A N/A $17.50 $45.94 $17.50 $24.18 $290.50 $26.60 $244.02 $283.15 $21.00 $17.50 $232.40 $309.87 $82.21 $137.83 $17.50 $24.18 $251.77 $24.50 $309.87 $17.50 $17.50 $21.00 $33.85 $17.50 $24.18 $24.18 $26.36 $309.87 $329.24 $23.62 $290.50 $35.88 $23.62 $193.67 $251.77 $33.97 $33.97 $33.97 $33.97 $40.84 $25.39 $24.18 $40.84 $17.50 $17.50 $18.13 $18.13 $18.13 $17.50 $329.24 330104 82679 398 301 HC ASSAY OF ESTRONE O $535.00 $24.95 $24.95 $24.95 $267.50 N/A N/A N/A $24.95 $47.40 $24.95 $24.95 $401.25 $27.45 $337.05 $391.08 $29.94 $24.95 $321.00 $428.00 $84.83 $142.22 $24.95 $24.95 $347.75 $34.93 $428.00 $24.95 $24.95 $29.94 $34.93 $24.95 $24.95 $24.95 $27.20 $428.00 $454.75 $33.68 $401.25 $51.15 $33.68 $267.50 $347.75 $35.05 $35.05 $35.05 $35.05 $42.14 $26.20 $24.95 $42.14 $24.95 $24.95 $18.71 $18.71 $18.71 $18.71 $454.75 330104 82681 398 301 HC ASSAY DIR MEAS FR ESTRADIOL O $169.06 $27.94 $27.94 $27.94 $84.53 N/A N/A N/A $27.94 $53.09 $27.94 $27.94 $126.80 $30.73 $106.51 $123.58 $33.53 $27.94 $101.44 $135.25 $95.00 $159.26 $27.94 $27.94 $109.89 $39.12 $135.25 $27.94 $27.94 $33.53 $39.12 $27.94 $27.94 $27.94 $30.45 $135.25 $143.70 $37.72 $126.80 $57.28 $37.72 $84.53 $109.89 $39.26 $39.26 $39.26 $39.26 N/A $29.34 $27.94 $112.76 $27.94 $27.94 $20.96 $20.96 $20.96 $20.96 $159.26 330104 82693 404 301 HC ASSAY OF ETHYLENE GLYCOL O $186.18 $14.90 $14.90 N/A $93.09 N/A N/A N/A N/A $28.31 N/A $14.90 $139.63 $16.39 $117.29 $136.10 N/A N/A $111.71 $148.94 $50.66 $84.93 N/A $14.90 $121.02 N/A $148.94 N/A N/A N/A $20.86 N/A $14.90 $14.90 $16.24 $148.94 $158.25 N/A $139.63 N/A N/A $93.09 $121.02 $20.93 $20.93 $20.93 $20.93 $25.15 $15.65 $14.90 $25.15 N/A N/A $11.18 $11.18 $11.18 $11.18 $158.25 330104 82705 402 301 HC FATS/LIPIDS FECES QUAL O $71.69 $5.10 $5.10 $5.10 $35.84 N/A N/A N/A $5.10 $9.69 $5.10 $5.10 $53.77 $5.61 $45.16 $52.41 $6.12 $5.10 $43.01 $57.35 $17.34 $29.07 $5.10 $5.10 $46.60 $7.14 $57.35 $5.10 $5.10 $6.12 $7.14 $5.10 $5.10 $5.10 $5.56 $57.35 $60.94 $6.88 $53.77 $10.45 $6.88 $35.84 $46.60 $7.17 $7.17 $7.17 $7.17 $8.59 $5.35 $5.10 $8.59 $5.10 $5.10 $3.82 $3.82 $3.82 $3.82 $60.94 330104 82726 400 301 HC LONG CHAIN FATTY ACIDS O $227.91 $19.75 $19.75 $19.75 $113.95 N/A N/A N/A $19.75 $37.52 $19.75 $19.75 $170.93 $21.73 $143.58 $166.60 $23.70 $19.75 $136.75 $182.33 $67.15 $112.58 $19.75 $19.75 $148.14 $27.65 $182.33 $19.75 $19.75 $23.70 $27.65 $19.75 $19.75 $19.75 $21.53 $182.33 $193.72 $26.66 $170.93 $40.49 $26.66 $113.95 $148.14 $27.75 $27.75 $27.75 $27.75 $30.49 $20.74 $19.75 $30.49 $19.75 $19.75 $14.81 $14.81 $14.81 $14.81 $193.72 330104 82728 400 301 HC ASSAY OF FERRITIN O $340.26 $13.63 $13.63 $13.63 $170.13 N/A N/A N/A $13.63 $25.90 $13.63 $13.63 $255.19 $14.99 $214.36 $248.73 $16.36 $13.63 $204.16 $272.21 $46.34 $77.69 $13.63 $13.63 $221.17 $19.08 $272.21 $13.63 $13.63 $16.36 $19.08 $13.63 $13.63 $13.63 $14.86 $272.21 $289.22 $18.40 $255.19 $27.94 $18.40 $170.13 $221.17 $19.15 $19.15 $19.15 $19.15 $23.00 $14.31 $13.63 $23.00 $13.63 $13.63 $10.22 $10.22 $10.22 $10.22 $289.22 330104 82731 384 301 HC ASSAY OF FETAL FIBRONECTIN O $830.32 $64.41 $64.41 $64.41 $415.16 N/A N/A N/A $64.41 $122.38 $64.41 $64.41 $622.74 $70.85 $523.10 $606.96 $77.29 $64.41 $498.19 $664.26 $218.99 $367.14 $64.41 $64.41 $539.71 $90.17 $664.26 $64.41 $64.41 $77.29 $90.17 $64.41 $64.41 $64.41 $70.21 $664.26 $705.77 $86.95 $622.74 $132.04 $86.95 $415.16 $539.71 $90.50 $90.50 $90.50 $90.50 $108.77 $67.63 $64.41 $108.77 $64.41 $64.41 $48.31 $48.31 $48.31 $48.31 $705.77 330104 82746 400 301 HC ASSAY OF FOLIC ACID SERUM O $306.02 $14.70 $14.70 $12.50 $153.01 N/A N/A N/A $12.50 $27.93 $12.50 $14.70 $229.51 $16.17 $192.79 $223.70 $15.00 $12.50 $183.61 $244.82 $49.98 $83.79 $12.50 $14.70 $198.91 $17.50 $244.82 $12.50 $12.50 $15.00 $20.58 $12.50 $14.70 $14.70 $16.02 $244.82 $260.12 $16.88 $229.51 $25.62 $16.88 $153.01 $198.91 $20.65 $20.65 $20.65 $20.65 $24.83 $15.44 $14.70 $24.83 $12.50 $12.50 $11.02 $11.02 $11.02 $11.02 $260.12 330104 82634 398 301 HC DEOXYCORTISOL O $233.26 $29.28 $29.28 $15.00 $116.63 N/A N/A N/A $15.00 $55.63 $15.00 $29.28 $174.94 $32.21 $146.95 $170.51 $18.00 $15.00 $139.96 $186.61 $99.55 $166.90 $15.00 $29.28 $151.62 $21.00 $186.61 $15.00 $15.00 $18.00 $40.99 $15.00 $29.28 $29.28 $31.92 $186.61 $198.27 $20.25 $174.94 $30.75 $20.25 $116.63 $151.62 $41.14 $41.14 $41.14 $41.14 $49.44 $30.74 $29.28 $49.44 $15.00 $15.00 $21.96 $21.96 $21.96 $15.00 $198.27 330104 82747 400 301 HC ASSAY OF FOLIC ACID RBC O $186.18 $17.65 $17.65 $12.50 $93.09 N/A N/A N/A $12.50 $33.53 $12.50 $17.65 $139.63 $19.41 $117.29 $136.10 $15.00 $12.50 $111.71 $148.94 $60.01 $100.60 $12.50 $17.65 $121.02 $17.50 $148.94 $12.50 $12.50 $15.00 $24.71 $12.50 $17.65 $17.65 $19.24 $148.94 $158.25 $16.88 $139.63 $25.62 $16.88 $93.09 $121.02 $24.80 $24.80 $24.80 $24.80 $29.26 $18.53 $17.65 $29.26 $12.50 $12.50 $13.24 $13.24 $13.24 $12.50 $158.25 330104 82633 399 301 HC DESOXYCORTICOSTERONE O $416.23 $30.98 $30.98 N/A $208.12 N/A N/A N/A N/A $58.86 N/A $30.98 $312.17 $34.08 $262.22 $304.26 N/A N/A $249.74 $332.98 $105.33 $176.59 N/A $30.98 $270.55 N/A $332.98 N/A N/A N/A $43.37 N/A $30.98 $30.98 $33.77 $332.98 $353.80 N/A $312.17 N/A N/A $208.12 $270.55 $43.53 $43.53 $43.53 $43.53 $52.31 $32.53 $30.98 $52.31 N/A N/A $23.23 $23.23 $23.23 $23.23 $353.80 330104 82626 400 301 HC DEHYDROEPIANDROSTERONE (DHEA) O "$1,800.81 " $25.27 $25.27 $23.82 $900.40 N/A N/A N/A $23.82 $48.01 $23.82 $25.27 "$1,350.61 " $27.80 "$1,134.51 " "$1,316.39 " $28.58 $23.82 "$1,080.49 " "$1,440.65 " $85.92 $144.04 $23.82 $25.27 "$1,170.53 " $33.35 "$1,440.65 " $23.82 $23.82 $28.58 $35.38 $23.82 $25.27 $25.27 $27.54 "$1,440.65 " "$1,530.69 " $32.16 "$1,350.61 " $48.83 $32.16 $900.40 "$1,170.53 " $35.50 $35.50 $35.50 $35.50 $42.67 $26.53 $25.27 $42.67 $23.82 $23.82 $18.95 $18.95 $18.95 $18.95 "$1,530.69 " 330104 82495 404 301 HC ASSAY OF CHROMIUM O $321.00 $20.28 $20.28 $20.28 $160.50 N/A N/A N/A $20.28 $38.53 $20.28 $20.28 $240.75 $22.31 $202.23 $234.65 $24.34 $20.28 $192.60 $256.80 $68.95 $115.60 $20.28 $20.28 $208.65 $28.39 $256.80 $20.28 $20.28 $24.34 $28.39 $20.28 $20.28 $20.28 $22.11 $256.80 $272.85 $27.38 $240.75 $41.57 $27.38 $160.50 $208.65 $28.49 $28.49 $28.49 $28.49 $34.25 $21.29 $20.28 $34.25 $20.28 $20.28 $15.21 $15.21 $15.21 $15.21 $272.85 330104 82523 400 301 HC COLLAGEN CROSSLINKS O $298.53 $18.68 $18.68 $18.68 $149.26 N/A N/A N/A $18.68 $35.49 $18.68 $18.68 $223.90 $20.55 $188.07 $218.23 $22.42 $18.68 $179.12 $238.82 $63.51 $106.48 $18.68 $18.68 $194.04 $26.15 $238.82 $18.68 $18.68 $22.42 $26.15 $18.68 $18.68 $18.68 $20.36 $238.82 $253.75 $25.22 $223.90 $38.29 $25.22 $149.26 $194.04 $26.25 $26.25 $26.25 $26.25 $31.57 $19.61 $18.68 $31.57 $18.68 $18.68 $14.01 $14.01 $14.01 $14.01 $253.75 330104 82525 404 301 HC ASSAY OF COPPER O $388.41 $12.41 $12.41 $12.41 $194.21 N/A N/A N/A $12.41 $23.58 $12.41 $12.41 $291.31 $13.65 $244.70 $283.93 $14.89 $12.41 $233.05 $310.73 $42.19 $70.74 $12.41 $12.41 $252.47 $17.37 $310.73 $12.41 $12.41 $14.89 $17.37 $12.41 $12.41 $12.41 $13.53 $310.73 $330.15 $16.75 $291.31 $25.44 $16.75 $194.21 $252.47 $17.44 $17.44 $17.44 $17.44 $20.95 $13.03 $12.41 $20.95 $12.41 $12.41 $9.31 $9.31 $9.31 $9.31 $330.15 330104 82530 400 301 HC CORTISOL FREE O $522.16 $16.71 $16.71 $16.71 $261.08 N/A N/A N/A $16.71 $31.75 $16.71 $16.71 $391.62 $18.38 $328.96 $381.70 $20.05 $16.71 $313.30 $417.73 $56.81 $95.25 $16.71 $16.71 $339.40 $23.39 $417.73 $16.71 $16.71 $20.05 $23.39 $16.71 $16.71 $16.71 $18.21 $417.73 $443.84 $22.56 $391.62 $34.26 $22.56 $261.08 $339.40 $23.48 $23.48 $23.48 $23.48 $28.22 $17.55 $16.71 $28.22 $16.71 $16.71 $12.53 $12.53 $12.53 $12.53 $443.84 330104 82533 398 301 HC TOTAL CORTISOL O $300.67 $16.30 $16.30 $16.30 $150.34 N/A N/A N/A $16.30 $30.97 $16.30 $16.30 $225.50 $17.93 $189.42 $219.79 $19.56 $16.30 $180.40 $240.54 $55.42 $92.91 $16.30 $16.30 $195.44 $22.82 $240.54 $16.30 $16.30 $19.56 $22.82 $16.30 $16.30 $16.30 $17.77 $240.54 $255.57 $22.01 $225.50 $33.41 $22.01 $150.34 $195.44 $22.90 $22.90 $22.90 $22.90 $27.54 $17.12 $16.30 $27.54 $16.30 $16.30 $12.23 $12.23 $12.23 $12.23 $255.57 330104 82542 400 301 HC COL CHROMOTOGRAPHY NON DRUG QUAL/QUAN O $283.55 $24.09 $24.09 N/A $141.78 N/A N/A N/A N/A $45.77 N/A $24.09 $212.66 $26.50 $178.64 $207.28 N/A N/A $170.13 $226.84 $81.91 $137.31 N/A $24.09 $184.31 N/A $226.84 N/A N/A N/A $33.73 N/A $24.09 $24.09 $26.26 $226.84 $241.02 N/A $212.66 N/A N/A $141.78 $184.31 $33.85 $33.85 $33.85 $33.85 $30.49 $25.29 $24.09 $30.49 N/A N/A $18.07 $18.07 $18.07 $18.07 $241.02 330104 82550 402 301 HC ASSAY OF CK (CPK) O $142.31 $6.51 $6.51 $5.03 $71.16 N/A N/A N/A $5.03 $12.37 $5.03 $6.51 $106.73 $7.16 $89.66 $104.03 $6.04 $5.03 $85.39 $113.85 $22.13 $37.11 $5.03 $6.51 $92.50 $7.04 $113.85 $5.03 $5.03 $6.04 $9.11 $5.03 $6.51 $6.51 $7.10 $113.85 $120.96 $6.79 $106.73 $10.31 $6.79 $71.16 $92.50 $9.15 $9.15 $9.15 $9.15 $11.00 $6.84 $6.51 $11.00 $5.03 $5.03 $4.88 $4.88 $4.88 $4.88 $120.96 330104 82553 400 301 HC CREATINE MB FRACTION O $311.37 $11.55 $11.55 $8.05 $155.69 N/A N/A N/A $8.05 $21.95 $8.05 $11.55 $233.53 $12.71 $196.16 $227.61 $9.66 $8.05 $186.82 $249.10 $39.27 $65.84 $8.05 $11.55 $202.39 $11.27 $249.10 $8.05 $8.05 $9.66 $16.17 $8.05 $11.55 $11.55 $12.59 $249.10 $264.66 $10.87 $233.53 $16.50 $10.87 $155.69 $202.39 $16.23 $16.23 $16.23 $16.23 $19.50 $12.13 $11.55 $19.50 $8.05 $8.05 $8.66 $8.66 $8.66 $8.05 $264.66 330104 83873 400 301 HC ASSAY OF CSF PROTEIN O $490.06 $17.20 $17.20 N/A $245.03 N/A N/A N/A N/A $32.68 N/A $17.20 $367.55 $18.92 $308.74 $358.23 N/A N/A $294.04 $392.05 $58.48 $98.04 N/A $17.20 $318.54 N/A $392.05 N/A N/A N/A $24.08 N/A $17.20 $17.20 $18.75 $392.05 $416.55 N/A $367.55 N/A N/A $245.03 $318.54 $24.17 $24.17 $24.17 $24.17 $29.05 $18.06 $17.20 $29.05 N/A N/A $12.90 $12.90 $12.90 $12.90 $416.55 330104 82570 402 301 HC ASSAY OF URINE CREATININE O $182.97 $5.18 $5.18 $5.03 $91.48 N/A N/A N/A $5.03 $9.84 $5.03 $5.18 $137.23 $5.70 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $17.61 $29.53 $5.03 $5.18 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.25 $5.03 $5.18 $5.18 $5.65 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $5.03 $5.03 $3.88 $3.88 $3.88 $3.88 $155.52 330104 82575 402 301 HC CREATININE CLEARANCE TEST O $311.37 $9.46 $9.46 $5.83 $155.69 N/A N/A N/A $5.83 $17.97 $5.83 $9.46 $233.53 $10.41 $196.16 $227.61 $7.00 $5.83 $186.82 $249.10 $32.16 $53.92 $5.83 $9.46 $202.39 $8.16 $249.10 $5.83 $5.83 $7.00 $13.24 $5.83 $9.46 $9.46 $10.31 $249.10 $264.66 $7.87 $233.53 $11.95 $7.87 $155.69 $202.39 $13.29 $13.29 $13.29 $13.29 $15.96 $9.93 $9.46 $15.96 $5.83 $5.83 $7.10 $7.10 $7.10 $5.83 $264.66 330104 82585 400 301 HC ASSAY OF CRYOFIBRINOGEN O $254.66 $14.14 $14.14 N/A $127.33 N/A N/A N/A N/A $26.87 N/A $14.14 $191.00 $15.55 $160.44 $186.16 N/A N/A $152.80 $203.73 $48.08 $80.60 N/A $14.14 $165.53 N/A $203.73 N/A N/A N/A $19.80 N/A $14.14 $14.14 $15.41 $203.73 $216.46 N/A $191.00 N/A N/A $127.33 $165.53 $19.87 $19.87 $19.87 $19.87 $14.48 $14.85 $14.14 $14.48 N/A N/A $10.61 $10.61 $10.61 $10.61 $216.46 330104 82595 402 301 HC ASSAY OF CRYOGLOBULIN O $108.07 $6.47 $6.47 $5.48 $54.03 N/A N/A N/A $5.48 $12.29 $5.48 $6.47 $81.05 $7.12 $68.08 $79.00 $6.58 $5.48 $64.84 $86.46 $22.00 $36.88 $5.48 $6.47 $70.25 $7.67 $86.46 $5.48 $5.48 $6.58 $9.06 $5.48 $6.47 $6.47 $7.05 $86.46 $91.86 $7.40 $81.05 $11.23 $7.40 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $5.48 $5.48 $4.85 $4.85 $4.85 $4.85 $91.86 330104 82607 398 301 HC VITAMIN B-12 O $276.06 $15.08 $15.08 $12.50 $138.03 N/A N/A N/A $12.50 $28.65 $12.50 $15.08 $207.05 $16.59 $173.92 $201.80 $15.00 $12.50 $165.64 $220.85 $51.27 $85.96 $12.50 $15.08 $179.44 $17.50 $220.85 $12.50 $12.50 $15.00 $21.11 $12.50 $15.08 $15.08 $16.44 $220.85 $234.65 $16.88 $207.05 $25.62 $16.88 $138.03 $179.44 $21.19 $21.19 $21.19 $21.19 $25.45 $15.83 $15.08 $25.45 $12.50 $12.50 $11.31 $11.31 $11.31 $11.31 $234.65 330104 82608 400 301 HC B-12 BINDING CAPACITY O $326.35 $14.32 $14.32 $14.32 $163.18 N/A N/A N/A $14.32 $27.21 $14.32 $14.32 $244.76 $15.75 $205.60 $238.56 $17.18 $14.32 $195.81 $261.08 $48.69 $81.62 $14.32 $14.32 $212.13 $20.05 $261.08 $14.32 $14.32 $17.18 $20.05 $14.32 $14.32 $14.32 $15.61 $261.08 $277.40 $19.33 $244.76 $29.36 $19.33 $163.18 $212.13 $20.12 $20.12 $20.12 $20.12 $24.18 $15.04 $14.32 $24.18 $14.32 $14.32 $10.74 $10.74 $10.74 $10.74 $277.40 330104 82627 398 301 HC DEHYDROEPIANDROSTERONE-SULFATE (DHEA-S) O $352.03 $22.23 $22.23 $22.23 $176.01 N/A N/A N/A $22.23 $42.24 $22.23 $22.23 $264.02 $24.45 $221.78 $257.33 $26.68 $22.23 $211.22 $281.62 $75.58 $126.71 $22.23 $22.23 $228.82 $31.12 $281.62 $22.23 $22.23 $26.68 $31.12 $22.23 $22.23 $22.23 $24.23 $281.62 $299.23 $30.01 $264.02 $45.57 $30.01 $176.01 $228.82 $31.23 $31.23 $31.23 $31.23 $37.55 $23.34 $22.23 $37.55 $22.23 $22.23 $16.67 $16.67 $16.67 $16.67 $299.23 330104 83695 400 301 HC ASSAY OF LIPOPROTEIN(A) O $207.58 $14.32 $14.32 N/A $103.79 N/A N/A N/A N/A $27.21 N/A $14.32 $155.69 $15.75 $130.78 $151.74 N/A N/A $124.55 $166.06 $48.69 $81.62 N/A $14.32 $134.93 N/A $166.06 N/A N/A N/A $20.05 N/A $14.32 $14.32 $15.61 $166.06 $176.44 N/A $155.69 N/A N/A $103.79 $134.93 $20.12 $20.12 $20.12 $20.12 $21.86 $15.04 $14.32 $21.86 N/A N/A $10.74 $10.74 $10.74 $10.74 $176.44 330104 82784 402 301 HC ASSAY IGA/IGD/IGG/IGM EACH O $439.77 $9.30 $9.30 $9.30 $219.88 N/A N/A N/A $9.30 $17.67 $9.30 $9.30 $329.83 $10.23 $277.06 $321.47 $11.16 $9.30 $263.86 $351.82 $31.62 $53.01 $9.30 $9.30 $285.85 $13.02 $351.82 $9.30 $9.30 $11.16 $13.02 $9.30 $9.30 $9.30 $10.14 $351.82 $373.80 $12.56 $329.83 $19.07 $12.56 $219.88 $285.85 $13.07 $13.07 $13.07 $13.07 $15.71 $9.77 $9.30 $15.71 $9.30 $9.30 $6.98 $6.98 $6.98 $6.98 $373.80 330104 82787 402 301 HC IGG 1 2 3 OR 4 EACH O $263.22 $8.02 $8.02 $5.90 $131.61 N/A N/A N/A $5.90 $15.24 $5.90 $8.02 $197.42 $8.82 $165.83 $192.41 $7.08 $5.90 $157.93 $210.58 $27.27 $45.71 $5.90 $8.02 $171.09 $8.26 $210.58 $5.90 $5.90 $7.08 $11.23 $5.90 $8.02 $8.02 $8.74 $210.58 $223.74 $7.97 $197.42 $12.09 $7.97 $131.61 $171.09 $11.27 $11.27 $11.27 $11.27 $13.55 $8.42 $8.02 $13.55 $5.90 $5.90 $6.01 $6.01 $6.01 $5.90 $223.74 330104 83070 402 301 HC ASSAY OF HEMOSIDERIN QUAL O $26.75 $4.75 $4.75 N/A $13.38 N/A N/A N/A N/A $9.03 N/A $4.75 $20.06 $5.23 $16.85 $19.55 N/A N/A $16.05 $21.40 $16.15 $27.07 N/A $4.75 $17.39 N/A $21.40 N/A N/A N/A $6.65 N/A $4.75 $4.75 $5.18 $21.40 $22.74 N/A $20.06 N/A N/A $13.38 $17.39 $6.67 $6.67 $6.67 $6.67 $8.02 $4.99 $4.75 $8.02 N/A N/A $3.56 $3.56 $3.56 $3.56 $27.07 330104 83088 401 301 HC ASSAY OF HISTAMINE O $572.45 $29.53 $29.53 N/A $286.23 N/A N/A N/A N/A $56.11 N/A $29.53 $429.34 $32.48 $360.64 $418.46 N/A N/A $343.47 $457.96 $100.40 $168.32 N/A $29.53 $372.09 N/A $457.96 N/A N/A N/A $41.34 N/A $29.53 $29.53 $32.19 $457.96 $486.58 N/A $429.34 N/A N/A $286.23 $372.09 $41.49 $41.49 $41.49 $41.49 $49.87 $31.01 $29.53 $49.87 N/A N/A $22.15 $22.15 $22.15 $22.15 $486.58 330104 83090 398 301 HC ASSAY OF HOMOCYSTINE O $265.36 $17.92 $17.92 $17.92 $132.68 N/A N/A N/A $17.92 $34.05 $17.92 $17.92 $199.02 $19.71 $167.18 $193.98 $21.50 $17.92 $159.22 $212.29 $60.93 $102.14 $17.92 $17.92 $172.48 $25.09 $212.29 $17.92 $17.92 $21.50 $25.09 $17.92 $17.92 $17.92 $19.53 $212.29 $225.56 $24.19 $199.02 $36.74 $24.19 $132.68 $172.48 $25.18 $25.18 $25.18 $25.18 $28.49 $18.82 $17.92 $28.49 $17.92 $17.92 $13.44 $13.44 $13.44 $13.44 $225.56 330104 83497 398 301 HC ASSAY OF 5-HIAA O $332.77 $12.90 $12.90 $12.90 $166.38 N/A N/A N/A $12.90 $24.51 $12.90 $12.90 $249.58 $14.19 $209.65 $243.25 $15.48 $12.90 $199.66 $266.22 $43.86 $73.53 $12.90 $12.90 $216.30 $18.06 $266.22 $12.90 $12.90 $15.48 $18.06 $12.90 $12.90 $12.90 $14.06 $266.22 $282.85 $17.42 $249.58 $26.44 $17.42 $166.38 $216.30 $18.12 $18.12 $18.12 $18.12 $21.77 $13.55 $12.90 $21.77 $12.90 $12.90 $9.68 $9.68 $9.68 $9.68 $282.85 330104 83498 398 301 HC ASSAY OF PROGESTERONE 17-D O $421.58 $27.17 $27.17 $27.17 $210.79 N/A N/A N/A $27.17 $51.62 $27.17 $27.17 $316.19 $29.89 $265.60 $308.17 $32.60 $27.17 $252.95 $337.26 $92.38 $154.87 $27.17 $27.17 $274.03 $38.04 $337.26 $27.17 $27.17 $32.60 $38.04 $27.17 $27.17 $27.17 $29.62 $337.26 $358.34 $36.68 $316.19 $55.70 $36.68 $210.79 $274.03 $38.17 $38.17 $38.17 $38.17 $45.88 $28.53 $27.17 $45.88 $27.17 $27.17 $20.38 $20.38 $20.38 $20.38 $358.34 330104 83516 400 301 HC IMMUNOASSAY NONANTIBODY O $548.91 $11.53 $11.53 N/A $274.45 N/A N/A N/A N/A $21.91 N/A $11.53 $411.68 $12.68 $345.81 $401.25 N/A N/A $329.35 $439.13 $39.20 $65.72 N/A $11.53 $356.79 N/A $439.13 N/A N/A N/A $16.14 N/A $11.53 $11.53 $12.57 $439.13 $466.57 N/A $411.68 N/A N/A $274.45 $356.79 $16.20 $16.20 $16.20 $16.20 $19.49 $12.11 $11.53 $19.49 N/A N/A $8.65 $8.65 $8.65 $8.65 $466.57 330104 83519 400 301 HC RIA NONANTIBODY O $218.28 $18.40 $18.40 N/A $109.14 N/A N/A N/A N/A $34.96 N/A $18.40 $163.71 $20.24 $137.52 $159.56 N/A N/A $130.97 $174.62 $62.56 $104.88 N/A $18.40 $141.88 N/A $174.62 N/A N/A N/A $25.76 N/A $18.40 $18.40 $20.06 $174.62 $185.54 N/A $163.71 N/A N/A $109.14 $141.88 $25.85 $25.85 $25.85 $25.85 $22.81 $19.32 $18.40 $22.81 N/A N/A $13.80 $13.80 $13.80 $13.80 $185.54 330104 83520 400 301 HC IMMUNOASSAY QUANT NOS NONAB O $143.38 $17.27 $17.27 N/A $71.69 N/A N/A N/A N/A $32.81 N/A $17.27 $107.53 $19.00 $90.33 $104.81 N/A N/A $86.03 $114.70 $58.72 $98.44 N/A $17.27 $93.20 N/A $114.70 N/A N/A N/A $24.18 N/A $17.27 $17.27 $18.82 $114.70 $121.87 N/A $107.53 N/A N/A $71.69 $93.20 $24.26 $24.26 $24.26 $24.26 $21.86 $18.13 $17.27 $21.86 N/A N/A $12.95 $12.95 $12.95 $12.95 $121.87 330104 83525 398 301 HC ASSAY OF INSULIN TOTAL O $439.77 $11.43 $11.43 $11.43 $219.88 N/A N/A N/A $11.43 $21.72 $11.43 $11.43 $329.83 $12.57 $277.06 $321.47 $13.72 $11.43 $263.86 $351.82 $38.86 $65.15 $11.43 $11.43 $285.85 $16.00 $351.82 $11.43 $11.43 $13.72 $16.00 $11.43 $11.43 $11.43 $12.46 $351.82 $373.80 $15.43 $329.83 $23.43 $15.43 $219.88 $285.85 $16.06 $16.06 $16.06 $16.06 $19.31 $12.00 $11.43 $19.31 $11.43 $11.43 $8.57 $8.57 $8.57 $8.57 $373.80 330104 83540 402 301 HC ASSAY OF IRON O $108.07 $6.47 $6.47 $5.03 $54.03 N/A N/A N/A $5.03 $12.29 $5.03 $6.47 $81.05 $7.12 $68.08 $79.00 $6.04 $5.03 $64.84 $86.46 $22.00 $36.88 $5.03 $6.47 $70.25 $7.04 $86.46 $5.03 $5.03 $6.04 $9.06 $5.03 $6.47 $6.47 $7.05 $86.46 $91.86 $6.79 $81.05 $10.31 $6.79 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.94 $6.79 $6.47 $10.94 $5.03 $5.03 $4.85 $4.85 $4.85 $4.85 $91.86 330104 83550 402 301 HC IRON BINDING TEST O $142.31 $8.74 $8.74 $5.03 $71.16 N/A N/A N/A $5.03 $16.61 $5.03 $8.74 $106.73 $9.61 $89.66 $104.03 $6.04 $5.03 $85.39 $113.85 $29.72 $49.82 $5.03 $8.74 $92.50 $7.04 $113.85 $5.03 $5.03 $6.04 $12.24 $5.03 $8.74 $8.74 $9.53 $113.85 $120.96 $6.79 $106.73 $10.31 $6.79 $71.16 $92.50 $12.28 $12.28 $12.28 $12.28 $14.76 $9.18 $8.74 $14.76 $5.03 $5.03 $6.55 $6.55 $6.55 $5.03 $120.96 330104 83586 398 301 HC ASSAY 17- KETOSTEROIDS O $311.37 $12.80 $12.80 $9.40 $155.69 N/A N/A N/A $9.40 $24.32 $9.40 $12.80 $233.53 $14.08 $196.16 $227.61 $11.28 $9.40 $186.82 $249.10 $43.52 $72.96 $9.40 $12.80 $202.39 $13.16 $249.10 $9.40 $9.40 $11.28 $17.92 $9.40 $12.80 $12.80 $13.95 $249.10 $264.66 $12.69 $233.53 $19.27 $12.69 $155.69 $202.39 $17.98 $17.98 $17.98 $17.98 $21.62 $13.44 $12.80 $21.62 $9.40 $9.40 $9.60 $9.60 $9.60 $9.40 $264.66 330104 83605 400 301 HC ASSAY OF LACTIC ACID O $263.22 $11.57 $11.57 $9.30 $131.61 N/A N/A N/A $9.30 $21.98 $9.30 $11.57 $197.42 $12.73 $165.83 $192.41 $11.16 $9.30 $157.93 $210.58 $39.34 $65.95 $9.30 $11.57 $171.09 $13.02 $210.58 $9.30 $9.30 $11.16 $16.20 $9.30 $11.57 $11.57 $12.61 $210.58 $223.74 $12.56 $197.42 $19.07 $12.56 $131.61 $171.09 $16.26 $16.26 $16.26 $16.26 $18.04 $12.15 $11.57 $18.04 $9.30 $9.30 $8.68 $8.68 $8.68 $8.68 $223.74 330104 83615 402 301 HC LACTATE (LD) (LDH) ENZYME O $182.97 $6.04 $6.04 $5.03 $91.48 N/A N/A N/A $5.03 $11.48 $5.03 $6.04 $137.23 $6.64 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $20.54 $34.43 $5.03 $6.04 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $8.46 $5.03 $6.04 $6.04 $6.58 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $8.49 $8.49 $8.49 $8.49 $10.20 $6.34 $6.04 $10.20 $5.03 $5.03 $4.53 $4.53 $4.53 $4.53 $155.52 330104 83655 404 301 HC ASSAY OF LEAD O $191.53 $12.11 $12.11 $12.11 $95.77 N/A N/A N/A $12.11 $23.01 $12.11 $12.11 $143.65 $13.32 $120.66 $140.01 $14.53 $12.11 $114.92 $153.22 $41.17 $69.03 $12.11 $12.11 $124.49 $16.95 $153.22 $12.11 $12.11 $14.53 $16.95 $12.11 $12.11 $12.11 $13.20 $153.22 $162.80 $16.35 $143.65 $24.83 $16.35 $95.77 $124.49 $17.01 $17.01 $17.01 $17.01 $20.44 $12.72 $12.11 $20.44 $12.11 $12.11 $9.08 $9.08 $9.08 $9.08 $162.80 330104 83051 402 301 HC ASSAY OF PLASMA HEMOGLOBIN O $296.39 $7.31 $7.31 $3.75 $148.19 N/A N/A N/A $3.75 $13.89 $3.75 $7.31 $222.29 $8.04 $186.73 $216.66 $4.50 $3.75 $177.83 $237.11 $24.85 $41.67 $3.75 $7.31 $192.65 $5.25 $237.11 $3.75 $3.75 $4.50 $10.23 $3.75 $7.31 $7.31 $7.97 $237.11 $251.93 $5.06 $222.29 $7.69 $5.06 $148.19 $192.65 $10.27 $10.27 $10.27 $10.27 $12.35 $7.68 $7.31 $12.35 $3.75 $3.75 $5.48 $5.48 $5.48 $3.75 $251.93 330104 82785 400 301 HC ASSAY OF IGE O $439.77 $16.46 $16.46 $12.50 $219.88 N/A N/A N/A $12.50 $31.27 $12.50 $16.46 $329.83 $18.11 $277.06 $321.47 $15.00 $12.50 $263.86 $351.82 $55.96 $93.82 $12.50 $16.46 $285.85 $17.50 $351.82 $12.50 $12.50 $15.00 $23.04 $12.50 $16.46 $16.46 $17.94 $351.82 $373.80 $16.88 $329.83 $25.62 $16.88 $219.88 $285.85 $23.13 $23.13 $23.13 $23.13 $27.82 $17.28 $16.46 $27.82 $12.50 $12.50 $12.35 $12.35 $12.35 $12.35 $373.80 330104 83050 402 301 HC BLOOD METHEMOGLOBIN ASSAY O $466.52 $8.20 $8.20 $3.75 $233.26 N/A N/A N/A $3.75 $15.58 $3.75 $8.20 $349.89 $9.02 $293.91 $341.03 $4.50 $3.75 $279.91 $373.22 $27.88 $46.74 $3.75 $8.20 $303.24 $5.25 $373.22 $3.75 $3.75 $4.50 $11.48 $3.75 $8.20 $8.20 $8.94 $373.22 $396.54 $5.06 $349.89 $7.69 $5.06 $233.26 $303.24 $11.52 $11.52 $11.52 $11.52 $12.37 $8.61 $8.20 $12.37 $3.75 $3.75 $6.15 $6.15 $6.15 $3.75 $396.54 330104 83018 404 301 HC QUANTITATIVE SCREEN METALS O $346.68 $21.96 $21.96 N/A $173.34 N/A N/A N/A N/A $41.72 N/A $21.96 $260.01 $24.16 $218.41 $253.42 N/A N/A $208.01 $277.34 $74.66 $125.17 N/A $21.96 $225.34 N/A $277.34 N/A N/A N/A $30.74 N/A $21.96 $21.96 $23.94 $277.34 $294.68 N/A $260.01 N/A N/A $173.34 $225.34 $30.85 $30.85 $30.85 $30.85 $37.09 $23.06 $21.96 $37.09 N/A N/A $16.47 $16.47 $16.47 $16.47 $294.68 330104 82805 384 301 HC BLOOD GASES W/O2 SATURATION O $836.74 $78.77 $78.77 $23.89 $418.37 N/A N/A N/A $23.89 $149.66 $23.89 $78.77 $627.56 $86.65 $527.15 $611.66 $28.67 $23.89 $502.04 $669.39 $267.82 $448.99 $23.89 $78.77 $543.88 $33.45 $669.39 $23.89 $23.89 $28.67 $110.28 $23.89 $78.77 $78.77 $85.86 $669.39 $711.23 $32.25 $627.56 $48.97 $32.25 $418.37 $543.88 $110.67 $110.67 $110.67 $110.67 $47.93 $82.71 $78.77 $47.93 $23.89 $23.89 $59.08 $59.08 $59.08 $23.89 $711.23 330104 82941 398 301 HC ASSAY OF GASTRIN O $527.51 $17.63 $17.63 $17.63 $263.75 N/A N/A N/A $17.63 $33.50 $17.63 $17.63 $395.63 $19.39 $332.33 $385.61 $21.16 $17.63 $316.51 $422.01 $59.94 $100.49 $17.63 $17.63 $342.88 $24.68 $422.01 $17.63 $17.63 $21.16 $24.68 $17.63 $17.63 $17.63 $19.22 $422.01 $448.38 $23.80 $395.63 $36.14 $23.80 $263.75 $342.88 $24.77 $24.77 $24.77 $24.77 $29.78 $18.51 $17.63 $29.78 $17.63 $17.63 $13.22 $13.22 $13.22 $13.22 $448.38 330104 82943 398 301 HC ASSAY OF GLUCAGON O $80.25 $14.29 $14.29 $14.29 $40.12 N/A N/A N/A $14.29 $27.15 $14.29 $14.29 $60.19 $15.72 $50.56 $58.66 $17.15 $14.29 $48.15 $64.20 $48.59 $81.45 $14.29 $14.29 $52.16 $20.01 $64.20 $14.29 $14.29 $17.15 $20.01 $14.29 $14.29 $14.29 $15.58 $64.20 $68.21 $19.29 $60.19 $29.29 $19.29 $40.12 $52.16 $20.08 $20.08 $20.08 $20.08 $24.13 $15.00 $14.29 $24.13 $14.29 $14.29 $10.72 $10.72 $10.72 $10.72 $81.45 330104 82947 402 301 HC ASSAY GLUCOSE BLOOD QUANT O $108.07 $3.93 $3.93 $3.93 $54.03 N/A N/A N/A $3.93 $7.47 $3.93 $3.93 $81.05 $4.32 $68.08 $79.00 $4.72 $3.93 $64.84 $86.46 $13.36 $22.40 $3.93 $3.93 $70.25 $5.50 $86.46 $3.93 $3.93 $4.72 $5.50 $3.93 $3.93 $3.93 $4.28 $86.46 $91.86 $5.31 $81.05 $8.06 $5.31 $54.03 $70.25 $5.52 $5.52 $5.52 $5.52 $6.62 $4.13 $3.93 $6.62 $3.93 $3.93 $2.95 $2.95 $2.95 $2.95 $91.86 330104 82951 400 301 HC GLUCOSE TOLERANCE TEST (GTT) O $206.51 $12.87 $12.87 $6.84 $103.25 N/A N/A N/A $6.84 $24.45 $6.84 $12.87 $154.88 $14.16 $130.10 $150.96 $8.21 $6.84 $123.91 $165.21 $43.76 $73.36 $6.84 $12.87 $134.23 $9.58 $165.21 $6.84 $6.84 $8.21 $18.02 $6.84 $12.87 $12.87 $14.03 $165.21 $175.53 $9.23 $154.88 $14.02 $9.23 $103.25 $134.23 $18.08 $18.08 $18.08 $18.08 $21.74 $13.51 $12.87 $21.74 $6.84 $6.84 $9.65 $9.65 $9.65 $6.84 $175.53 330104 82952 402 301 HC GTT-ADDED SAMPLES O $185.11 $3.92 $3.92 $1.40 $92.56 N/A N/A N/A $1.40 $7.45 $1.40 $3.92 $138.83 $4.31 $116.62 $135.32 $1.68 $1.40 $111.07 $148.09 $13.33 $22.34 $1.40 $3.92 $120.32 $1.96 $148.09 $1.40 $1.40 $1.68 $5.49 $1.40 $3.92 $3.92 $4.27 $148.09 $157.34 $1.89 $138.83 $2.87 $1.89 $92.56 $120.32 $5.51 $5.51 $5.51 $5.51 $6.61 $4.12 $3.92 $6.61 $1.40 $1.40 $2.94 $2.94 $2.94 $1.40 $157.34 330104 82955 402 301 HC ASSAY OF G6PD ENZYME O $155.15 $9.70 $9.70 $9.70 $77.58 N/A N/A N/A $9.70 $18.43 $9.70 $9.70 $116.36 $10.67 $97.74 $113.41 $11.64 $9.70 $93.09 $124.12 $32.98 $55.29 $9.70 $9.70 $100.85 $13.58 $124.12 $9.70 $9.70 $11.64 $13.58 $9.70 $9.70 $9.70 $10.57 $124.12 $131.88 $13.10 $116.36 $19.88 $13.10 $77.58 $100.85 $13.63 $13.63 $13.63 $13.63 $16.38 $10.19 $9.70 $16.38 $9.70 $9.70 $7.27 $7.27 $7.27 $7.27 $131.88 330104 82963 400 301 HC ASSAY OF GLUCOSIDASE O $155.15 $21.48 $21.48 $21.48 $77.58 N/A N/A N/A $21.48 $40.81 $21.48 $21.48 $116.36 $23.63 $97.74 $113.41 $25.78 $21.48 $93.09 $124.12 $73.03 $122.44 $21.48 $21.48 $100.85 $30.07 $124.12 $21.48 $21.48 $25.78 $30.07 $21.48 $21.48 $21.48 $23.41 $124.12 $131.88 $29.00 $116.36 $44.03 $29.00 $77.58 $100.85 $30.18 $30.18 $30.18 $30.18 $36.28 $22.55 $21.48 $36.28 $21.48 $21.48 $16.11 $16.11 $16.11 $16.11 $131.88 330104 82977 402 301 HC ASSAY OF GGT O $121.98 $7.20 $7.20 $5.03 $60.99 N/A N/A N/A $5.03 $13.68 $5.03 $7.20 $91.48 $7.92 $76.85 $89.17 $6.04 $5.03 $73.19 $97.58 $24.48 $41.04 $5.03 $7.20 $79.29 $7.04 $97.58 $5.03 $5.03 $6.04 $10.08 $5.03 $7.20 $7.20 $7.85 $97.58 $103.68 $6.79 $91.48 $10.31 $6.79 $60.99 $79.29 $10.12 $10.12 $10.12 $10.12 $12.16 $7.56 $7.20 $12.16 $5.03 $5.03 $5.40 $5.40 $5.40 $5.03 $103.68 330104 82985 400 301 HC ASSAY OF GLYCATED PROTEIN O $84.53 $16.76 $16.76 $10.64 $42.27 N/A N/A N/A $10.64 $31.84 $10.64 $16.76 $63.40 $18.44 $53.25 $61.79 $12.77 $10.64 $50.72 $67.62 $56.98 $95.53 $10.64 $16.76 $54.94 $14.90 $67.62 $10.64 $10.64 $12.77 $23.46 $10.64 $16.76 $16.76 $18.27 $67.62 $71.85 $14.36 $63.40 $21.81 $14.36 $42.27 $54.94 $23.55 $23.55 $23.55 $23.55 $25.45 $17.60 $16.76 $25.45 $10.64 $10.64 $12.57 $12.57 $12.57 $10.64 $95.53 330104 83001 398 301 HC ASSAY OF GONADOTROPIN (FSH) O $454.75 $18.58 $18.58 $18.58 $227.38 N/A N/A N/A $18.58 $35.30 $18.58 $18.58 $341.06 $20.44 $286.49 $332.42 $22.30 $18.58 $272.85 $363.80 $63.17 $105.91 $18.58 $18.58 $295.59 $26.01 $363.80 $18.58 $18.58 $22.30 $26.01 $18.58 $18.58 $18.58 $20.25 $363.80 $386.54 $25.08 $341.06 $38.09 $25.08 $227.38 $295.59 $26.10 $26.10 $26.10 $26.10 $31.38 $19.51 $18.58 $31.38 $18.58 $18.58 $13.93 $13.93 $13.93 $13.93 $386.54 330104 83002 398 301 HC ASSAY OF GONADOTROPIN (LH) O $522.16 $18.52 $18.52 $18.52 $261.08 N/A N/A N/A $18.52 $35.19 $18.52 $18.52 $391.62 $20.37 $328.96 $381.70 $22.22 $18.52 $313.30 $417.73 $62.97 $105.56 $18.52 $18.52 $339.40 $25.93 $417.73 $18.52 $18.52 $22.22 $25.93 $18.52 $18.52 $18.52 $20.19 $417.73 $443.84 $25.00 $391.62 $37.97 $25.00 $261.08 $339.40 $26.02 $26.02 $26.02 $26.02 $31.27 $19.45 $18.52 $31.27 $18.52 $18.52 $13.89 $13.89 $13.89 $13.89 $443.84 330104 83003 398 301 HC ASSAY GROWTH HORMONE (HGH) O $535.00 $16.67 $16.67 $16.67 $267.50 N/A N/A N/A $16.67 $31.67 $16.67 $16.67 $401.25 $18.34 $337.05 $391.08 $20.00 $16.67 $321.00 $428.00 $56.68 $95.02 $16.67 $16.67 $347.75 $23.34 $428.00 $16.67 $16.67 $20.00 $23.34 $16.67 $16.67 $16.67 $18.17 $428.00 $454.75 $22.50 $401.25 $34.17 $22.50 $267.50 $347.75 $23.42 $23.42 $23.42 $23.42 $28.16 $17.50 $16.67 $28.16 $16.67 $16.67 $12.50 $12.50 $12.50 $12.50 $454.75 330104 83010 400 301 HC ASSAY OF HAPTOGLOBIN QUANT O $368.08 $12.58 $12.58 $12.58 $184.04 N/A N/A N/A $12.58 $23.90 $12.58 $12.58 $276.06 $13.84 $231.89 $269.07 $15.10 $12.58 $220.85 $294.46 $42.77 $71.71 $12.58 $12.58 $239.25 $17.61 $294.46 $12.58 $12.58 $15.10 $17.61 $12.58 $12.58 $12.58 $13.71 $294.46 $312.87 $16.98 $276.06 $25.79 $16.98 $184.04 $239.25 $17.67 $17.67 $17.67 $17.67 $21.24 $13.21 $12.58 $21.24 $12.58 $12.58 $9.44 $9.44 $9.44 $9.44 $312.87 330104 83013 384 301 HC H PYLORI (C-13) BREATH O $267.50 $67.36 $67.36 $67.36 $133.75 N/A N/A N/A $67.36 $127.98 $67.36 $67.36 $200.62 $74.10 $168.53 $195.54 $80.83 $67.36 $160.50 $214.00 $229.02 $383.95 $67.36 $67.36 $173.88 $94.30 $214.00 $67.36 $67.36 $80.83 $94.30 $67.36 $67.36 $67.36 $73.42 $214.00 $227.38 $90.94 $200.62 $138.09 $90.94 $133.75 $173.88 $94.64 $94.64 $94.64 $94.64 $113.75 $70.73 $67.36 $113.75 $67.36 $67.36 $50.52 $50.52 $50.52 $50.52 $383.95 330104 83036 402 301 HC GLYCOSYLATED HEMOGLOBIN TEST O $131.61 $9.71 $9.71 $9.71 $65.81 N/A N/A N/A $9.71 $18.45 $9.71 $9.71 $98.71 $10.68 $82.91 $96.21 $11.65 $9.71 $78.97 $105.29 $33.01 $55.35 $9.71 $9.71 $85.55 $13.59 $105.29 $9.71 $9.71 $11.65 $13.59 $9.71 $9.71 $9.71 $10.58 $105.29 $111.87 $13.11 $98.71 $19.91 $13.11 $65.81 $85.55 $13.64 $13.64 $13.64 $13.64 $16.39 $10.20 $9.71 $16.39 $9.71 $9.71 $7.28 $7.28 $7.28 $7.28 $111.87 330104 83874 400 301 HC ASSAY OF MYOGLOBIN O $584.22 $12.92 $12.92 N/A $292.11 N/A N/A N/A N/A $24.55 N/A $12.92 $438.17 $14.21 $368.06 $427.06 N/A N/A $350.53 $467.38 $43.93 $73.64 N/A $12.92 $379.74 N/A $467.38 N/A N/A N/A $18.09 N/A $12.92 $12.92 $14.08 $467.38 $496.59 N/A $438.17 N/A N/A $292.11 $379.74 $18.15 $18.15 $18.15 $18.15 $21.80 $13.57 $12.92 $21.80 N/A N/A $9.69 $9.69 $9.69 $9.69 $496.59 330104 84166 400 301 HC PROTEIN E-PHORESIS/URINE/CSF O $281.41 $17.83 $17.83 $11.25 $140.71 N/A N/A N/A $11.25 $33.88 $11.25 $17.83 $211.06 $19.61 $177.29 $205.71 $13.50 $11.25 $168.85 $225.13 $60.62 $101.63 $11.25 $17.83 $182.92 $15.75 $225.13 $11.25 $11.25 $13.50 $24.96 $11.25 $17.83 $17.83 $19.43 $225.13 $239.20 $15.19 $211.06 $23.06 $15.19 $140.71 $182.92 $25.05 $25.05 $25.05 $25.05 $30.11 $18.72 $17.83 $30.11 $11.25 $11.25 $13.37 $13.37 $13.37 $11.25 $239.20 330104 83883 394 301 HC ASSAY NEPHELOMETRY NOT SPEC O $185.11 $13.60 $13.60 N/A $92.56 N/A N/A N/A N/A $25.84 N/A $13.60 $138.83 $14.96 $116.62 $135.32 N/A N/A $111.07 $148.09 $46.24 $77.52 N/A $13.60 $120.32 N/A $148.09 N/A N/A N/A $19.04 N/A $13.60 $13.60 $14.82 $148.09 $157.34 N/A $138.83 N/A N/A $92.56 $120.32 $19.11 $19.11 $19.11 $19.11 $22.96 $14.28 $13.60 $22.96 N/A N/A $10.20 $10.20 $10.20 $10.20 $157.34 330104 84480 398 301 HC ASSAY TRIIODOTHYRONINE (T3) O $420.51 $14.18 $14.18 $5.70 $210.25 N/A N/A N/A $5.70 $26.94 $5.70 $14.18 $315.38 $15.60 $264.92 $307.39 $6.84 $5.70 $252.31 $336.41 $48.21 $80.83 $5.70 $14.18 $273.33 $7.98 $336.41 $5.70 $5.70 $6.84 $19.85 $5.70 $14.18 $14.18 $15.46 $336.41 $357.43 $7.70 $315.38 $11.68 $7.70 $210.25 $273.33 $19.92 $19.92 $19.92 $19.92 $23.94 $14.89 $14.18 $23.94 $5.70 $5.70 $10.63 $10.63 $10.63 $5.70 $357.43 330104 84479 398 301 HC ASSAY OF THYROID (T3 OR T4) O $108.07 $6.47 $6.47 $3.30 $54.03 N/A N/A N/A $3.30 $12.29 $3.30 $6.47 $81.05 $7.12 $68.08 $79.00 $3.96 $3.30 $64.84 $86.46 $22.00 $36.88 $3.30 $6.47 $70.25 $4.62 $86.46 $3.30 $3.30 $3.96 $9.06 $3.30 $6.47 $6.47 $7.05 $86.46 $91.86 $4.46 $81.05 $6.76 $4.46 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $3.30 $3.30 $4.85 $4.85 $4.85 $3.30 $91.86 330104 84478 402 301 HC ASSAY OF TRIGLYCERIDES O $96.30 $5.74 $5.74 $5.03 $48.15 N/A N/A N/A $5.03 $10.91 $5.03 $5.74 $72.22 $6.31 $60.67 $70.40 $6.04 $5.03 $57.78 $77.04 $19.52 $32.72 $5.03 $5.74 $62.59 $7.04 $77.04 $5.03 $5.03 $6.04 $8.04 $5.03 $5.74 $5.74 $6.26 $77.04 $81.85 $6.79 $72.22 $10.31 $6.79 $48.15 $62.59 $8.06 $8.06 $8.06 $8.06 $9.72 $6.03 $5.74 $9.72 $5.03 $5.03 $4.30 $4.30 $4.30 $4.30 $81.85 330104 84466 400 301 HC ASSAY OF TRANSFERRIN O $378.78 $12.76 $12.76 $12.50 $189.39 N/A N/A N/A $12.50 $24.24 $12.50 $12.76 $284.08 $14.04 $238.63 $276.89 $15.00 $12.50 $227.27 $303.02 $43.38 $72.73 $12.50 $12.76 $246.21 $17.50 $303.02 $12.50 $12.50 $15.00 $17.86 $12.50 $12.76 $12.76 $13.91 $303.02 $321.96 $16.88 $284.08 $25.62 $16.88 $189.39 $246.21 $17.93 $17.93 $17.93 $17.93 $21.56 $13.40 $12.76 $21.56 $12.50 $12.50 $9.57 $9.57 $9.57 $9.57 $321.96 330104 84460 402 301 HC ALANINE AMINO (ALT) (SGPT) O $121.98 $5.30 $5.30 $5.03 $60.99 N/A N/A N/A $5.03 $10.07 $5.03 $5.30 $91.48 $5.83 $76.85 $89.17 $6.04 $5.03 $73.19 $97.58 $18.02 $30.21 $5.03 $5.30 $79.29 $7.04 $97.58 $5.03 $5.03 $6.04 $7.42 $5.03 $5.30 $5.30 $5.78 $97.58 $103.68 $6.79 $91.48 $10.31 $6.79 $60.99 $79.29 $7.45 $7.45 $7.45 $7.45 $8.93 $5.57 $5.30 $8.93 $5.03 $5.03 $3.97 $3.97 $3.97 $3.97 $103.68 330104 84450 402 301 HC TRANSFERASE (AST) (SGOT) O $142.31 $5.18 $5.18 $5.03 $71.16 N/A N/A N/A $5.03 $9.84 $5.03 $5.18 $106.73 $5.70 $89.66 $104.03 $6.04 $5.03 $85.39 $113.85 $17.61 $29.53 $5.03 $5.18 $92.50 $7.04 $113.85 $5.03 $5.03 $6.04 $7.25 $5.03 $5.18 $5.18 $5.65 $113.85 $120.96 $6.79 $106.73 $10.31 $6.79 $71.16 $92.50 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $5.03 $5.03 $3.88 $3.88 $3.88 $3.88 $120.96 330104 84446 400 301 HC ASSAY OF VITAMIN E O $58.85 $14.18 $14.18 $14.18 $29.43 N/A N/A N/A $14.18 $26.94 $14.18 $14.18 $44.14 $15.60 $37.08 $43.02 $17.02 $14.18 $35.31 $47.08 $48.21 $80.83 $14.18 $14.18 $38.25 $19.85 $47.08 $14.18 $14.18 $17.02 $19.85 $14.18 $14.18 $14.18 $15.46 $47.08 $50.02 $19.14 $44.14 $29.07 $19.14 $29.43 $38.25 $19.92 $19.92 $19.92 $19.92 $23.94 $14.89 $14.18 $23.94 $14.18 $14.18 $10.63 $10.63 $10.63 $10.63 $80.83 330104 84445 399 301 HC ASSAY OF TSI GLOBULIN O $795.01 $50.86 $50.86 N/A $397.50 N/A N/A N/A N/A $96.63 N/A $50.86 $596.26 $55.95 $500.86 $581.15 N/A N/A $477.01 $636.01 $172.92 $289.90 N/A $50.86 $516.76 N/A $636.01 N/A N/A N/A $71.20 N/A $50.86 $50.86 $55.44 $636.01 $675.76 N/A $596.26 N/A N/A $397.50 $516.76 $71.46 $71.46 $71.46 $71.46 $85.87 $53.40 $50.86 $85.87 N/A N/A $38.14 $38.14 $38.14 $38.14 $675.76 330104 84443 398 301 HC ASSAY THYROID STIM HORMONE O $340.26 $16.80 $16.80 $9.00 $170.13 N/A N/A N/A $9.00 $31.92 $9.00 $16.80 $255.19 $18.48 $214.36 $248.73 $10.80 $9.00 $204.16 $272.21 $57.12 $95.76 $9.00 $16.80 $221.17 $12.60 $272.21 $9.00 $9.00 $10.80 $23.52 $9.00 $16.80 $16.80 $18.31 $272.21 $289.22 $12.15 $255.19 $18.45 $12.15 $170.13 $221.17 $23.60 $23.60 $23.60 $23.60 $28.37 $17.64 $16.80 $28.37 $9.00 $9.00 $12.60 $12.60 $12.60 $9.00 $289.22 330104 84442 398 301 HC ASSAY OF THYROID ACTIVITY O $522.16 $14.78 $14.78 $9.00 $261.08 N/A N/A N/A $9.00 $28.08 $9.00 $14.78 $391.62 $16.26 $328.96 $381.70 $10.80 $9.00 $313.30 $417.73 $50.25 $84.25 $9.00 $14.78 $339.40 $12.60 $417.73 $9.00 $9.00 $10.80 $20.69 $9.00 $14.78 $14.78 $16.11 $417.73 $443.84 $12.15 $391.62 $18.45 $12.15 $261.08 $339.40 $20.77 $20.77 $20.77 $20.77 $24.98 $15.52 $14.78 $24.98 $9.00 $9.00 $11.08 $11.08 $11.08 $9.00 $443.84 330104 84439 398 301 HC ASSAY OF FREE THYROXINE O $154.08 $9.02 $9.02 $9.00 $77.04 N/A N/A N/A $9.00 $17.14 $9.00 $9.02 $115.56 $9.92 $97.07 $112.63 $10.80 $9.00 $92.45 $123.26 $30.67 $51.41 $9.00 $9.02 $100.15 $12.60 $123.26 $9.00 $9.00 $10.80 $12.63 $9.00 $9.02 $9.02 $9.83 $123.26 $130.97 $12.15 $115.56 $18.45 $12.15 $77.04 $100.15 $12.67 $12.67 $12.67 $12.67 $15.23 $9.47 $9.02 $15.23 $9.00 $9.00 $6.76 $6.76 $6.76 $6.76 $130.97 330104 84436 398 301 HC ASSAY OF TOTAL THYROXINE O $112.35 $6.87 $6.87 $5.70 $56.17 N/A N/A N/A $5.70 $13.05 $5.70 $6.87 $84.26 $7.56 $70.78 $82.13 $6.84 $5.70 $67.41 $89.88 $23.36 $39.16 $5.70 $6.87 $73.03 $7.98 $89.88 $5.70 $5.70 $6.84 $9.62 $5.70 $6.87 $6.87 $7.49 $89.88 $95.50 $7.70 $84.26 $11.68 $7.70 $56.17 $73.03 $9.65 $9.65 $9.65 $9.65 $11.60 $7.21 $6.87 $11.60 $5.70 $5.70 $5.15 $5.15 $5.15 $5.15 $95.50 330104 84432 398 301 HC ASSAY OF THYROGLOBULIN O $254.66 $16.06 $16.06 N/A $127.33 N/A N/A N/A N/A $30.51 N/A $16.06 $191.00 $17.67 $160.44 $186.16 N/A N/A $152.80 $203.73 $54.60 $91.54 N/A $16.06 $165.53 N/A $203.73 N/A N/A N/A $22.48 N/A $16.06 $16.06 $17.51 $203.73 $216.46 N/A $191.00 N/A N/A $127.33 $165.53 $22.56 $22.56 $22.56 $22.56 $27.13 $16.86 $16.06 $27.13 N/A N/A $12.04 $12.04 $12.04 $12.04 $216.46 330104 84425 400 301 HC ASSAY OF VITAMIN B-1 O $814.27 $21.23 $21.23 $15.00 $407.13 N/A N/A N/A $15.00 $40.34 $15.00 $21.23 $610.70 $23.35 $512.99 $595.23 $18.00 $15.00 $488.56 $651.42 $72.18 $121.01 $15.00 $21.23 $529.28 $21.00 $651.42 $15.00 $15.00 $18.00 $29.72 $15.00 $21.23 $21.23 $23.14 $651.42 $692.13 $20.25 $610.70 $30.75 $20.25 $407.13 $529.28 $29.83 $29.83 $29.83 $29.83 $35.86 $22.29 $21.23 $35.86 $15.00 $15.00 $15.92 $15.92 $15.92 $15.00 $692.13 330104 84403 398 301 HC ASSAY OF TOTAL TESTOSTERONE O $800.36 $25.81 $25.81 $25.81 $400.18 N/A N/A N/A $25.81 $49.04 $25.81 $25.81 $600.27 $28.39 $504.23 $585.06 $30.97 $25.81 $480.22 $640.29 $87.75 $147.12 $25.81 $25.81 $520.23 $36.13 $640.29 $25.81 $25.81 $30.97 $36.13 $25.81 $25.81 $25.81 $28.13 $640.29 $680.31 $34.84 $600.27 $52.91 $34.84 $400.18 $520.23 $36.26 $36.26 $36.26 $36.26 $43.60 $27.10 $25.81 $43.60 $25.81 $25.81 $19.36 $19.36 $19.36 $19.36 $680.31 330104 84402 398 301 HC ASSAY OF FREE TESTOSTERONE O $404.46 $25.47 $25.47 $25.47 $202.23 N/A N/A N/A $25.47 $48.39 $25.47 $25.47 $303.34 $28.02 $254.81 $295.66 $30.56 $25.47 $242.68 $323.57 $86.60 $145.18 $25.47 $25.47 $262.90 $35.66 $323.57 $25.47 $25.47 $30.56 $35.66 $25.47 $25.47 $25.47 $27.76 $323.57 $343.79 $34.38 $303.34 $52.21 $34.38 $202.23 $262.90 $35.79 $35.79 $35.79 $35.79 $43.01 $26.74 $25.47 $43.01 $25.47 $25.47 $19.10 $19.10 $19.10 $19.10 $343.79 330104 84378 400 301 HC SUGARS SINGLE QUANT O $53.50 $11.53 $11.53 $11.53 $26.75 N/A N/A N/A $11.53 $21.91 $11.53 $11.53 $40.12 $12.68 $33.70 $39.11 $13.84 $11.53 $32.10 $42.80 $39.20 $65.72 $11.53 $11.53 $34.77 $16.14 $42.80 $11.53 $11.53 $13.84 $16.14 $11.53 $11.53 $11.53 $12.57 $42.80 $45.48 $15.57 $40.12 $23.64 $15.57 $26.75 $34.77 $16.20 $16.20 $16.20 $16.20 $19.46 $12.11 $11.53 $19.46 $11.53 $11.53 $8.65 $8.65 $8.65 $8.65 $65.72 330104 84481 398 301 HC FREE ASSAY (FT-3) O "$1,009.01 " $16.94 $16.94 $9.00 $504.50 N/A N/A N/A $9.00 $32.19 $9.00 $16.94 $756.76 $18.63 $635.68 $737.59 $10.80 $9.00 $605.41 $807.21 $57.60 $96.56 $9.00 $16.94 $655.86 $12.60 $807.21 $9.00 $9.00 $10.80 $23.72 $9.00 $16.94 $16.94 $18.46 $807.21 $857.66 $12.15 $756.76 $18.45 $12.15 $504.50 $655.86 $23.80 $23.80 $23.80 $23.80 $28.61 $17.79 $16.94 $28.61 $9.00 $9.00 $12.71 $12.71 $12.71 $9.00 $857.66 330104 84311 402 301 HC SPECTROPHOTOMETRY O $254.66 $8.10 $8.10 N/A $127.33 N/A N/A N/A N/A $15.39 N/A $8.10 $191.00 $8.91 $160.44 $186.16 N/A N/A $152.80 $203.73 $27.54 $46.17 N/A $8.10 $165.53 N/A $203.73 N/A N/A N/A $11.34 N/A $8.10 $8.10 $8.83 $203.73 $216.46 N/A $191.00 N/A N/A $127.33 $165.53 $11.38 $11.38 $11.38 $11.38 $11.80 $8.51 $8.10 $11.80 N/A N/A $6.07 $6.07 $6.07 $6.07 $216.46 330104 84482 398 301 HC T3 REVERSE O $864.56 $15.76 $15.76 $5.70 $432.28 N/A N/A N/A $5.70 $29.94 $5.70 $15.76 $648.42 $17.34 $544.67 $631.99 $6.84 $5.70 $518.74 $691.65 $53.58 $89.83 $5.70 $15.76 $561.96 $7.98 $691.65 $5.70 $5.70 $6.84 $22.06 $5.70 $15.76 $15.76 $17.18 $691.65 $734.88 $7.70 $648.42 $11.68 $7.70 $432.28 $561.96 $22.14 $22.14 $22.14 $22.14 $26.62 $16.55 $15.76 $26.62 $5.70 $5.70 $11.82 $11.82 $11.82 $5.70 $734.88 330104 84520 402 301 HC ASSAY OF UREA NITROGEN O $79.18 $3.95 $3.95 $3.95 $39.59 N/A N/A N/A $3.95 $7.50 $3.95 $3.95 $59.39 $4.35 $49.88 $57.88 $4.74 $3.95 $47.51 $63.34 $13.43 $22.52 $3.95 $3.95 $51.47 $5.53 $63.34 $3.95 $3.95 $4.74 $5.53 $3.95 $3.95 $3.95 $4.31 $63.34 $67.30 $5.33 $59.39 $8.10 $5.33 $39.59 $51.47 $5.55 $5.55 $5.55 $5.55 $6.67 $4.15 $3.95 $6.67 $3.95 $3.95 $2.96 $2.96 $2.96 $2.96 $67.30 330104 87529 397 301 HC HERPES S AMPLIF NA PROBE O $222.56 $35.09 $35.09 $32.15 $111.28 N/A N/A N/A $32.15 $66.67 $32.15 $35.09 $166.92 $38.60 $140.21 $162.69 $38.58 $32.15 $133.54 $178.05 $119.31 $200.01 $32.15 $35.09 $144.66 $45.01 $178.05 $32.15 $32.15 $38.58 $49.13 $32.15 $35.09 $35.09 $38.25 $178.05 $189.18 $43.40 $166.92 $65.91 $43.40 $111.28 $144.66 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $32.15 $32.15 $26.32 $26.32 $26.32 $26.32 $200.01 330104 87158 396 301 HC CULTURE TYPING ADDED METHOD O $155.15 $7.74 $7.74 N/A $77.58 N/A N/A N/A N/A $14.71 N/A $7.74 $116.36 $8.51 $97.74 $113.41 N/A N/A $93.09 $124.12 $26.32 $44.12 N/A $7.74 $100.85 N/A $124.12 N/A N/A N/A $10.84 N/A $7.74 $7.74 $8.44 $124.12 $131.88 N/A $116.36 N/A N/A $77.58 $100.85 $10.87 $10.87 $10.87 $10.87 $8.83 $8.13 $7.74 $8.83 N/A N/A $5.80 $5.80 $5.80 $5.80 $131.88 330104 86352 395 301 HC CELL FUNCTION ASSAY W/STIM O $505.04 $135.86 $135.86 N/A $252.52 N/A N/A N/A N/A $258.13 N/A $135.86 $378.78 $149.45 $318.18 $369.18 N/A N/A $303.02 $404.03 $461.92 $774.40 N/A $135.86 $328.28 N/A $404.03 N/A N/A N/A $190.20 N/A $135.86 $135.86 $148.09 $404.03 $429.28 N/A $378.78 N/A N/A $252.52 $328.28 $190.88 $190.88 $190.88 $190.88 $229.43 $142.65 $135.86 $229.43 N/A N/A $101.90 $101.90 $101.90 $101.90 $774.40 330104 86336 394 301 HC INHIBIN A O $528.58 $15.59 $15.59 $6.50 $264.29 N/A N/A N/A $6.50 $29.62 $6.50 $15.59 $396.44 $17.15 $333.01 $386.39 $7.80 $6.50 $317.15 $422.86 $53.01 $88.86 $6.50 $15.59 $343.58 $9.10 $422.86 $6.50 $6.50 $7.80 $21.83 $6.50 $15.59 $15.59 $16.99 $422.86 $449.29 $8.78 $396.44 $13.32 $8.78 $264.29 $343.58 $21.90 $21.90 $21.90 $21.90 $26.32 $16.37 $15.59 $26.32 $6.50 $6.50 $11.69 $11.69 $11.69 $6.50 $449.29 330104 86335 395 301 HC IMMUNFIX E-PHORSIS/URINE/CSF O $465.45 $29.35 $29.35 $29.35 $232.72 N/A N/A N/A $29.35 $55.77 $29.35 $29.35 $349.09 $32.29 $293.23 $340.24 $35.22 $29.35 $279.27 $372.36 $99.79 $167.30 $29.35 $29.35 $302.54 $41.09 $372.36 $29.35 $29.35 $35.22 $41.09 $29.35 $29.35 $29.35 $31.99 $372.36 $395.63 $39.62 $349.09 $60.17 $39.62 $232.72 $302.54 $41.24 $41.24 $41.24 $41.24 $49.56 $30.82 $29.35 $49.56 $29.35 $29.35 $22.01 $22.01 $22.01 $22.01 $395.63 330104 85415 406 301 HC FIBRINOLYTIC PLASMINOGEN ACTIVATOR O $333.84 $17.19 $17.19 N/A $166.92 N/A N/A N/A N/A $32.66 N/A $17.19 $250.38 $18.91 $210.32 $244.04 N/A N/A $200.30 $267.07 $58.45 $97.98 N/A $17.19 $217.00 N/A $267.07 N/A N/A N/A $24.07 N/A $17.19 $17.19 $18.74 $267.07 $283.76 N/A $250.38 N/A N/A $166.92 $217.00 $24.15 $24.15 $24.15 $24.15 $29.04 $18.05 $17.19 $29.04 N/A N/A $12.89 $12.89 $12.89 $12.89 $283.76 330104 84703 402 301 HC CHORIONIC GONADOTROPIN ASSAY O $79.18 $7.52 $7.52 $2.00 $39.59 N/A N/A N/A $2.00 $14.29 $2.00 $7.52 $59.39 $8.27 $49.88 $57.88 $2.40 $2.00 $47.51 $63.34 $25.57 $42.86 $2.00 $7.52 $51.47 $2.80 $63.34 $2.00 $2.00 $2.40 $10.53 $2.00 $7.52 $7.52 $8.20 $63.34 $67.30 $2.70 $59.39 $4.10 $2.70 $39.59 $51.47 $10.57 $10.57 $10.57 $10.57 $12.68 $7.90 $7.52 $12.68 $2.00 $2.00 $5.64 $5.64 $5.64 $2.00 $67.30 330104 84702 398 301 HC CHORIONIC GONADOTROPIN TEST O $284.62 $15.05 $15.05 $12.37 $142.31 N/A N/A N/A $12.37 $28.59 $12.37 $15.05 $213.47 $16.56 $179.31 $208.06 $14.84 $12.37 $170.77 $227.70 $51.17 $85.79 $12.37 $15.05 $185.00 $17.32 $227.70 $12.37 $12.37 $14.84 $21.07 $12.37 $15.05 $15.05 $16.40 $227.70 $241.93 $16.70 $213.47 $25.36 $16.70 $142.31 $185.00 $21.15 $21.15 $21.15 $21.15 $25.43 $15.80 $15.05 $25.43 $12.37 $12.37 $11.29 $11.29 $11.29 $11.29 $241.93 330104 84681 400 301 HC ASSAY OF C-PEPTIDE O "$1,153.46 " $20.81 $20.81 $20.81 $576.73 N/A N/A N/A $20.81 $39.54 $20.81 $20.81 $865.10 $22.89 $726.68 $843.18 $24.97 $20.81 $692.08 $922.77 $70.75 $118.62 $20.81 $20.81 $749.75 $29.13 $922.77 $20.81 $20.81 $24.97 $29.13 $20.81 $20.81 $20.81 $22.68 $922.77 $980.44 $28.09 $865.10 $42.66 $28.09 $576.73 $749.75 $29.24 $29.24 $29.24 $29.24 $35.14 $21.85 $20.81 $35.14 $20.81 $20.81 $15.61 $15.61 $15.61 $15.61 $980.44 330104 84630 404 301 HC ASSAY OF ZINC O $194.74 $11.39 $11.39 $7.90 $97.37 N/A N/A N/A $7.90 $21.64 $7.90 $11.39 $146.06 $12.53 $122.69 $142.35 $9.48 $7.90 $116.84 $155.79 $38.73 $64.92 $7.90 $11.39 $126.58 $11.06 $155.79 $7.90 $7.90 $9.48 $15.95 $7.90 $11.39 $11.39 $12.42 $155.79 $165.53 $10.67 $146.06 $16.20 $10.67 $97.37 $126.58 $16.00 $16.00 $16.00 $16.00 $19.22 $11.96 $11.39 $19.22 $7.90 $7.90 $8.54 $8.54 $8.54 $7.90 $165.53 330104 84597 400 301 HC ASSAY OF VITAMIN K O $218.28 $13.72 $13.72 $13.72 $109.14 N/A N/A N/A $13.72 $26.07 $13.72 $13.72 $163.71 $15.09 $137.52 $159.56 $16.46 $13.72 $130.97 $174.62 $46.65 $78.20 $13.72 $13.72 $141.88 $19.21 $174.62 $13.72 $13.72 $16.46 $19.21 $13.72 $13.72 $13.72 $14.95 $174.62 $185.54 $18.52 $163.71 $28.13 $18.52 $109.14 $141.88 $19.28 $19.28 $19.28 $19.28 $23.15 $14.41 $13.72 $23.15 $13.72 $13.72 $10.29 $10.29 $10.29 $10.29 $185.54 330104 84591 400 301 HC ASSAY OF NOS VITAMIN O $129.47 $17.06 $17.06 N/A $64.73 N/A N/A N/A N/A $32.41 N/A $17.06 $97.10 $18.77 $81.57 $94.64 N/A N/A $77.68 $103.58 $58.00 $97.24 N/A $17.06 $84.16 N/A $103.58 N/A N/A N/A $23.88 N/A $17.06 $17.06 $18.60 $103.58 $110.05 N/A $97.10 N/A N/A $64.73 $84.16 $23.97 $23.97 $23.97 $23.97 $19.58 $17.91 $17.06 $19.58 N/A N/A $12.79 $12.79 $12.79 $12.79 $110.05 330104 84590 400 301 HC ASSAY OF VITAMIN A O $235.40 $11.61 $11.61 $11.61 $117.70 N/A N/A N/A $11.61 $22.06 $11.61 $11.61 $176.55 $12.77 $148.30 $172.08 $13.93 $11.61 $141.24 $188.32 $39.47 $66.18 $11.61 $11.61 $153.01 $16.25 $188.32 $11.61 $11.61 $13.93 $16.25 $11.61 $11.61 $11.61 $12.65 $188.32 $200.09 $15.67 $176.55 $23.80 $15.67 $117.70 $153.01 $16.31 $16.31 $16.31 $16.31 $19.58 $12.19 $11.61 $19.58 $11.61 $11.61 $8.71 $8.71 $8.71 $8.71 $200.09 330104 84586 399 301 HC ASSAY OF VASOACTIVE INTESTINAL PEPTIDE O $760.77 $35.33 $35.33 N/A $380.38 N/A N/A N/A N/A $67.13 N/A $35.33 $570.58 $38.86 $479.29 $556.12 N/A N/A $456.46 $608.62 $120.12 $201.38 N/A $35.33 $494.50 N/A $608.62 N/A N/A N/A $49.46 N/A $35.33 $35.33 $38.51 $608.62 $646.65 N/A $570.58 N/A N/A $380.38 $494.50 $49.64 $49.64 $49.64 $49.64 $59.66 $37.10 $35.33 $59.66 N/A N/A $26.50 $26.50 $26.50 $26.50 $646.65 330104 84560 402 301 HC ASSAY OF URINE/URIC ACID O $182.97 $5.08 $5.08 $5.03 $91.48 N/A N/A N/A $5.03 $9.65 $5.03 $5.08 $137.23 $5.59 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $17.27 $28.96 $5.03 $5.08 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.11 $5.03 $5.08 $5.08 $5.54 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.14 $7.14 $7.14 $7.14 $8.02 $5.33 $5.08 $8.02 $5.03 $5.03 $3.81 $3.81 $3.81 $3.81 $155.52 330104 84550 402 301 HC ASSAY OF BLOOD/URIC ACID O $79.18 $4.52 $4.52 $4.52 $39.59 N/A N/A N/A $4.52 $8.59 $4.52 $4.52 $59.39 $4.97 $49.88 $57.88 $5.42 $4.52 $47.51 $63.34 $15.37 $25.76 $4.52 $4.52 $51.47 $6.33 $63.34 $4.52 $4.52 $5.42 $6.33 $4.52 $4.52 $4.52 $4.93 $63.34 $67.30 $6.10 $59.39 $9.27 $6.10 $39.59 $51.47 $6.35 $6.35 $6.35 $6.35 $7.63 $4.75 $4.52 $7.63 $4.52 $4.52 $3.39 $3.39 $3.39 $3.39 $67.30 330104 84540 402 301 HC ASSAY OF URINE/UREA-N O $182.97 $5.56 $5.56 $5.03 $91.48 N/A N/A N/A $5.03 $10.56 $5.03 $5.56 $137.23 $6.12 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $18.90 $31.69 $5.03 $5.56 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.78 $5.03 $5.56 $5.56 $6.06 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.81 $7.81 $7.81 $7.81 $8.02 $5.84 $5.56 $8.02 $5.03 $5.03 $4.17 $4.17 $4.17 $4.17 $155.52 330104 84484 400 301 HC ASSAY OF TROPONIN QUANT O $311.37 $12.47 $12.47 $8.05 $155.69 N/A N/A N/A $8.05 $23.69 $8.05 $12.47 $233.53 $13.72 $196.16 $227.61 $9.66 $8.05 $186.82 $249.10 $42.40 $71.08 $8.05 $12.47 $202.39 $11.27 $249.10 $8.05 $8.05 $9.66 $17.46 $8.05 $12.47 $12.47 $13.59 $249.10 $264.66 $10.87 $233.53 $16.50 $10.87 $155.69 $202.39 $17.52 $17.52 $17.52 $17.52 $16.62 $13.09 $12.47 $16.62 $8.05 $8.05 $9.35 $9.35 $9.35 $8.05 $264.66 330104 83880 401 301 HC ASSAY OF NATRIURETIC PEPTIDE O $210.79 $39.26 $39.26 $34.07 $105.39 N/A N/A N/A $34.07 $74.59 $34.07 $39.26 $158.09 $43.19 $132.80 $154.09 $40.88 $34.07 $126.47 $168.63 $133.48 $223.78 $34.07 $39.26 $137.01 $47.70 $168.63 $34.07 $34.07 $40.88 $54.96 $34.07 $39.26 $39.26 $42.79 $168.63 $179.17 $45.99 $158.09 $69.84 $45.99 $105.39 $137.01 $55.16 $55.16 $55.16 $55.16 $57.32 $41.22 $39.26 $57.32 $34.07 $34.07 $29.45 $29.45 $29.45 $29.45 $223.78 330104 84305 398 301 HC ASSAY OF SOMATOMEDIN O $432.28 $21.26 $21.26 $20.50 $216.14 N/A N/A N/A $20.50 $40.39 $20.50 $21.26 $324.21 $23.39 $272.34 $316.00 $24.60 $20.50 $259.37 $345.82 $72.28 $121.18 $20.50 $21.26 $280.98 $28.70 $345.82 $20.50 $20.50 $24.60 $29.76 $20.50 $21.26 $21.26 $23.17 $345.82 $367.44 $27.68 $324.21 $42.02 $27.68 $216.14 $280.98 $29.87 $29.87 $29.87 $29.87 $35.90 $22.32 $21.26 $35.90 $20.50 $20.50 $15.95 $15.95 $15.95 $15.95 $367.44 330104 84295 402 301 HC ASSAY OF SERUM SODIUM O $79.18 $4.81 $4.81 $4.81 $39.59 N/A N/A N/A $4.81 $9.14 $4.81 $4.81 $59.39 $5.29 $49.88 $57.88 $5.77 $4.81 $47.51 $63.34 $16.35 $27.42 $4.81 $4.81 $51.47 $6.73 $63.34 $4.81 $4.81 $5.77 $6.73 $4.81 $4.81 $4.81 $5.24 $63.34 $67.30 $6.49 $59.39 $9.86 $6.49 $39.59 $51.47 $6.76 $6.76 $6.76 $6.76 $8.12 $5.05 $4.81 $8.12 $4.81 $4.81 $3.61 $3.61 $3.61 $3.61 $67.30 330104 84132 402 301 HC ASSAY OF SERUM POTASSIUM O $79.18 $4.76 $4.76 $4.76 $39.59 N/A N/A N/A $4.76 $9.04 $4.76 $4.76 $59.39 $5.24 $49.88 $57.88 $5.71 $4.76 $47.51 $63.34 $16.18 $27.13 $4.76 $4.76 $51.47 $6.66 $63.34 $4.76 $4.76 $5.71 $6.66 $4.76 $4.76 $4.76 $5.19 $63.34 $67.30 $6.43 $59.39 $9.76 $6.43 $39.59 $51.47 $6.69 $6.69 $6.69 $6.69 $7.76 $5.00 $4.76 $7.76 $4.76 $4.76 $3.57 $3.57 $3.57 $3.57 $67.30 330104 84120 400 301 HC ASSAY OF URINE PORPHYRINS O $475.08 $14.71 $14.71 $14.71 $237.54 N/A N/A N/A $14.71 $27.95 $14.71 $14.71 $356.31 $16.18 $299.30 $347.28 $17.65 $14.71 $285.05 $380.06 $50.01 $83.85 $14.71 $14.71 $308.80 $20.59 $380.06 $14.71 $14.71 $17.65 $20.59 $14.71 $14.71 $14.71 $16.03 $380.06 $403.82 $19.86 $356.31 $30.16 $19.86 $237.54 $308.80 $20.67 $20.67 $20.67 $20.67 $24.84 $15.45 $14.71 $24.84 $14.71 $14.71 $11.03 $11.03 $11.03 $11.03 $403.82 330104 84110 402 301 HC ASSAY OF PORPHOBILINOGEN O $34.24 $8.44 $8.44 $8.44 $17.12 N/A N/A N/A $8.44 $16.04 $8.44 $8.44 $25.68 $9.28 $21.57 $25.03 $10.13 $8.44 $20.54 $27.39 $28.70 $48.11 $8.44 $8.44 $22.26 $11.82 $27.39 $8.44 $8.44 $10.13 $11.82 $8.44 $8.44 $8.44 $9.20 $27.39 $29.10 $11.39 $25.68 $17.30 $11.39 $17.12 $22.26 $11.86 $11.86 $11.86 $11.86 $14.26 $8.86 $8.44 $14.26 $8.44 $8.44 $6.33 $6.33 $6.33 $6.33 $48.11 330104 84105 402 301 HC ASSAY OF URINE PHOSPHORUS O $79.18 $5.78 $5.78 $5.03 $39.59 N/A N/A N/A $5.03 $10.98 $5.03 $5.78 $59.39 $6.36 $49.88 $57.88 $6.04 $5.03 $47.51 $63.34 $19.65 $32.95 $5.03 $5.78 $51.47 $7.04 $63.34 $5.03 $5.03 $6.04 $8.09 $5.03 $5.78 $5.78 $6.30 $63.34 $67.30 $6.79 $59.39 $10.31 $6.79 $39.59 $51.47 $8.12 $8.12 $8.12 $8.12 $8.74 $6.07 $5.78 $8.74 $5.03 $5.03 $4.33 $4.33 $4.33 $4.33 $67.30 330104 84100 402 301 HC ASSAY OF PHOSPHORUS O $182.97 $4.74 $4.74 $4.74 $91.48 N/A N/A N/A $4.74 $9.01 $4.74 $4.74 $137.23 $5.21 $115.27 $133.75 $5.69 $4.74 $109.78 $146.38 $16.12 $27.02 $4.74 $4.74 $118.93 $6.64 $146.38 $4.74 $4.74 $5.69 $6.64 $4.74 $4.74 $4.74 $5.17 $146.38 $155.52 $6.40 $137.23 $9.72 $6.40 $91.48 $118.93 $6.66 $6.66 $6.66 $6.66 $8.00 $4.98 $4.74 $8.00 $4.74 $4.74 $3.56 $3.56 $3.56 $3.56 $155.52 330104 84080 400 301 HC ASSAY ALKALINE PHOSPHATASES O $236.47 $14.78 $14.78 $9.91 $118.23 N/A N/A N/A $9.91 $28.08 $9.91 $14.78 $177.35 $16.26 $148.98 $172.86 $11.89 $9.91 $141.88 $189.18 $50.25 $84.25 $9.91 $14.78 $153.71 $13.87 $189.18 $9.91 $9.91 $11.89 $20.69 $9.91 $14.78 $14.78 $16.11 $189.18 $201.00 $13.38 $177.35 $20.32 $13.38 $118.23 $153.71 $20.77 $20.77 $20.77 $20.77 $24.98 $15.52 $14.78 $24.98 $9.91 $9.91 $11.08 $11.08 $11.08 $9.91 $201.00 330104 84075 402 301 HC ASSAY ALKALINE PHOSPHATASE O $306.02 $5.18 $5.18 $5.03 $153.01 N/A N/A N/A $5.03 $9.84 $5.03 $5.18 $229.51 $5.70 $192.79 $223.70 $6.04 $5.03 $183.61 $244.82 $17.61 $29.53 $5.03 $5.18 $198.91 $7.04 $244.82 $5.03 $5.03 $6.04 $7.25 $5.03 $5.18 $5.18 $5.65 $244.82 $260.12 $6.79 $229.51 $10.31 $6.79 $153.01 $198.91 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $5.03 $5.03 $3.88 $3.88 $3.88 $3.88 $260.12 330104 84030 402 301 HC ASSAY OF BLOOD PKU O $263.22 $5.50 $5.50 $5.50 $131.61 N/A N/A N/A $5.50 $10.45 $5.50 $5.50 $197.42 $6.05 $165.83 $192.41 $6.60 $5.50 $157.93 $210.58 $18.70 $31.35 $5.50 $5.50 $171.09 $7.70 $210.58 $5.50 $5.50 $6.60 $7.70 $5.50 $5.50 $5.50 $6.00 $210.58 $223.74 $7.43 $197.42 $11.27 $7.43 $131.61 $171.09 $7.73 $7.73 $7.73 $7.73 $9.29 $5.78 $5.50 $9.29 $5.50 $5.50 $4.12 $4.12 $4.12 $4.12 $223.74 330104 83993 400 301 HC ASSAY FOR CALPROTECTIN FECAL O $121.98 $19.63 $19.63 $11.28 $60.99 N/A N/A N/A $11.28 $37.30 $11.28 $19.63 $91.48 $21.59 $76.85 $89.17 $13.54 $11.28 $73.19 $97.58 $66.74 $111.89 $11.28 $19.63 $79.29 $15.79 $97.58 $11.28 $11.28 $13.54 $27.48 $11.28 $19.63 $19.63 $21.40 $97.58 $103.68 $15.23 $91.48 $23.12 $15.23 $60.99 $79.29 $27.58 $27.58 $27.58 $27.58 $33.14 $20.61 $19.63 $33.14 $11.28 $11.28 $14.72 $14.72 $14.72 $11.28 $111.89 330104 83992 404 301 HC PHENCYCLIDINE O $235.40 N/A N/A N/A $117.70 N/A N/A N/A N/A N/A N/A N/A $176.55 N/A $148.30 $172.08 N/A N/A $141.24 $188.32 N/A N/A N/A N/A $153.01 N/A $188.32 N/A N/A N/A N/A N/A N/A N/A N/A $188.32 $200.09 N/A $176.55 N/A N/A $117.70 $153.01 N/A N/A N/A N/A $24.82 N/A N/A $24.82 N/A N/A N/A N/A N/A $24.82 $200.09 330104 83986 402 301 HC ASSAY PH BODY FLUID NOS O $182.97 $3.58 $3.58 N/A $91.48 N/A N/A N/A N/A $6.80 N/A $3.58 $137.23 $3.94 $115.27 $133.75 N/A N/A $109.78 $146.38 $12.17 $20.41 N/A $3.58 $118.93 N/A $146.38 N/A N/A N/A $5.01 N/A $3.58 $3.58 $3.90 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 $5.03 $5.03 $5.03 $5.03 $6.05 $3.76 $3.58 $6.05 N/A N/A $2.69 $2.69 $2.69 $2.69 $155.52 330104 83970 399 301 HC ASSAY OF PARATHORMONE O $859.21 $41.28 $41.28 $41.28 $429.61 N/A N/A N/A $41.28 $78.43 $41.28 $41.28 $644.41 $45.41 $541.30 $628.08 $49.54 $41.28 $515.53 $687.37 $140.35 $235.30 $41.28 $41.28 $558.49 $57.79 $687.37 $41.28 $41.28 $49.54 $57.79 $41.28 $41.28 $41.28 $45.00 $687.37 $730.33 $55.73 $644.41 $84.62 $55.73 $429.61 $558.49 $58.00 $58.00 $58.00 $58.00 $69.70 $43.34 $41.28 $69.70 $41.28 $41.28 $30.96 $30.96 $30.96 $30.96 $730.33 330104 83937 399 301 HC ASSAY OF OSTEOCALCIN O $112.35 $29.85 $29.85 N/A $56.17 N/A N/A N/A N/A $56.72 N/A $29.85 $84.26 $32.84 $70.78 $82.13 N/A N/A $67.41 $89.88 $101.49 $170.15 N/A $29.85 $73.03 N/A $89.88 N/A N/A N/A $41.79 N/A $29.85 $29.85 $32.54 $89.88 $95.50 N/A $84.26 N/A N/A $56.17 $73.03 $41.94 $41.94 $41.94 $41.94 $50.41 $31.34 $29.85 $50.41 N/A N/A $22.39 $22.39 $22.39 $22.39 $170.15 330104 83935 402 301 HC ASSAY OF URINE OSMOLALITY O $182.97 $6.82 $6.82 $6.04 $91.48 N/A N/A N/A $6.04 $12.96 $6.04 $6.82 $137.23 $7.50 $115.27 $133.75 $7.25 $6.04 $109.78 $146.38 $23.19 $38.87 $6.04 $6.82 $118.93 $8.46 $146.38 $6.04 $6.04 $7.25 $9.55 $6.04 $6.82 $6.82 $7.43 $146.38 $155.52 $8.15 $137.23 $12.38 $8.15 $91.48 $118.93 $9.58 $9.58 $9.58 $9.58 $11.51 $7.16 $6.82 $11.51 $6.04 $6.04 $5.12 $5.12 $5.12 $5.12 $155.52 330104 83930 402 301 HC ASSAY OF BLOOD OSMOLALITY O $151.94 $6.61 $6.61 $6.04 $75.97 N/A N/A N/A $6.04 $12.56 $6.04 $6.61 $113.95 $7.27 $95.72 $111.07 $7.25 $6.04 $91.16 $121.55 $22.47 $37.68 $6.04 $6.61 $98.76 $8.46 $121.55 $6.04 $6.04 $7.25 $9.25 $6.04 $6.61 $6.61 $7.20 $121.55 $129.15 $8.15 $113.95 $12.38 $8.15 $75.97 $98.76 $9.29 $9.29 $9.29 $9.29 $11.16 $6.94 $6.61 $11.16 $6.04 $6.04 $4.96 $4.96 $4.96 $4.96 $129.15 330104 83921 400 301 HC ORGANIC ACID SINGLE QUANT O $439.77 $21.21 $21.21 $21.21 $219.88 N/A N/A N/A $21.21 $40.30 $21.21 $21.21 $329.83 $23.33 $277.06 $321.47 $25.45 $21.21 $263.86 $351.82 $72.11 $120.90 $21.21 $21.21 $285.85 $29.69 $351.82 $21.21 $21.21 $25.45 $29.69 $21.21 $21.21 $21.21 $23.12 $351.82 $373.80 $28.63 $329.83 $43.48 $28.63 $219.88 $285.85 $29.80 $29.80 $29.80 $29.80 $27.79 $22.27 $21.21 $27.79 $21.21 $21.21 $15.91 $15.91 $15.91 $15.91 $373.80 330104 83916 401 301 HC OLIGOCLONAL BANDS O $548.91 $27.39 $27.39 N/A $274.45 N/A N/A N/A N/A $52.04 N/A $27.39 $411.68 $30.13 $345.81 $401.25 N/A N/A $329.35 $439.13 $93.13 $156.12 N/A $27.39 $356.79 N/A $439.13 N/A N/A N/A $38.35 N/A $27.39 $27.39 $29.86 $439.13 $466.57 N/A $411.68 N/A N/A $274.45 $356.79 $38.48 $38.48 $38.48 $38.48 $33.96 $28.76 $27.39 $33.96 N/A N/A $20.54 $20.54 $20.54 $20.54 $466.57 330104 84133 402 301 HC ASSAY OF URINE POTASSIUM O $182.97 $4.73 $4.73 $4.73 $91.48 N/A N/A N/A $4.73 $8.99 $4.73 $4.73 $137.23 $5.20 $115.27 $133.75 $5.68 $4.73 $109.78 $146.38 $16.08 $26.96 $4.73 $4.73 $118.93 $6.62 $146.38 $4.73 $4.73 $5.68 $6.62 $4.73 $4.73 $4.73 $5.16 $146.38 $155.52 $6.39 $137.23 $9.70 $6.39 $91.48 $118.93 $6.65 $6.65 $6.65 $6.65 $7.26 $4.97 $4.73 $7.26 $4.73 $4.73 $3.55 $3.55 $3.55 $3.55 $155.52 330104 84300 402 301 HC ASSAY OF URINE SODIUM O $182.97 $5.06 $5.06 $5.03 $91.48 N/A N/A N/A $5.03 $9.61 $5.03 $5.06 $137.23 $5.57 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $17.20 $28.84 $5.03 $5.06 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.08 $5.03 $5.06 $5.06 $5.52 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.11 $7.11 $7.11 $7.11 $8.22 $5.31 $5.06 $8.22 $5.03 $5.03 $3.79 $3.79 $3.79 $3.79 $155.52 330104 84134 400 301 HC ASSAY OF PREALBUMIN O "$1,023.99 " $14.59 $14.59 $7.32 $512.00 N/A N/A N/A $7.32 $27.72 $7.32 $14.59 $767.99 $16.05 $645.11 $748.54 $8.78 $7.32 $614.39 $819.19 $49.61 $83.16 $7.32 $14.59 $665.59 $10.25 $819.19 $7.32 $7.32 $8.78 $20.43 $7.32 $14.59 $14.59 $15.90 $819.19 $870.39 $9.88 $767.99 $15.01 $9.88 $512.00 $665.59 $20.50 $20.50 $20.50 $20.50 $24.62 $15.32 $14.59 $24.62 $7.32 $7.32 $10.94 $10.94 $10.94 $7.32 $870.39 330104 84144 398 301 HC ASSAY OF PROGESTERONE O $527.51 $20.86 $20.86 $20.86 $263.75 N/A N/A N/A $20.86 $39.63 $20.86 $20.86 $395.63 $22.95 $332.33 $385.61 $25.03 $20.86 $316.51 $422.01 $70.92 $118.90 $20.86 $20.86 $342.88 $29.20 $422.01 $20.86 $20.86 $25.03 $29.20 $20.86 $20.86 $20.86 $22.74 $422.01 $448.38 $28.16 $395.63 $42.76 $28.16 $263.75 $342.88 $29.31 $29.31 $29.31 $29.31 $35.23 $21.90 $20.86 $35.23 $20.86 $20.86 $15.64 $15.64 $15.64 $15.64 $448.38 330104 84270 400 301 HC ASSAY OF SEX HORMONE GLOBUL O "$1,088.19 " $21.73 $21.73 N/A $544.10 N/A N/A N/A N/A $41.29 N/A $21.73 $816.14 $23.90 $685.56 $795.47 N/A N/A $652.91 $870.55 $73.88 $123.86 N/A $21.73 $707.32 N/A $870.55 N/A N/A N/A $30.42 N/A $21.73 $21.73 $23.69 $870.55 $924.96 N/A $816.14 N/A N/A $544.10 $707.32 $30.53 $30.53 $30.53 $30.53 $36.70 $22.82 $21.73 $36.70 N/A N/A $16.30 $16.30 $16.30 $16.30 $924.96 330104 84260 399 301 HC ASSAY OF SEROTONIN O $439.77 $30.98 $30.98 N/A $219.88 N/A N/A N/A N/A $58.86 N/A $30.98 $329.83 $34.08 $277.06 $321.47 N/A N/A $263.86 $351.82 $105.33 $176.59 N/A $30.98 $285.85 N/A $351.82 N/A N/A N/A $43.37 N/A $30.98 $30.98 $33.77 $351.82 $373.80 N/A $329.83 N/A N/A $219.88 $285.85 $43.53 $43.53 $43.53 $43.53 $52.31 $32.53 $30.98 $52.31 N/A N/A $23.23 $23.23 $23.23 $23.23 $373.80 330104 84252 400 301 HC ASSAY OF VITAMIN B-2 O $590.64 $20.24 $20.24 N/A $295.32 N/A N/A N/A N/A $38.46 N/A $20.24 $442.98 $22.26 $372.10 $431.76 N/A N/A $354.38 $472.51 $68.82 $115.37 N/A $20.24 $383.92 N/A $472.51 N/A N/A N/A $28.34 N/A $20.24 $20.24 $22.06 $472.51 $502.04 N/A $442.98 N/A N/A $295.32 $383.92 $28.44 $28.44 $28.44 $28.44 $34.18 $21.25 $20.24 $34.18 N/A N/A $15.18 $15.18 $15.18 $15.18 $502.04 330104 84244 398 301 HC ASSAY OF RENIN O $621.67 $21.99 $21.99 N/A $310.83 N/A N/A N/A N/A $41.78 N/A $21.99 $466.25 $24.19 $391.65 $454.44 N/A N/A $373.00 $497.34 $74.77 $125.34 N/A $21.99 $404.09 N/A $497.34 N/A N/A N/A $30.79 N/A $21.99 $21.99 $23.97 $497.34 $528.42 N/A $466.25 N/A N/A $310.83 $404.09 $30.90 $30.90 $30.90 $30.90 $37.14 $23.09 $21.99 $37.14 N/A N/A $16.49 $16.49 $16.49 $16.49 $528.42 330104 84220 402 301 HC ASSAY OF PYRUVATE KINASE O $263.22 $9.44 $9.44 $9.44 $131.61 N/A N/A N/A $9.44 $17.94 $9.44 $9.44 $197.42 $10.38 $165.83 $192.41 $11.33 $9.44 $157.93 $210.58 $32.10 $53.81 $9.44 $9.44 $171.09 $13.22 $210.58 $9.44 $9.44 $11.33 $13.22 $9.44 $9.44 $9.44 $10.29 $210.58 $223.74 $12.74 $197.42 $19.35 $12.74 $131.61 $171.09 $13.26 $13.26 $13.26 $13.26 $15.94 $9.91 $9.44 $15.94 $9.44 $9.44 $7.08 $7.08 $7.08 $7.08 $223.74 330104 84207 401 301 HC ASSAY OF VITAMIN B-6 O $892.38 $28.10 $28.10 $28.10 $446.19 N/A N/A N/A $28.10 $53.39 $28.10 $28.10 $669.28 $30.91 $562.20 $652.33 $33.72 $28.10 $535.43 $713.90 $95.54 $160.17 $28.10 $28.10 $580.05 $39.34 $713.90 $28.10 $28.10 $33.72 $39.34 $28.10 $28.10 $28.10 $30.63 $713.90 $758.52 $37.94 $669.28 $57.60 $37.94 $446.19 $580.05 $39.48 $39.48 $39.48 $39.48 $47.45 $29.51 $28.10 $47.45 $28.10 $28.10 $21.08 $21.08 $21.08 $21.08 $758.52 330104 84206 398 301 HC ASSAY OF PROINSULIN O $449.40 $26.69 $26.69 N/A $224.70 N/A N/A N/A N/A $50.71 N/A $26.69 $337.05 $29.36 $283.12 $328.51 N/A N/A $269.64 $359.52 $90.75 $152.13 N/A $26.69 $292.11 N/A $359.52 N/A N/A N/A $37.37 N/A $26.69 $26.69 $29.09 $359.52 $381.99 N/A $337.05 N/A N/A $224.70 $292.11 $37.50 $37.50 $37.50 $37.50 $30.08 $28.02 $26.69 $30.08 N/A N/A $20.02 $20.02 $20.02 $20.02 $381.99 330104 84182 395 301 HC PROTEIN WESTERN BLOT TEST O $283.55 $29.21 $29.21 N/A $141.78 N/A N/A N/A N/A $55.50 N/A $29.21 $212.66 $32.13 $178.64 $207.28 N/A N/A $170.13 $226.84 $99.31 $166.50 N/A $29.21 $184.31 N/A $226.84 N/A N/A N/A $40.89 N/A $29.21 $29.21 $31.84 $226.84 $241.02 N/A $212.66 N/A N/A $141.78 $184.31 $41.04 $41.04 $41.04 $41.04 $30.40 $30.67 $29.21 $30.40 N/A N/A $21.91 $21.91 $21.91 $21.91 $241.02 330104 82482 402 301 HC ASSAY RBC CHOLINESTERASE O $400.18 $9.81 $9.81 N/A $200.09 N/A N/A N/A N/A $18.64 N/A $9.81 $300.13 $10.79 $252.11 $292.53 N/A N/A $240.11 $320.14 $33.35 $55.92 N/A $9.81 $260.12 N/A $320.14 N/A N/A N/A $13.73 N/A $9.81 $9.81 $10.69 $320.14 $340.15 N/A $300.13 N/A N/A $200.09 $260.12 $13.78 $13.78 $13.78 $13.78 $12.97 $10.30 $9.81 $12.97 N/A N/A $7.36 $7.36 $7.36 $7.36 $340.15 330104 84165 402 301 HC PROTEIN E-PHORESIS SERUM O $321.00 $10.74 $10.74 $8.00 $160.50 N/A N/A N/A $8.00 $20.41 $8.00 $10.74 $240.75 $11.81 $202.23 $234.65 $9.60 $8.00 $192.60 $256.80 $36.52 $61.22 $8.00 $10.74 $208.65 $11.20 $256.80 $8.00 $8.00 $9.60 $15.04 $8.00 $10.74 $10.74 $11.71 $256.80 $272.85 $10.80 $240.75 $16.40 $10.80 $160.50 $208.65 $15.09 $15.09 $15.09 $15.09 $18.14 $11.28 $10.74 $18.14 $8.00 $8.00 $8.05 $8.05 $8.05 $8.00 $272.85 330104 84157 402 301 HC ASSAY OF PROTEIN OTHER O $182.97 $4.00 $4.00 $4.00 $91.48 N/A N/A N/A $4.00 $7.60 $4.00 $4.00 $137.23 $4.40 $115.27 $133.75 $4.80 $4.00 $109.78 $146.38 $13.60 $22.80 $4.00 $4.00 $118.93 $5.60 $146.38 $4.00 $4.00 $4.80 $5.60 $4.00 $4.00 $4.00 $4.36 $146.38 $155.52 $5.40 $137.23 $8.20 $5.40 $91.48 $118.93 $5.62 $5.62 $5.62 $5.62 $6.19 $4.20 $4.00 $6.19 $4.00 $4.00 $3.00 $3.00 $3.00 $3.00 $155.52 330104 84156 402 301 HC ASSAY OF PROTEIN URINE O $63.13 $3.67 $3.67 $3.67 $31.57 N/A N/A N/A $3.67 $6.97 $3.67 $3.67 $47.35 $4.04 $39.77 $46.15 $4.40 $3.67 $37.88 $50.50 $12.48 $20.92 $3.67 $3.67 $41.03 $5.14 $50.50 $3.67 $3.67 $4.40 $5.14 $3.67 $3.67 $3.67 $4.00 $50.50 $53.66 $4.95 $47.35 $7.52 $4.95 $31.57 $41.03 $5.16 $5.16 $5.16 $5.16 $6.19 $3.85 $3.67 $6.19 $3.67 $3.67 $2.75 $2.75 $2.75 $2.75 $53.66 330104 84155 402 301 HC ASSAY OF PROTEIN SERUM O $79.18 $3.67 $3.67 $3.67 $39.59 N/A N/A N/A $3.67 $6.97 $3.67 $3.67 $59.39 $4.04 $49.88 $57.88 $4.40 $3.67 $47.51 $63.34 $12.48 $20.92 $3.67 $3.67 $51.47 $5.14 $63.34 $3.67 $3.67 $4.40 $5.14 $3.67 $3.67 $3.67 $4.00 $63.34 $67.30 $4.95 $59.39 $7.52 $4.95 $39.59 $51.47 $5.16 $5.16 $5.16 $5.16 $6.19 $3.85 $3.67 $6.19 $3.67 $3.67 $2.75 $2.75 $2.75 $2.75 $67.30 330104 84154 400 301 HC ASSAY OF PSA FREE O $296.39 $18.39 $18.39 $18.39 $148.19 N/A N/A N/A $18.39 $34.94 $18.39 $18.39 $222.29 $20.23 $186.73 $216.66 $22.07 $18.39 $177.83 $237.11 $62.53 $104.82 $18.39 $18.39 $192.65 $25.75 $237.11 $18.39 $18.39 $22.07 $25.75 $18.39 $18.39 $18.39 $20.05 $237.11 $251.93 $24.83 $222.29 $37.70 $24.83 $148.19 $192.65 $25.84 $25.84 $25.84 $25.84 $31.07 $19.31 $18.39 $31.07 $18.39 $18.39 $13.79 $13.79 $13.79 $13.79 $251.93 330104 84153 400 301 HC ASSAY OF PSA TOTAL -SCREENING O $507.18 $18.39 $18.39 $18.39 $253.59 N/A N/A N/A $18.39 $34.94 $18.39 $18.39 $380.38 $20.23 $319.52 $370.75 $22.07 $18.39 $304.31 $405.74 $62.53 $104.82 $18.39 $18.39 $329.67 $25.75 $405.74 $18.39 $18.39 $22.07 $25.75 $18.39 $18.39 $18.39 $20.05 $405.74 $431.10 $24.83 $380.38 $37.70 $24.83 $253.59 $329.67 $25.84 $25.84 $25.84 $25.84 $31.07 $19.31 $18.39 $31.07 $18.39 $18.39 $13.79 $13.79 $13.79 $13.79 $431.10 330104 84146 398 301 HC ASSAY OF PROLACTIN O $590.64 $19.38 $19.38 $19.38 $295.32 N/A N/A N/A $19.38 $36.82 $19.38 $19.38 $442.98 $21.32 $372.10 $431.76 $23.26 $19.38 $354.38 $472.51 $65.89 $110.47 $19.38 $19.38 $383.92 $27.13 $472.51 $19.38 $19.38 $23.26 $27.13 $19.38 $19.38 $19.38 $21.12 $472.51 $502.04 $26.16 $442.98 $39.73 $26.16 $295.32 $383.92 $27.23 $27.23 $27.23 $27.23 $32.72 $20.35 $19.38 $32.72 $19.38 $19.38 $14.54 $14.54 $14.54 $14.54 $502.04 330104 84145 398 301 HC PROCALCITONIN (PCT) O $182.97 $27.22 $27.22 N/A $91.48 N/A N/A N/A N/A $51.72 N/A $27.22 $137.23 $29.94 $115.27 $133.75 N/A N/A $109.78 $146.38 $92.55 $155.15 N/A $27.22 $118.93 N/A $146.38 N/A N/A N/A $38.11 N/A $27.22 $27.22 $29.67 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 $38.24 $38.24 $38.24 $38.24 $45.23 $28.58 $27.22 $45.23 N/A N/A $20.41 $20.41 $20.41 $20.41 $155.52 330104 84143 398 301 HC ASSAY OF 17-HYDROXYPREGNENO O $332.77 $22.81 $22.81 $22.81 $166.38 N/A N/A N/A $22.81 $43.34 $22.81 $22.81 $249.58 $25.09 $209.65 $243.25 $27.37 $22.81 $199.66 $266.22 $77.55 $130.02 $22.81 $22.81 $216.30 $31.93 $266.22 $22.81 $22.81 $27.37 $31.93 $22.81 $22.81 $22.81 $24.86 $266.22 $282.85 $30.79 $249.58 $46.76 $30.79 $166.38 $216.30 $32.05 $32.05 $32.05 $32.05 $38.54 $23.95 $22.81 $38.54 $22.81 $22.81 $17.11 $17.11 $17.11 $17.11 $282.85 330104 82480 402 301 HC ASSAY SERUM CHOLINESTERASE O $143.38 $7.87 $7.87 $7.87 $71.69 N/A N/A N/A $7.87 $14.95 $7.87 $7.87 $107.53 $8.66 $90.33 $104.81 $9.44 $7.87 $86.03 $114.70 $26.76 $44.86 $7.87 $7.87 $93.20 $11.02 $114.70 $7.87 $7.87 $9.44 $11.02 $7.87 $7.87 $7.87 $8.58 $114.70 $121.87 $10.62 $107.53 $16.13 $10.62 $71.69 $93.20 $11.06 $11.06 $11.06 $11.06 $13.31 $8.26 $7.87 $13.31 $7.87 $7.87 $5.90 $5.90 $5.90 $5.90 $121.87 330104 83021 408 301 HC HEMOGLOBIN CHROMOTOGRAPHY O $283.55 $18.06 $18.06 $18.06 $141.78 N/A N/A N/A $18.06 $34.31 $18.06 $18.06 $212.66 $19.87 $178.64 $207.28 $21.67 $18.06 $170.13 $226.84 $61.40 $102.94 $18.06 $18.06 $184.31 $25.28 $226.84 $18.06 $18.06 $21.67 $25.28 $18.06 $18.06 $18.06 $19.69 $226.84 $241.02 $24.38 $212.66 $37.02 $24.38 $141.78 $184.31 $25.37 $25.37 $25.37 $25.37 $30.49 $18.96 $18.06 $30.49 $18.06 $18.06 $13.54 $13.54 $13.54 $13.54 $241.02 330104 82436 402 301 HC ASSAY OF URINE CHLORIDE O $182.97 $5.75 $5.75 $5.03 $91.48 N/A N/A N/A $5.03 $10.92 $5.03 $5.75 $137.23 $6.33 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $19.55 $32.77 $5.03 $5.75 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $8.05 $5.03 $5.75 $5.75 $6.27 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $8.08 $8.08 $8.08 $8.08 $8.48 $6.04 $5.75 $8.48 $5.03 $5.03 $4.31 $4.31 $4.31 $4.31 $155.52 330104 80176 405 301 HC ASSAY OF LIDOCAINE O $85.60 $14.69 $14.69 N/A $42.80 N/A N/A N/A N/A $27.91 N/A $14.69 $64.20 $16.16 $53.93 $62.57 N/A N/A $51.36 $68.48 $49.95 $83.73 N/A $14.69 $55.64 N/A $68.48 N/A N/A N/A $20.57 N/A $14.69 $14.69 $16.01 $68.48 $72.76 N/A $64.20 N/A N/A $42.80 $55.64 $20.64 $20.64 $20.64 $20.64 $24.80 $15.42 $14.69 $24.80 N/A N/A $11.02 $11.02 $11.02 $11.02 $83.73 330104 80177 405 301 HC DRUG SCRN QUAN LEVETIRACETAM O $141.24 $13.25 $13.25 $10.50 $70.62 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $105.93 $14.58 $88.98 $103.25 $12.60 $10.50 $84.74 $112.99 $45.05 $75.53 $10.50 $13.25 $91.81 $14.70 $112.99 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $112.99 $120.05 $14.18 $105.93 $21.52 $14.18 $70.62 $91.81 $18.62 $18.62 $18.62 $18.62 $21.71 $13.91 $13.25 $21.71 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $120.05 330104 80178 405 301 HC ASSAY OF LITHIUM O $162.64 $6.61 $6.61 $6.61 $81.32 N/A N/A N/A $6.61 $12.56 $6.61 $6.61 $121.98 $7.27 $102.46 $118.89 $7.93 $6.61 $97.58 $130.11 $22.47 $37.68 $6.61 $6.61 $105.72 $9.25 $130.11 $6.61 $6.61 $7.93 $9.25 $6.61 $6.61 $6.61 $7.20 $130.11 $138.24 $8.92 $121.98 $13.55 $8.92 $81.32 $105.72 $9.29 $9.29 $9.29 $9.29 $11.16 $6.94 $6.61 $11.16 $6.61 $6.61 $4.96 $4.96 $4.96 $4.96 $138.24 330104 80179 405 301 HC DRUG ASSAY SALICYLATE O $169.06 $18.64 $18.64 N/A $84.53 N/A N/A N/A N/A $35.42 N/A $18.64 $126.80 $20.50 $106.51 $123.58 N/A N/A $101.44 $135.25 $63.38 $106.25 N/A $18.64 $109.89 N/A $135.25 N/A N/A N/A $26.10 N/A $18.64 $18.64 $20.32 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 N/A N/A $13.98 $13.98 $13.98 $13.98 $143.70 330104 80181 405 301 HC DRUG ASSAY FLECAINIDE O $169.06 $18.64 $18.64 $10.50 $84.53 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $126.80 $20.50 $106.51 $123.58 $12.60 $10.50 $101.44 $135.25 $63.38 $106.25 $10.50 $18.64 $109.89 $14.70 $135.25 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $135.25 $143.70 $14.18 $126.80 $21.52 $14.18 $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $143.70 330104 80183 405 301 HC DRUG SCRN QUANT OXCARBAZEPIN O $115.56 $13.25 $13.25 $10.50 $57.78 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $86.67 $14.58 $72.80 $84.47 $12.60 $10.50 $69.34 $92.45 $45.05 $75.53 $10.50 $13.25 $75.11 $14.70 $92.45 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $92.45 $98.23 $14.18 $86.67 $21.52 $14.18 $57.78 $75.11 $18.62 $18.62 $18.62 $18.62 $21.71 $13.91 $13.25 $21.71 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $98.23 330104 80184 405 301 HC ASSAY OF PHENOBARBITAL O $326.35 $15.30 $15.30 $10.50 $163.18 N/A N/A N/A $10.50 $29.07 $10.50 $15.30 $244.76 $16.83 $205.60 $238.56 $12.60 $10.50 $195.81 $261.08 $52.02 $87.21 $10.50 $15.30 $212.13 $14.70 $261.08 $10.50 $10.50 $12.60 $21.42 $10.50 $15.30 $15.30 $16.68 $261.08 $277.40 $14.18 $244.76 $21.52 $14.18 $163.18 $212.13 $21.50 $21.50 $21.50 $21.50 $19.34 $16.07 $15.30 $19.34 $10.50 $10.50 $11.48 $11.48 $11.48 $10.50 $277.40 330104 80185 405 301 HC ASSAY OF PHENYTOIN TOTAL O $306.02 $13.25 $13.25 $10.50 $153.01 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $229.51 $14.58 $192.79 $223.70 $12.60 $10.50 $183.61 $244.82 $45.05 $75.53 $10.50 $13.25 $198.91 $14.70 $244.82 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $244.82 $260.12 $14.18 $229.51 $21.52 $14.18 $153.01 $198.91 $18.62 $18.62 $18.62 $18.62 $22.39 $13.91 $13.25 $22.39 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $260.12 330104 80186 405 301 HC ASSAY OF PHENYTOIN FREE O $218.28 $13.76 $13.76 $10.50 $109.14 N/A N/A N/A $10.50 $26.14 $10.50 $13.76 $163.71 $15.14 $137.52 $159.56 $12.60 $10.50 $130.97 $174.62 $46.78 $78.43 $10.50 $13.76 $141.88 $14.70 $174.62 $10.50 $10.50 $12.60 $19.26 $10.50 $13.76 $13.76 $15.00 $174.62 $185.54 $14.18 $163.71 $21.52 $14.18 $109.14 $141.88 $19.33 $19.33 $19.33 $19.33 $23.24 $14.45 $13.76 $23.24 $10.50 $10.50 $10.32 $10.32 $10.32 $10.32 $185.54 330104 80189 405 301 HC DRUG ASSAY ITRACONAZOLE O $169.06 $27.11 $27.11 N/A $84.53 N/A N/A N/A N/A $51.51 N/A $27.11 $126.80 $29.82 $106.51 $123.58 N/A N/A $101.44 $135.25 $92.17 $154.53 N/A $27.11 $109.89 N/A $135.25 N/A N/A N/A $37.95 N/A $27.11 $27.11 $29.55 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $38.09 $38.09 $38.09 $38.09 N/A $28.47 $27.11 $112.76 N/A N/A $20.33 $20.33 $20.33 $20.33 $154.53 330104 80193 405 301 HC DRUG ASSAY LEFLUNOMIDE O $169.06 $38.57 $38.57 $23.14 $84.53 N/A N/A N/A $23.14 $73.28 $23.14 $38.57 $126.80 $42.43 $106.51 $123.58 $27.77 $23.14 $101.44 $135.25 $131.14 $219.85 $23.14 $38.57 $109.89 $32.40 $135.25 $23.14 $23.14 $27.77 $54.00 $23.14 $38.57 $38.57 $42.04 $135.25 $143.70 $31.24 $126.80 $47.44 $31.24 $84.53 $109.89 $54.19 $54.19 $54.19 $54.19 N/A $40.50 $38.57 $112.76 $23.14 $23.14 $28.93 $28.93 $28.93 $23.14 $219.85 330104 80197 405 301 HC ASSAY OF TACROLIMUS O $249.31 $13.73 $13.73 $10.50 $124.66 N/A N/A N/A $10.50 $26.09 $10.50 $13.73 $186.98 $15.10 $157.07 $182.25 $12.60 $10.50 $149.59 $199.45 $46.68 $78.26 $10.50 $13.73 $162.05 $14.70 $199.45 $10.50 $10.50 $12.60 $19.22 $10.50 $13.73 $13.73 $14.97 $199.45 $211.91 $14.18 $186.98 $21.52 $14.18 $124.66 $162.05 $19.29 $19.29 $19.29 $19.29 $23.18 $14.42 $13.73 $23.18 $10.50 $10.50 $10.30 $10.30 $10.30 $10.30 $211.91 330104 80198 405 301 HC ASSAY OF THEOPHYLLINE O $300.67 $14.14 $14.14 $8.00 $150.34 N/A N/A N/A $8.00 $26.87 $8.00 $14.14 $225.50 $15.55 $189.42 $219.79 $9.60 $8.00 $180.40 $240.54 $48.08 $80.60 $8.00 $14.14 $195.44 $11.20 $240.54 $8.00 $8.00 $9.60 $19.80 $8.00 $14.14 $14.14 $15.41 $240.54 $255.57 $10.80 $225.50 $16.40 $10.80 $150.34 $195.44 $19.87 $19.87 $19.87 $19.87 $23.89 $14.85 $14.14 $23.89 $8.00 $8.00 $10.61 $10.61 $10.61 $8.00 $255.57 330104 80200 405 301 HC ASSAY OF TOBRAMYCIN O $420.51 $16.13 $16.13 $10.50 $210.25 N/A N/A N/A $10.50 $30.65 $10.50 $16.13 $315.38 $17.74 $264.92 $307.39 $12.60 $10.50 $252.31 $336.41 $54.84 $91.94 $10.50 $16.13 $273.33 $14.70 $336.41 $10.50 $10.50 $12.60 $22.58 $10.50 $16.13 $16.13 $17.58 $336.41 $357.43 $14.18 $315.38 $21.52 $14.18 $210.25 $273.33 $22.66 $22.66 $22.66 $22.66 $27.22 $16.94 $16.13 $27.22 $10.50 $10.50 $12.10 $12.10 $12.10 $10.50 $357.43 330104 80202 405 301 HC ASSAY OF VANCOMYCIN O $245.03 $13.54 $13.54 $10.50 $122.52 N/A N/A N/A $10.50 $25.73 $10.50 $13.54 $183.77 $14.89 $154.37 $179.12 $12.60 $10.50 $147.02 $196.02 $46.04 $77.18 $10.50 $13.54 $159.27 $14.70 $196.02 $10.50 $10.50 $12.60 $18.96 $10.50 $13.54 $13.54 $14.76 $196.02 $208.28 $14.18 $183.77 $21.52 $14.18 $122.52 $159.27 $19.02 $19.02 $19.02 $19.02 $22.87 $14.22 $13.54 $22.87 $10.50 $10.50 $10.15 $10.15 $10.15 $10.15 $208.28 330104 80203 405 301 HC DRUG SCREEN QUANT ZONISAMIDE O $133.75 $13.25 $13.25 $10.50 $66.88 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $100.31 $14.58 $84.26 $97.77 $12.60 $10.50 $80.25 $107.00 $45.05 $75.53 $10.50 $13.25 $86.94 $14.70 $107.00 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $107.00 $113.69 $14.18 $100.31 $21.52 $14.18 $66.88 $86.94 $18.62 $18.62 $18.62 $18.62 $21.71 $13.91 $13.25 $21.71 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $113.69 330104 80204 405 301 HC DRUG ASSAY METHOTREXATE O $169.06 $38.57 $38.57 $23.14 $84.53 N/A N/A N/A $23.14 $73.28 $23.14 $38.57 $126.80 $42.43 $106.51 $123.58 $27.77 $23.14 $101.44 $135.25 $131.14 $219.85 $23.14 $38.57 $109.89 $32.40 $135.25 $23.14 $23.14 $27.77 $54.00 $23.14 $38.57 $38.57 $42.04 $135.25 $143.70 $31.24 $126.80 $47.44 $31.24 $84.53 $109.89 $54.19 $54.19 $54.19 $54.19 N/A $40.50 $38.57 $112.76 $23.14 $23.14 $28.93 $28.93 $28.93 $23.14 $219.85 330104 80210 405 301 HC DRUG ASSAY RUFINAMIDE O $169.06 $27.11 $27.11 $16.27 $84.53 N/A N/A N/A $16.27 $51.51 $16.27 $27.11 $126.80 $29.82 $106.51 $123.58 $19.52 $16.27 $101.44 $135.25 $92.17 $154.53 $16.27 $27.11 $109.89 $22.78 $135.25 $16.27 $16.27 $19.52 $37.95 $16.27 $27.11 $27.11 $29.55 $135.25 $143.70 $21.96 $126.80 $33.35 $21.96 $84.53 $109.89 $38.09 $38.09 $38.09 $38.09 N/A $28.47 $27.11 $112.76 $16.27 $16.27 $20.33 $20.33 $20.33 $16.27 $154.53 330104 80220 405 301 HC DRUG ASSAY HYDROXYCHLOROQUINE O $107.00 $18.64 $18.64 $10.50 $53.50 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $80.25 $20.50 $67.41 $78.22 $12.60 $10.50 $64.20 $85.60 $63.38 $106.25 $10.50 $18.64 $69.55 $14.70 $85.60 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $85.60 $90.95 $14.18 $80.25 $21.52 $14.18 $53.50 $69.55 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $71.37 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $106.25 330104 80175 405 301 HC DRUG SCREEN QUAN LAMOTRIGINE O $112.35 $13.25 $13.25 $10.50 $56.17 N/A N/A N/A $10.50 $25.17 $10.50 $13.25 $84.26 $14.58 $70.78 $82.13 $12.60 $10.50 $67.41 $89.88 $45.05 $75.53 $10.50 $13.25 $73.03 $14.70 $89.88 $10.50 $10.50 $12.60 $18.55 $10.50 $13.25 $13.25 $14.44 $89.88 $95.50 $14.18 $84.26 $21.52 $14.18 $56.17 $73.03 $18.62 $18.62 $18.62 $18.62 $21.71 $13.91 $13.25 $21.71 $10.50 $10.50 $9.94 $9.94 $9.94 $9.94 $95.50 330104 80170 405 301 HC ASSAY OF GENTAMICIN O $418.37 $16.38 $16.38 $10.50 $209.19 N/A N/A N/A $10.50 $31.12 $10.50 $16.38 $313.78 $18.02 $263.57 $305.83 $12.60 $10.50 $251.02 $334.70 $55.69 $93.37 $10.50 $16.38 $271.94 $14.70 $334.70 $10.50 $10.50 $12.60 $22.93 $10.50 $16.38 $16.38 $17.85 $334.70 $355.61 $14.18 $313.78 $21.52 $14.18 $209.19 $271.94 $23.01 $23.01 $23.01 $23.01 $27.68 $17.20 $16.38 $27.68 $10.50 $10.50 $12.29 $12.29 $12.29 $10.50 $355.61 330104 80167 405 301 HC DRUG ASSAY FELBAMATE O $169.06 $18.64 $18.64 $10.50 $84.53 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $126.80 $20.50 $106.51 $123.58 $12.60 $10.50 $101.44 $135.25 $63.38 $106.25 $10.50 $18.64 $109.89 $14.70 $135.25 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $135.25 $143.70 $14.18 $126.80 $21.52 $14.18 $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $143.70 330104 80164 405 301 HC ASSAY DIPROPYLACETIC ACID O $326.35 $13.54 $13.54 $10.50 $163.18 N/A N/A N/A $10.50 $25.73 $10.50 $13.54 $244.76 $14.89 $205.60 $238.56 $12.60 $10.50 $195.81 $261.08 $46.04 $77.18 $10.50 $13.54 $212.13 $14.70 $261.08 $10.50 $10.50 $12.60 $18.96 $10.50 $13.54 $13.54 $14.76 $261.08 $277.40 $14.18 $244.76 $21.52 $14.18 $163.18 $212.13 $19.02 $19.02 $19.02 $19.02 $22.87 $14.22 $13.54 $22.87 $10.50 $10.50 $10.15 $10.15 $10.15 $10.15 $277.40 330104 82465 402 301 HC ASSAY BLD/SERUM CHOLESTEROL O $71.69 $4.35 $4.35 $4.35 $35.84 N/A N/A N/A $4.35 $8.26 $4.35 $4.35 $53.77 $4.79 $45.16 $52.41 $5.22 $4.35 $43.01 $57.35 $14.79 $24.79 $4.35 $4.35 $46.60 $6.09 $57.35 $4.35 $4.35 $5.22 $6.09 $4.35 $4.35 $4.35 $4.74 $57.35 $60.94 $5.87 $53.77 $8.92 $5.87 $35.84 $46.60 $6.11 $6.11 $6.11 $6.11 $7.36 $4.57 $4.35 $7.36 $4.35 $4.35 $3.26 $3.26 $3.26 $3.26 $60.94 330104 82105 400 301 HC ALPHA-FETOPROTEIN (AFP); SERUM O $522.16 $16.77 $16.77 $6.50 $261.08 N/A N/A N/A $6.50 $31.86 $6.50 $16.77 $391.62 $18.45 $328.96 $381.70 $7.80 $6.50 $313.30 $417.73 $57.02 $95.59 $6.50 $16.77 $339.40 $9.10 $417.73 $6.50 $6.50 $7.80 $23.48 $6.50 $16.77 $16.77 $18.28 $417.73 $443.84 $8.78 $391.62 $13.32 $8.78 $261.08 $339.40 $23.56 $23.56 $23.56 $23.56 $28.33 $17.61 $16.77 $28.33 $6.50 $6.50 $12.58 $12.58 $12.58 $6.50 $443.84 330104 82945 402 301 HC GLUCOSE OTHER FLUID O $182.97 $3.93 $3.93 $3.93 $91.48 N/A N/A N/A $3.93 $7.47 $3.93 $3.93 $137.23 $4.32 $115.27 $133.75 $4.72 $3.93 $109.78 $146.38 $13.36 $22.40 $3.93 $3.93 $118.93 $5.50 $146.38 $3.93 $3.93 $4.72 $5.50 $3.93 $3.93 $3.93 $4.28 $146.38 $155.52 $5.31 $137.23 $8.06 $5.31 $91.48 $118.93 $5.52 $5.52 $5.52 $5.52 $6.62 $4.13 $3.93 $6.62 $3.93 $3.93 $2.95 $2.95 $2.95 $2.95 $155.52 330104 82948 402 301 HC REAGENT STRIP/BLOOD GLUCOSE O $52.43 $5.04 $5.04 $2.00 $26.21 N/A N/A N/A $2.00 $9.58 $2.00 $5.04 $39.32 $5.54 $33.03 $38.33 $2.40 $2.00 $31.46 $41.94 $17.14 $28.73 $2.00 $5.04 $34.08 $2.80 $41.94 $2.00 $2.00 $2.40 $7.06 $2.00 $5.04 $5.04 $5.49 $41.94 $44.57 $2.70 $39.32 $4.10 $2.70 $26.21 $34.08 $7.08 $7.08 $7.08 $7.08 $5.34 $5.29 $5.04 $5.34 $2.00 $2.00 $3.78 $3.78 $3.78 $2.00 $44.57 330104 82962 402 301 HC GLUCOSE BLOOD TEST O $33.17 $3.28 $3.28 N/A $16.59 N/A N/A N/A N/A $6.23 N/A $3.28 $24.88 $3.61 $20.90 $24.25 N/A N/A $19.90 $26.54 $11.15 $18.70 N/A $3.28 $21.56 N/A $26.54 N/A N/A N/A $4.59 N/A $3.28 $3.28 $3.58 $26.54 $28.19 N/A $24.88 N/A N/A $16.59 $21.56 $4.61 $4.61 $4.61 $4.61 $3.95 $3.44 $3.28 $3.95 N/A N/A $2.46 $2.46 $2.46 $2.46 $28.19 330104 84238 401 301 HC ASSAY NONENDOCRINE RECEPTOR O "$1,043.25 " $36.57 $36.57 N/A $521.62 N/A N/A N/A N/A $69.48 N/A $36.57 $782.44 $40.23 $657.25 $762.62 N/A N/A $625.95 $834.60 $124.34 $208.45 N/A $36.57 $678.11 N/A $834.60 N/A N/A N/A $51.20 N/A $36.57 $36.57 $39.86 $834.60 $886.76 N/A $782.44 N/A N/A $521.62 $678.11 $51.38 $51.38 $51.38 $51.38 $61.75 $38.40 $36.57 $61.75 N/A N/A $27.43 $27.43 $27.43 $27.43 $886.76 330104 80048 403 301 HC METABOLIC PANEL TOTAL CA O $186.18 $8.46 $8.46 $7.25 $93.09 N/A N/A N/A $7.25 $16.07 $7.25 $8.46 $139.63 $9.31 $117.29 $136.10 $8.70 $7.25 $111.71 $148.94 $28.76 $48.22 $7.25 $8.46 $121.02 $10.15 $148.94 $7.25 $7.25 $8.70 $11.84 $7.25 $8.46 $8.46 $9.22 $148.94 $158.25 $9.79 $139.63 $14.86 $9.79 $93.09 $121.02 $11.89 $11.89 $11.89 $11.89 $14.29 $8.88 $8.46 $14.29 $7.25 $7.25 $6.35 $6.35 $6.35 $6.35 $158.25 330104 80051 403 301 HC ELECTROLYTE PANEL O $107.00 $7.01 $7.01 $6.04 $53.50 N/A N/A N/A $6.04 $13.32 $6.04 $7.01 $80.25 $7.71 $67.41 $78.22 $7.25 $6.04 $64.20 $85.60 $23.83 $39.96 $6.04 $7.01 $69.55 $8.46 $85.60 $6.04 $6.04 $7.25 $9.81 $6.04 $7.01 $7.01 $7.64 $85.60 $90.95 $8.15 $80.25 $12.38 $8.15 $53.50 $69.55 $9.85 $9.85 $9.85 $9.85 $11.84 $7.36 $7.01 $11.84 $6.04 $6.04 $5.26 $5.26 $5.26 $5.26 $90.95 330104 80053 403 301 HC COMPREHEN METABOLIC PANEL O $151.94 $10.56 $10.56 $10.00 $75.97 N/A N/A N/A $10.00 $20.06 $10.00 $10.56 $113.95 $11.62 $95.72 $111.07 $12.00 $10.00 $91.16 $121.55 $35.90 $60.19 $10.00 $10.56 $98.76 $14.00 $121.55 $10.00 $10.00 $12.00 $14.78 $10.00 $10.56 $10.56 $11.51 $121.55 $129.15 $13.50 $113.95 $20.50 $13.50 $75.97 $98.76 $14.84 $14.84 $14.84 $14.84 $17.84 $11.09 $10.56 $17.84 $10.00 $10.00 $7.92 $7.92 $7.92 $7.92 $129.15 330104 80235 405 301 HC DRUG ASSAY LACOSAMIDE O $182.97 $27.11 $27.11 $10.50 $91.48 N/A N/A N/A $10.50 $51.51 $10.50 $27.11 $137.23 $29.82 $115.27 $133.75 $12.60 $10.50 $109.78 $146.38 $92.17 $154.53 $10.50 $27.11 $118.93 $14.70 $146.38 $10.50 $10.50 $12.60 $37.95 $10.50 $27.11 $27.11 $29.55 $146.38 $155.52 $14.18 $137.23 $21.52 $14.18 $91.48 $118.93 $38.09 $38.09 $38.09 $38.09 $32.53 $28.47 $27.11 $32.53 $10.50 $10.50 $20.33 $20.33 $20.33 $10.50 $155.52 330104 80061 403 301 HC LIPID PANEL O $182.97 $13.39 $13.39 $6.04 $91.48 N/A N/A N/A $6.04 $25.44 $6.04 $13.39 $137.23 $14.73 $115.27 $133.75 $7.25 $6.04 $109.78 $146.38 $45.53 $76.32 $6.04 $13.39 $118.93 $8.46 $146.38 $6.04 $6.04 $7.25 $18.75 $6.04 $13.39 $13.39 $14.60 $146.38 $155.52 $8.15 $137.23 $12.38 $8.15 $91.48 $118.93 $18.81 $18.81 $18.81 $18.81 $22.62 $14.06 $13.39 $22.62 $6.04 $6.04 $10.04 $10.04 $10.04 $6.04 $155.52 330104 80076 403 301 HC HEPATIC FUNCTION PANEL O $254.66 $8.17 $8.17 $7.25 $127.33 N/A N/A N/A $7.25 $15.52 $7.25 $8.17 $191.00 $8.99 $160.44 $186.16 $8.70 $7.25 $152.80 $203.73 $27.78 $46.57 $7.25 $8.17 $165.53 $10.15 $203.73 $7.25 $7.25 $8.70 $11.44 $7.25 $8.17 $8.17 $8.91 $203.73 $216.46 $9.79 $191.00 $14.86 $9.79 $127.33 $165.53 $11.48 $11.48 $11.48 $11.48 $13.79 $8.58 $8.17 $13.79 $7.25 $7.25 $6.13 $6.13 $6.13 $6.13 $216.46 330104 80143 405 301 HC DRUG ASSAY ACETAMINOPHEN O $67.41 $18.64 $18.64 N/A $33.70 N/A N/A N/A N/A $35.42 N/A $18.64 $50.56 $20.50 $42.47 $49.28 N/A N/A $40.45 $53.93 $63.38 $106.25 N/A $18.64 $43.82 N/A $53.93 N/A N/A N/A $26.10 N/A $18.64 $18.64 $20.32 $53.93 $57.30 N/A $50.56 N/A N/A $33.70 $43.82 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $44.96 N/A N/A $13.98 $13.98 $13.98 $13.98 $106.25 330104 80150 405 301 HC ASSAY OF AMIKACIN O $326.35 $15.08 $15.08 $10.50 $163.18 N/A N/A N/A $10.50 $28.65 $10.50 $15.08 $244.76 $16.59 $205.60 $238.56 $12.60 $10.50 $195.81 $261.08 $51.27 $85.96 $10.50 $15.08 $212.13 $14.70 $261.08 $10.50 $10.50 $12.60 $21.11 $10.50 $15.08 $15.08 $16.44 $261.08 $277.40 $14.18 $244.76 $21.52 $14.18 $163.18 $212.13 $21.19 $21.19 $21.19 $21.19 $25.45 $15.83 $15.08 $25.45 $10.50 $10.50 $11.31 $11.31 $11.31 $10.50 $277.40 330104 80151 405 301 HC DRUG ASSAY AMIODARONE O $169.06 $18.64 $18.64 $10.50 $84.53 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $126.80 $20.50 $106.51 $123.58 $12.60 $10.50 $101.44 $135.25 $63.38 $106.25 $10.50 $18.64 $109.89 $14.70 $135.25 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $135.25 $143.70 $14.18 $126.80 $21.52 $14.18 $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $143.70 330104 80156 405 301 HC ASSAY CARBAMAZEPINE TOTAL O $311.37 $14.57 $14.57 $10.50 $155.69 N/A N/A N/A $10.50 $27.68 $10.50 $14.57 $233.53 $16.03 $196.16 $227.61 $12.60 $10.50 $186.82 $249.10 $49.54 $83.05 $10.50 $14.57 $202.39 $14.70 $249.10 $10.50 $10.50 $12.60 $20.40 $10.50 $14.57 $14.57 $15.88 $249.10 $264.66 $14.18 $233.53 $21.52 $14.18 $155.69 $202.39 $20.47 $20.47 $20.47 $20.47 $24.59 $15.30 $14.57 $24.59 $10.50 $10.50 $10.93 $10.93 $10.93 $10.50 $264.66 330104 80158 405 301 HC ASSAY OF CYCLOSPORINE O $792.87 $18.05 $18.05 $10.50 $396.44 N/A N/A N/A $10.50 $34.30 $10.50 $18.05 $594.65 $19.86 $499.51 $579.59 $12.60 $10.50 $475.72 $634.30 $61.37 $102.89 $10.50 $18.05 $515.37 $14.70 $634.30 $10.50 $10.50 $12.60 $25.27 $10.50 $18.05 $18.05 $19.67 $634.30 $673.94 $14.18 $594.65 $21.52 $14.18 $396.44 $515.37 $25.36 $25.36 $25.36 $25.36 $30.48 $18.95 $18.05 $30.48 $10.50 $10.50 $13.54 $13.54 $13.54 $10.50 $673.94 330104 80159 405 301 HC DRUG SCREEN QUANT CLOZAPINE O $69.55 $20.15 $20.15 $10.50 $34.77 N/A N/A N/A $10.50 $38.28 $10.50 $20.15 $52.16 $22.16 $43.82 $50.84 $12.60 $10.50 $41.73 $55.64 $68.51 $114.85 $10.50 $20.15 $45.21 $14.70 $55.64 $10.50 $10.50 $12.60 $28.21 $10.50 $20.15 $20.15 $21.96 $55.64 $59.12 $14.18 $52.16 $21.52 $14.18 $34.77 $45.21 $28.31 $28.31 $28.31 $28.31 $30.28 $21.16 $20.15 $30.28 $10.50 $10.50 $15.11 $15.11 $15.11 $10.50 $114.85 330104 80161 405 301 "HC DRUG ASSAY CARBAMAZEPINE -10,11-EPOXIDE" O $169.06 $18.64 $18.64 $10.50 $84.53 N/A N/A N/A $10.50 $35.42 $10.50 $18.64 $126.80 $20.50 $106.51 $123.58 $12.60 $10.50 $101.44 $135.25 $63.38 $106.25 $10.50 $18.64 $109.89 $14.70 $135.25 $10.50 $10.50 $12.60 $26.10 $10.50 $18.64 $18.64 $20.32 $135.25 $143.70 $14.18 $126.80 $21.52 $14.18 $84.53 $109.89 $26.19 $26.19 $26.19 $26.19 N/A $19.57 $18.64 $112.76 $10.50 $10.50 $13.98 $13.98 $13.98 $10.50 $143.70 330104 80162 405 301 HC ASSAY OF DIGOXIN O $306.02 $13.28 $13.28 $10.50 $153.01 N/A N/A N/A $10.50 $25.23 $10.50 $13.28 $229.51 $14.61 $192.79 $223.70 $12.60 $10.50 $183.61 $244.82 $45.15 $75.70 $10.50 $13.28 $198.91 $14.70 $244.82 $10.50 $10.50 $12.60 $18.59 $10.50 $13.28 $13.28 $14.48 $244.82 $260.12 $14.18 $229.51 $21.52 $14.18 $153.01 $198.91 $18.66 $18.66 $18.66 $18.66 $22.43 $13.94 $13.28 $22.43 $10.50 $10.50 $9.96 $9.96 $9.96 $9.96 $260.12 330104 80074 403 301 HC HEPATITIS PANELACUTE O $752.21 $47.63 $47.63 N/A $376.11 N/A N/A N/A N/A $90.50 N/A $47.63 $564.16 $52.39 $473.89 $549.87 N/A N/A $451.33 $601.77 $161.94 $271.49 N/A $47.63 $488.94 N/A $601.77 N/A N/A N/A $66.68 N/A $47.63 $47.63 $51.92 $601.77 $639.38 N/A $564.16 N/A N/A $376.11 $488.94 $66.92 $66.92 $66.92 $66.92 $80.41 $50.01 $47.63 $80.41 N/A N/A $35.72 $35.72 $35.72 $35.72 $639.38 330104 80299 405 301 HC QUANTITATIVE ASSAY DRUG O $449.40 $18.64 $18.64 N/A $224.70 N/A N/A N/A N/A $35.42 N/A $18.64 $337.05 $20.50 $283.12 $328.51 N/A N/A $269.64 $359.52 $63.38 $106.25 N/A $18.64 $292.11 N/A $359.52 N/A N/A N/A $26.10 N/A $18.64 $18.64 $20.32 $359.52 $381.99 N/A $337.05 N/A N/A $224.70 $292.11 $26.19 $26.19 $26.19 $26.19 $23.12 $19.57 $18.64 $23.12 N/A N/A $13.98 $13.98 $13.98 $13.98 $381.99 330104 80069 403 301 HC RENAL FUNCTION PANEL O $117.70 $8.68 $8.68 $8.68 $58.85 N/A N/A N/A $8.68 $16.49 $8.68 $8.68 $88.28 $9.55 $74.15 $86.04 $10.42 $8.68 $70.62 $94.16 $29.51 $49.48 $8.68 $8.68 $76.51 $12.15 $94.16 $8.68 $8.68 $10.42 $12.15 $8.68 $8.68 $8.68 $9.46 $94.16 $100.05 $11.72 $88.28 $17.79 $11.72 $58.85 $76.51 $12.20 $12.20 $12.20 $12.20 $14.66 $9.11 $8.68 $14.66 $8.68 $8.68 $6.51 $6.51 $6.51 $6.51 $100.05 330104 80377 2040 301 HC DRUG/SUBSTANCE NOS 7/MORE O $182.97 N/A N/A N/A $91.48 N/A N/A N/A N/A N/A N/A N/A $137.23 N/A $115.27 $133.75 N/A N/A $109.78 $146.38 N/A N/A N/A N/A $118.93 N/A $146.38 N/A N/A N/A N/A N/A N/A N/A N/A $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 N/A N/A N/A N/A $29.66 N/A N/A $29.66 N/A N/A N/A N/A N/A $29.66 $155.52 330104 82232 398 301 HC ASSAY OF BETA-2 PROTEIN O $548.91 $16.18 $16.18 $12.50 $274.45 N/A N/A N/A $12.50 $30.74 $12.50 $16.18 $411.68 $17.80 $345.81 $401.25 $15.00 $12.50 $329.35 $439.13 $55.01 $92.23 $12.50 $16.18 $356.79 $17.50 $439.13 $12.50 $12.50 $15.00 $22.65 $12.50 $16.18 $16.18 $17.64 $439.13 $466.57 $16.88 $411.68 $25.62 $16.88 $274.45 $356.79 $22.73 $22.73 $22.73 $22.73 $27.31 $16.99 $16.18 $27.31 $12.50 $12.50 $12.13 $12.13 $12.13 $12.13 $466.57 330104 82239 400 301 HC BILE ACIDS TOTAL O $226.84 $17.12 $17.12 $13.05 $113.42 N/A N/A N/A $13.05 $32.53 $13.05 $17.12 $170.13 $18.83 $142.91 $165.82 $15.66 $13.05 $136.10 $181.47 $58.21 $97.58 $13.05 $17.12 $147.45 $18.27 $181.47 $13.05 $13.05 $15.66 $23.97 $13.05 $17.12 $17.12 $18.66 $181.47 $192.81 $17.62 $170.13 $26.75 $17.62 $113.42 $147.45 $24.05 $24.05 $24.05 $24.05 $28.93 $17.98 $17.12 $28.93 $13.05 $13.05 $12.84 $12.84 $12.84 $12.84 $192.81 330104 82247 402 301 HC BILIRUBIN TOTAL O $84.53 $5.02 $5.02 $5.02 $42.27 N/A N/A N/A $5.02 $9.54 $5.02 $5.02 $63.40 $5.52 $53.25 $61.79 $6.02 $5.02 $50.72 $67.62 $17.07 $28.61 $5.02 $5.02 $54.94 $7.03 $67.62 $5.02 $5.02 $6.02 $7.03 $5.02 $5.02 $5.02 $5.47 $67.62 $71.85 $6.78 $63.40 $10.29 $6.78 $42.27 $54.94 $7.05 $7.05 $7.05 $7.05 $8.47 $5.27 $5.02 $8.47 $5.02 $5.02 $3.76 $3.76 $3.76 $3.76 $71.85 330104 82248 402 301 HC BILIRUBIN DIRECT O $84.53 $5.02 $5.02 $5.02 $42.27 N/A N/A N/A $5.02 $9.54 $5.02 $5.02 $63.40 $5.52 $53.25 $61.79 $6.02 $5.02 $50.72 $67.62 $17.07 $28.61 $5.02 $5.02 $54.94 $7.03 $67.62 $5.02 $5.02 $6.02 $7.03 $5.02 $5.02 $5.02 $5.47 $67.62 $71.85 $6.78 $63.40 $10.29 $6.78 $42.27 $54.94 $7.05 $7.05 $7.05 $7.05 $8.47 $5.27 $5.02 $8.47 $5.02 $5.02 $3.76 $3.76 $3.76 $3.76 $71.85 330104 82271 402 301 HC OCCULT BLOOD OTHER SOURCES O $121.98 $5.32 $5.32 N/A $60.99 N/A N/A N/A N/A $10.11 N/A $5.32 $91.48 $5.85 $76.85 $89.17 N/A N/A $73.19 $97.58 $18.09 $30.32 N/A $5.32 $79.29 N/A $97.58 N/A N/A N/A $7.45 N/A $5.32 $5.32 $5.80 $97.58 $103.68 N/A $91.48 N/A N/A $60.99 $79.29 $7.47 $7.47 $7.47 $7.47 $5.50 $5.59 $5.32 $5.50 N/A N/A $3.99 $3.99 $3.99 $3.99 $103.68 330104 82306 401 301 HC VITAMIN D 25 HYDROXY O $466.52 $29.60 $29.60 $29.60 $233.26 N/A N/A N/A $29.60 $56.24 $29.60 $29.60 $349.89 $32.56 $293.91 $341.03 $35.52 $29.60 $279.91 $373.22 $100.64 $168.72 $29.60 $29.60 $303.24 $41.44 $373.22 $29.60 $29.60 $35.52 $41.44 $29.60 $29.60 $29.60 $32.26 $373.22 $396.54 $39.96 $349.89 $60.68 $39.96 $233.26 $303.24 $41.59 $41.59 $41.59 $41.59 $49.99 $31.08 $29.60 $49.99 $29.60 $29.60 $22.20 $22.20 $22.20 $22.20 $396.54 330104 82308 398 301 HC ASSAY OF CALCITONIN O $712.62 $26.79 $26.79 $26.79 $356.31 N/A N/A N/A $26.79 $50.90 $26.79 $26.79 $534.47 $29.47 $448.95 $520.93 $32.15 $26.79 $427.57 $570.10 $91.09 $152.70 $26.79 $26.79 $463.20 $37.51 $570.10 $26.79 $26.79 $32.15 $37.51 $26.79 $26.79 $26.79 $29.20 $570.10 $605.73 $36.17 $534.47 $54.92 $36.17 $356.31 $463.20 $37.64 $37.64 $37.64 $37.64 $45.23 $28.13 $26.79 $45.23 $26.79 $26.79 $20.09 $20.09 $20.09 $20.09 $605.73 330104 82310 402 301 HC CALCIUM; TOTAL O $182.97 $5.16 $5.16 $5.03 $91.48 N/A N/A N/A $5.03 $9.80 $5.03 $5.16 $137.23 $5.68 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $17.54 $29.41 $5.03 $5.16 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $7.22 $5.03 $5.16 $5.16 $5.62 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $7.25 $7.25 $7.25 $7.25 $8.71 $5.42 $5.16 $8.71 $5.03 $5.03 $3.87 $3.87 $3.87 $3.87 $155.52 330104 82330 400 301 HC CALCIUM; IONIZED O $963.00 $13.68 $13.68 $5.03 $481.50 N/A N/A N/A $5.03 $25.99 $5.03 $13.68 $722.25 $15.05 $606.69 $703.95 $6.04 $5.03 $577.80 $770.40 $46.51 $77.98 $5.03 $13.68 $625.95 $7.04 $770.40 $5.03 $5.03 $6.04 $19.15 $5.03 $13.68 $13.68 $14.91 $770.40 $818.55 $6.79 $722.25 $10.31 $6.79 $481.50 $625.95 $19.22 $19.22 $19.22 $19.22 $23.08 $14.36 $13.68 $23.08 $5.03 $5.03 $10.26 $10.26 $10.26 $5.03 $818.55 330104 82180 402 301 HC ASSAY OF ASCORBIC ACID O $260.01 $9.89 $9.89 $9.89 $130.00 N/A N/A N/A $9.89 $18.79 $9.89 $9.89 $195.01 $10.88 $163.81 $190.07 $11.87 $9.89 $156.01 $208.01 $33.63 $56.37 $9.89 $9.89 $169.01 $13.85 $208.01 $9.89 $9.89 $11.87 $13.85 $9.89 $9.89 $9.89 $10.78 $208.01 $221.01 $13.35 $195.01 $20.27 $13.35 $130.00 $169.01 $13.90 $13.90 $13.90 $13.90 $16.69 $10.38 $9.89 $16.69 $9.89 $9.89 $7.42 $7.42 $7.42 $7.42 $221.01 330104 82340 402 301 HC ASSAY OF CALCIUM IN URINE O $182.97 $6.03 $6.03 $6.03 $91.48 N/A N/A N/A $6.03 $11.46 $6.03 $6.03 $137.23 $6.63 $115.27 $133.75 $7.24 $6.03 $109.78 $146.38 $20.50 $34.37 $6.03 $6.03 $118.93 $8.44 $146.38 $6.03 $6.03 $7.24 $8.44 $6.03 $6.03 $6.03 $6.57 $146.38 $155.52 $8.14 $137.23 $12.36 $8.14 $91.48 $118.93 $8.47 $8.47 $8.47 $8.47 $10.19 $6.33 $6.03 $10.19 $6.03 $6.03 $4.52 $4.52 $4.52 $4.52 $155.52 330104 82374 402 301 HC ASSAY BLOOD CARBON DIOXIDE O $97.37 $4.88 $4.88 $4.88 $48.69 N/A N/A N/A $4.88 $9.27 $4.88 $4.88 $73.03 $5.37 $61.34 $71.18 $5.86 $4.88 $58.42 $77.90 $16.59 $27.82 $4.88 $4.88 $63.29 $6.83 $77.90 $4.88 $4.88 $5.86 $6.83 $4.88 $4.88 $4.88 $5.32 $77.90 $82.76 $6.59 $73.03 $10.00 $6.59 $48.69 $63.29 $6.86 $6.86 $6.86 $6.86 $8.26 $5.12 $4.88 $8.26 $4.88 $4.88 $3.66 $3.66 $3.66 $3.66 $82.76 330104 82375 400 301 HC ASSAY CARBOXYHB QUANT O $466.52 $12.32 $12.32 $11.00 $233.26 N/A N/A N/A $11.00 $23.41 $11.00 $12.32 $349.89 $13.55 $293.91 $341.03 $13.20 $11.00 $279.91 $373.22 $41.89 $70.22 $11.00 $12.32 $303.24 $15.40 $373.22 $11.00 $11.00 $13.20 $17.25 $11.00 $12.32 $12.32 $13.43 $373.22 $396.54 $14.85 $349.89 $22.55 $14.85 $233.26 $303.24 $17.31 $17.31 $17.31 $17.31 $20.82 $12.94 $12.32 $20.82 $11.00 $11.00 $9.24 $9.24 $9.24 $9.24 $396.54 330104 82435 402 301 HC ASSAY OF BLOOD CHLORIDE O $112.35 $4.60 $4.60 $4.60 $56.17 N/A N/A N/A $4.60 $8.74 $4.60 $4.60 $84.26 $5.06 $70.78 $82.13 $5.52 $4.60 $67.41 $89.88 $15.64 $26.22 $4.60 $4.60 $73.03 $6.44 $89.88 $4.60 $4.60 $5.52 $6.44 $4.60 $4.60 $4.60 $5.01 $89.88 $95.50 $6.21 $84.26 $9.43 $6.21 $56.17 $73.03 $6.46 $6.46 $6.46 $6.46 $7.76 $4.83 $4.60 $7.76 $4.60 $4.60 $3.45 $3.45 $3.45 $3.45 $95.50 330104 82379 400 301 HC ASSAY OF CARNITINE O "$1,668.13 " $16.87 $16.87 $10.50 $834.07 N/A N/A N/A $10.50 $32.05 $10.50 $16.87 "$1,251.10 " $18.56 "$1,050.92 " "$1,219.40 " $12.60 $10.50 "$1,000.88 " "$1,334.50 " $57.36 $96.16 $10.50 $16.87 "$1,084.28 " $14.70 "$1,334.50 " $10.50 $10.50 $12.60 $23.62 $10.50 $16.87 $16.87 $18.39 "$1,334.50 " "$1,417.91 " $14.18 "$1,251.10 " $21.52 $14.18 $834.07 "$1,084.28 " $23.70 $23.70 $23.70 $23.70 $28.49 $17.71 $16.87 $28.49 $10.50 $10.50 $12.65 $12.65 $12.65 $10.50 "$1,417.91 " 330104 82380 402 301 HC ASSAY OF CAROTENE O $263.22 $9.22 $9.22 N/A $131.61 N/A N/A N/A N/A $17.52 N/A $9.22 $197.42 $10.14 $165.83 $192.41 N/A N/A $157.93 $210.58 $31.35 $52.55 N/A $9.22 $171.09 N/A $210.58 N/A N/A N/A $12.91 N/A $9.22 $9.22 $10.05 $210.58 $223.74 N/A $197.42 N/A N/A $131.61 $171.09 $12.95 $12.95 $12.95 $12.95 $15.58 $9.68 $9.22 $15.58 N/A N/A $6.92 $6.92 $6.92 $6.92 $223.74 330104 82384 398 301 HC ASSAY THREE CATECHOLAMINES O $996.17 $25.25 $25.25 $18.40 $498.08 N/A N/A N/A $18.40 $47.97 $18.40 $25.25 $747.13 $27.78 $627.59 $728.20 $22.08 $18.40 $597.70 $796.94 $85.85 $143.93 $18.40 $25.25 $647.51 $25.76 $796.94 $18.40 $18.40 $22.08 $35.35 $18.40 $25.25 $25.25 $27.52 $796.94 $846.74 $24.84 $747.13 $37.72 $24.84 $498.08 $647.51 $35.48 $35.48 $35.48 $35.48 $42.64 $26.51 $25.25 $42.64 $18.40 $18.40 $18.94 $18.94 $18.94 $18.40 $846.74 330104 82390 402 301 HC ASSAY OF CERULOPLASMIN O $326.35 $10.74 $10.74 $8.10 $163.18 N/A N/A N/A $8.10 $20.41 $8.10 $10.74 $244.76 $11.81 $205.60 $238.56 $9.72 $8.10 $195.81 $261.08 $36.52 $61.22 $8.10 $10.74 $212.13 $11.34 $261.08 $8.10 $8.10 $9.72 $15.04 $8.10 $10.74 $10.74 $11.71 $261.08 $277.40 $10.94 $244.76 $16.60 $10.94 $163.18 $212.13 $15.09 $15.09 $15.09 $15.09 $18.14 $11.28 $10.74 $18.14 $8.10 $8.10 $8.05 $8.05 $8.05 $8.05 $277.40 330104 82397 400 301 HC CHEMILUMINESCENT ASSAY O $318.86 $14.12 $14.12 N/A $159.43 N/A N/A N/A N/A $26.83 N/A $14.12 $239.15 $15.53 $200.88 $233.09 N/A N/A $191.32 $255.09 $48.01 $80.48 N/A $14.12 $207.26 N/A $255.09 N/A N/A N/A $19.77 N/A $14.12 $14.12 $15.39 $255.09 $271.03 N/A $239.15 N/A N/A $159.43 $207.26 $19.84 $19.84 $19.84 $19.84 $23.86 $14.83 $14.12 $23.86 N/A N/A $10.59 $10.59 $10.59 $10.59 $271.03 330104 80307 2041 301 HC DRUG TEST PRSMV CHEM ANLYZR O $227.91 $62.14 $62.14 $7.50 $113.95 N/A N/A N/A $7.50 $118.07 $7.50 $62.14 $170.93 $68.35 $143.58 $166.60 $9.00 $7.50 $136.75 $182.33 $211.28 $354.20 $7.50 $62.14 $148.14 $10.50 $182.33 $7.50 $7.50 $9.00 $87.00 $7.50 $62.14 $62.14 $67.73 $182.33 $193.72 $10.12 $170.93 $15.37 $10.12 $113.95 $148.14 $87.31 $87.31 $87.31 $87.31 $95.77 $65.25 $62.14 $95.77 $7.50 $7.50 $46.61 $46.61 $46.61 $7.50 $354.20 330104 82360 400 301 HC CALCULUS ASSAY QUANT O $306.02 $12.87 $12.87 $12.87 $153.01 N/A N/A N/A $12.87 $24.45 $12.87 $12.87 $229.51 $14.16 $192.79 $223.70 $15.44 $12.87 $183.61 $244.82 $43.76 $73.36 $12.87 $12.87 $198.91 $18.02 $244.82 $12.87 $12.87 $15.44 $18.02 $12.87 $12.87 $12.87 $14.03 $244.82 $260.12 $17.37 $229.51 $26.38 $17.37 $153.01 $198.91 $18.08 $18.08 $18.08 $18.08 $21.74 $13.51 $12.87 $21.74 $12.87 $12.87 $9.65 $9.65 $9.65 $9.65 $260.12 330104 82175 404 301 HC ASSAY OF ARSENIC O $475.08 $18.97 $18.97 $18.97 $237.54 N/A N/A N/A $18.97 $36.04 $18.97 $18.97 $356.31 $20.87 $299.30 $347.28 $22.76 $18.97 $285.05 $380.06 $64.50 $108.13 $18.97 $18.97 $308.80 $26.56 $380.06 $18.97 $18.97 $22.76 $26.56 $18.97 $18.97 $18.97 $20.68 $380.06 $403.82 $25.61 $356.31 $38.89 $25.61 $237.54 $308.80 $26.65 $26.65 $26.65 $26.65 $32.04 $19.92 $18.97 $32.04 $18.97 $18.97 $14.23 $14.23 $14.23 $14.23 $403.82 330104 82378 400 301 HC CARCINOEMBRYONIC ANTIGEN O $340.26 $18.96 $18.96 $18.96 $170.13 N/A N/A N/A $18.96 $36.02 $18.96 $18.96 $255.19 $20.86 $214.36 $248.73 $22.75 $18.96 $204.16 $272.21 $64.46 $108.07 $18.96 $18.96 $221.17 $26.54 $272.21 $18.96 $18.96 $22.75 $26.54 $18.96 $18.96 $18.96 $20.67 $272.21 $289.22 $25.60 $255.19 $38.87 $25.60 $170.13 $221.17 $26.64 $26.64 $26.64 $26.64 $32.04 $19.91 $18.96 $32.04 $18.96 $18.96 $14.22 $14.22 $14.22 $14.22 $289.22 330104 82164 400 301 HC ANGIOTENSIN I ENZYME TEST O $479.36 $14.60 $14.60 N/A $239.68 N/A N/A N/A N/A $27.74 N/A $14.60 $359.52 $16.06 $302.00 $350.41 N/A N/A $287.62 $383.49 $49.64 $83.22 N/A $14.60 $311.58 N/A $383.49 N/A N/A N/A $20.44 N/A $14.60 $14.60 $15.91 $383.49 $407.46 N/A $359.52 N/A N/A $239.68 $311.58 $20.51 $20.51 $20.51 $20.51 $24.65 $15.33 $14.60 $24.65 N/A N/A $10.95 $10.95 $10.95 $10.95 $407.46 330104 81105 385 301 HC HPA-1 GENOTYPING O $606.69 $122.22 $122.22 N/A $303.35 N/A N/A N/A N/A $232.22 N/A $122.22 $455.02 $134.44 $382.21 $443.49 N/A N/A $364.01 $485.35 $415.55 $696.65 N/A $122.22 $394.35 N/A $485.35 N/A N/A N/A $171.11 N/A $122.22 $122.22 $133.22 $485.35 $515.69 N/A $455.02 N/A N/A $303.35 $394.35 $171.72 $171.72 $171.72 $171.72 $181.07 $128.33 $122.22 $181.07 N/A N/A $91.66 $91.66 $91.66 $91.66 $696.65 330104 82172 400 301 HC ASSAY OF APOLIPOPROTEIN O $96.30 $21.09 $21.09 $15.93 $48.15 N/A N/A N/A $15.93 $40.07 $15.93 $21.09 $72.22 $23.20 $60.67 $70.40 $19.12 $15.93 $57.78 $77.04 $71.71 $120.21 $15.93 $21.09 $62.59 $22.30 $77.04 $15.93 $15.93 $19.12 $29.53 $15.93 $21.09 $21.09 $22.99 $77.04 $81.85 $21.51 $72.22 $32.66 $21.51 $48.15 $62.59 $29.63 $29.63 $29.63 $29.63 $26.17 $22.14 $21.09 $26.17 $15.93 $15.93 $15.82 $15.82 $15.82 $15.82 $120.21 330104 81162 2045 301 HC BRCA 1 BRCA 2 COMPREHENSIVE ANALYSIS O "$7,972.57 " "$1,824.88 " "$1,824.88 " N/A "$3,986.28 " N/A N/A N/A N/A "$3,467.27 " N/A "$1,824.88 " "$5,979.43 " "$2,007.37 " "$5,022.72 " "$5,827.95 " N/A N/A "$4,783.54 " "$6,378.06 " "$6,204.59 " "$10,401.82 " N/A "$1,824.88 " "$5,182.17 " N/A "$6,378.06 " N/A N/A N/A "$2,554.83 " N/A "$1,824.88 " "$1,824.88 " "$1,989.12 " "$6,378.06 " "$6,776.68 " N/A "$5,979.43 " N/A N/A "$3,986.28 " "$5,182.17 " "$2,563.96 " "$2,563.96 " "$2,563.96 " "$2,563.96 " "$2,983.03 " "$1,916.12 " "$1,824.88 " "$2,983.03 " N/A N/A "$1,368.66 " "$1,368.66 " "$1,368.66 " "$1,368.66 " "$10,401.82 " 330104 81263 386 301 HC IGH VARI REGIONAL MUTATION O "$1,855.38 " $294.52 $294.52 N/A $927.69 N/A N/A N/A N/A $559.59 N/A $294.52 "$1,391.54 " $323.97 "$1,168.89 " "$1,356.28 " N/A N/A "$1,113.23 " "$1,484.30 " "$1,001.37 " "$1,678.76 " N/A $294.52 "$1,206.00 " N/A "$1,484.30 " N/A N/A N/A $412.33 N/A $294.52 $294.52 $321.03 "$1,484.30 " "$1,577.07 " N/A "$1,391.54 " N/A N/A $927.69 "$1,206.00 " $413.80 $413.80 $413.80 $413.80 $482.15 $309.25 $294.52 $482.15 N/A N/A $220.89 $220.89 $220.89 $220.89 "$1,678.76 " 330104 82024 399 301 HC ASSAY OF ACTH O "$1,231.57 " $38.62 $38.62 $38.62 $615.78 N/A N/A N/A $38.62 $73.38 $38.62 $38.62 $923.68 $42.48 $775.89 $900.28 $46.34 $38.62 $738.94 $985.26 $131.31 $220.13 $38.62 $38.62 $800.52 $54.07 $985.26 $38.62 $38.62 $46.34 $54.07 $38.62 $38.62 $38.62 $42.10 $985.26 "$1,046.83 " $52.14 $923.68 $79.17 $52.14 $615.78 $800.52 $54.26 $54.26 $54.26 $54.26 $65.22 $40.55 $38.62 $65.22 $38.62 $38.62 $28.96 $28.96 $28.96 $28.96 "$1,046.83 " 330104 82040 402 301 HC ASSAY OF SERUM ALBUMIN O $117.70 $4.95 $4.95 $4.95 $58.85 N/A N/A N/A $4.95 $9.40 $4.95 $4.95 $88.28 $5.45 $74.15 $86.04 $5.94 $4.95 $70.62 $94.16 $16.83 $28.22 $4.95 $4.95 $76.51 $6.93 $94.16 $4.95 $4.95 $5.94 $6.93 $4.95 $4.95 $4.95 $5.40 $94.16 $100.05 $6.68 $88.28 $10.15 $6.68 $58.85 $76.51 $6.95 $6.95 $6.95 $6.95 $8.35 $5.20 $4.95 $8.35 $4.95 $4.95 $3.71 $3.71 $3.71 $3.71 $100.05 330104 82042 402 301 HC ASSAY OF URINE ALBUMIN O $82.39 $7.78 $7.78 $5.03 $41.20 N/A N/A N/A $5.03 $14.78 $5.03 $7.78 $61.79 $8.56 $51.91 $60.23 $6.04 $5.03 $49.43 $65.91 $26.45 $44.35 $5.03 $7.78 $53.55 $7.04 $65.91 $5.03 $5.03 $6.04 $10.89 $5.03 $7.78 $7.78 $8.48 $65.91 $70.03 $6.79 $61.79 $10.31 $6.79 $41.20 $53.55 $10.93 $10.93 $10.93 $10.93 $8.74 $8.17 $7.78 $8.74 $5.03 $5.03 $5.83 $5.83 $5.83 $5.03 $70.03 330104 82043 410 301 HC MICROALBUMIN QUANTITATIVE O $160.50 $5.78 $5.78 $5.03 $80.25 N/A N/A N/A $5.03 $10.98 $5.03 $5.78 $120.38 $6.36 $101.11 $117.33 $6.04 $5.03 $96.30 $128.40 $19.65 $32.95 $5.03 $5.78 $104.33 $7.04 $128.40 $5.03 $5.03 $6.04 $8.09 $5.03 $5.78 $5.78 $6.30 $128.40 $136.42 $6.79 $120.38 $10.31 $6.79 $80.25 $104.33 $8.12 $8.12 $8.12 $8.12 $9.77 $6.07 $5.78 $9.77 $5.03 $5.03 $4.33 $4.33 $4.33 $4.33 $136.42 330104 82077 2040 301 HC ASSAY SPEC XCP UR&BREATH IA O $58.85 $17.27 $17.27 N/A $29.43 N/A N/A N/A N/A $32.81 N/A $17.27 $44.14 $19.00 $37.08 $43.02 N/A N/A $35.31 $47.08 $58.72 $98.44 N/A $17.27 $38.25 N/A $47.08 N/A N/A N/A $24.18 N/A $17.27 $17.27 $18.82 $47.08 $50.02 N/A $44.14 N/A N/A $29.43 $38.25 $24.26 $24.26 $24.26 $24.26 N/A $18.13 $17.27 $39.25 N/A N/A $12.95 $12.95 $12.95 $12.95 $98.44 330104 82010 402 301 HC ACETONE ASSAY O $131.61 $8.17 $8.17 N/A $65.81 N/A N/A N/A N/A $15.52 N/A $8.17 $98.71 $8.99 $82.91 $96.21 N/A N/A $78.97 $105.29 $27.78 $46.57 N/A $8.17 $85.55 N/A $105.29 N/A N/A N/A $11.44 N/A $8.17 $8.17 $8.91 $105.29 $111.87 N/A $98.71 N/A N/A $65.81 $85.55 $11.48 $11.48 $11.48 $11.48 $13.80 $8.58 $8.17 $13.80 N/A N/A $6.13 $6.13 $6.13 $6.13 $111.87 330104 82139 400 301 HC AMINO ACIDS QUAN 6 OR MORE O $227.91 $16.87 $16.87 $14.00 $113.95 N/A N/A N/A $14.00 $32.05 $14.00 $16.87 $170.93 $18.56 $143.58 $166.60 $16.80 $14.00 $136.75 $182.33 $57.36 $96.16 $14.00 $16.87 $148.14 $19.60 $182.33 $14.00 $14.00 $16.80 $23.62 $14.00 $16.87 $16.87 $18.39 $182.33 $193.72 $18.90 $170.93 $28.70 $18.90 $113.95 $148.14 $23.70 $23.70 $23.70 $23.70 $28.49 $17.71 $16.87 $28.49 $14.00 $14.00 $12.65 $12.65 $12.65 $12.65 $193.72 330104 82085 402 301 HC ASSAY OF ALDOLASE O $332.77 $9.71 $9.71 N/A $166.38 N/A N/A N/A N/A $18.45 N/A $9.71 $249.58 $10.68 $209.65 $243.25 N/A N/A $199.66 $266.22 $33.01 $55.35 N/A $9.71 $216.30 N/A $266.22 N/A N/A N/A $13.59 N/A $9.71 $9.71 $10.58 $266.22 $282.85 N/A $249.58 N/A N/A $166.38 $216.30 $13.64 $13.64 $13.64 $13.64 $16.39 $10.20 $9.71 $16.39 N/A N/A $7.28 $7.28 $7.28 $7.28 $282.85 330104 82140 400 301 HC ASSAY OF AMMONIA O $210.79 $14.57 $14.57 $14.57 $105.39 N/A N/A N/A $14.57 $27.68 $14.57 $14.57 $158.09 $16.03 $132.80 $154.09 $17.48 $14.57 $126.47 $168.63 $49.54 $83.05 $14.57 $14.57 $137.01 $20.40 $168.63 $14.57 $14.57 $17.48 $20.40 $14.57 $14.57 $14.57 $15.88 $168.63 $179.17 $19.67 $158.09 $29.87 $19.67 $105.39 $137.01 $20.47 $20.47 $20.47 $20.47 $24.61 $15.30 $14.57 $24.61 $14.57 $14.57 $10.93 $10.93 $10.93 $10.93 $179.17 330104 82135 400 301 HC ASSAY AMINOLEVULINIC ACID O $442.98 $16.45 $16.45 N/A $221.49 N/A N/A N/A N/A $31.25 N/A $16.45 $332.24 $18.10 $279.08 $323.82 N/A N/A $265.79 $354.38 $55.93 $93.77 N/A $16.45 $287.94 N/A $354.38 N/A N/A N/A $23.03 N/A $16.45 $16.45 $17.93 $354.38 $376.53 N/A $332.24 N/A N/A $221.49 $287.94 $23.11 $23.11 $23.11 $23.11 $27.79 $17.27 $16.45 $27.79 N/A N/A $12.34 $12.34 $12.34 $12.34 $376.53 330104 82131 400 301 HC AMINO ACIDS SINGLE QUANT O $507.18 $22.98 $22.98 $14.00 $253.59 N/A N/A N/A $14.00 $43.66 $14.00 $22.98 $380.38 $25.28 $319.52 $370.75 $16.80 $14.00 $304.31 $405.74 $78.13 $130.99 $14.00 $22.98 $329.67 $19.60 $405.74 $14.00 $14.00 $16.80 $32.17 $14.00 $22.98 $22.98 $25.05 $405.74 $431.10 $18.90 $380.38 $28.70 $18.90 $253.59 $329.67 $32.29 $32.29 $32.29 $32.29 $28.49 $24.13 $22.98 $28.49 $14.00 $14.00 $17.23 $17.23 $17.23 $14.00 $431.10 330104 82150 402 301 HC ASSAY OF AMYLASE O $182.97 $6.48 $6.48 $5.03 $91.48 N/A N/A N/A $5.03 $12.31 $5.03 $6.48 $137.23 $7.13 $115.27 $133.75 $6.04 $5.03 $109.78 $146.38 $22.03 $36.94 $5.03 $6.48 $118.93 $7.04 $146.38 $5.03 $5.03 $6.04 $9.07 $5.03 $6.48 $6.48 $7.06 $146.38 $155.52 $6.79 $137.23 $10.31 $6.79 $91.48 $118.93 $9.10 $9.10 $9.10 $9.10 $10.94 $6.80 $6.48 $10.94 $5.03 $5.03 $4.86 $4.86 $4.86 $4.86 $155.52 330104 82157 398 301 HC ASSAY OF ANDROSTENEDIONE O $740.44 $29.28 $29.28 $29.28 $370.22 N/A N/A N/A $29.28 $55.63 $29.28 $29.28 $555.33 $32.21 $466.48 $541.26 $35.14 $29.28 $444.26 $592.35 $99.55 $166.90 $29.28 $29.28 $481.29 $40.99 $592.35 $29.28 $29.28 $35.14 $40.99 $29.28 $29.28 $29.28 $31.92 $592.35 $629.37 $39.53 $555.33 $60.02 $39.53 $370.22 $481.29 $41.14 $41.14 $41.14 $41.14 $49.44 $30.74 $29.28 $49.44 $29.28 $29.28 $21.96 $21.96 $21.96 $21.96 $629.37 330104 82103 400 301 HC ALPHA-1-ANTITRYPSIN; TOTAL O $449.40 $13.44 $13.44 $12.50 $224.70 N/A N/A N/A $12.50 $25.54 $12.50 $13.44 $337.05 $14.78 $283.12 $328.51 $15.00 $12.50 $269.64 $359.52 $45.70 $76.61 $12.50 $13.44 $292.11 $17.50 $359.52 $12.50 $12.50 $15.00 $18.82 $12.50 $13.44 $13.44 $14.65 $359.52 $381.99 $16.88 $337.05 $25.62 $16.88 $224.70 $292.11 $18.88 $18.88 $18.88 $18.88 $22.69 $14.11 $13.44 $22.69 $12.50 $12.50 $10.08 $10.08 $10.08 $10.08 $381.99 330104 82088 399 301 HC ASSAY OF ALDOSTERONE O "$1,121.36 " $40.75 $40.75 $40.75 $560.68 N/A N/A N/A $40.75 $77.42 $40.75 $40.75 $841.02 $44.83 $706.46 $819.71 $48.90 $40.75 $672.82 $897.09 $138.55 $232.28 $40.75 $40.75 $728.88 $57.05 $897.09 $40.75 $40.75 $48.90 $57.05 $40.75 $40.75 $40.75 $44.42 $897.09 $953.16 $55.01 $841.02 $83.54 $55.01 $560.68 $728.88 $57.25 $57.25 $57.25 $57.25 $68.82 $42.79 $40.75 $68.82 $40.75 $40.75 $30.56 $30.56 $30.56 $30.56 $953.16 330104 82104 400 301 HC ALPHA-1-ANTITRYPSIN; PHENOTYPE O $129.47 $14.46 $14.46 $13.72 $64.73 N/A N/A N/A $13.72 $27.47 $13.72 $14.46 $97.10 $15.91 $81.57 $94.64 $16.46 $13.72 $77.68 $103.58 $49.16 $82.42 $13.72 $14.46 $84.16 $19.21 $103.58 $13.72 $13.72 $16.46 $20.24 $13.72 $14.46 $14.46 $15.76 $103.58 $110.05 $18.52 $97.10 $28.13 $18.52 $64.73 $84.16 $20.32 $20.32 $20.32 $20.32 $24.42 $15.18 $14.46 $24.42 $13.72 $13.72 $10.85 $10.85 $10.85 $10.85 $110.05 330104 86256 394 302 HC FLUORESCENT ANTIBODY TITER O $432.28 $12.05 $12.05 N/A $216.14 N/A N/A N/A N/A $22.89 N/A $12.05 $324.21 $13.26 $272.34 $316.00 N/A N/A $259.37 $345.82 $40.97 $68.69 N/A $12.05 $280.98 N/A $345.82 N/A N/A N/A $16.87 N/A $12.05 $12.05 $13.13 $345.82 $367.44 N/A $324.21 N/A N/A $216.14 $280.98 $16.93 $16.93 $16.93 $16.93 $20.35 $12.65 $12.05 $20.35 N/A N/A $9.04 $9.04 $9.04 $9.04 $367.44 330104 86309 394 302 HC HETEROPHILE ANTIBODY TITER O $108.07 $6.47 $6.47 $6.47 $54.03 N/A N/A N/A $6.47 $12.29 $6.47 $6.47 $81.05 $7.12 $68.08 $79.00 $7.76 $6.47 $64.84 $86.46 $22.00 $36.88 $6.47 $6.47 $70.25 $9.06 $86.46 $6.47 $6.47 $7.76 $9.06 $6.47 $6.47 $6.47 $7.05 $86.46 $91.86 $8.73 $81.05 $13.26 $8.73 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $6.47 $6.47 $4.85 $4.85 $4.85 $4.85 $91.86 330104 86300 394 302 HC IMMUNOASSAY TUMOR CA 15-3 O "$1,006.87 " $20.81 $20.81 $20.81 $503.44 N/A N/A N/A $20.81 $39.54 $20.81 $20.81 $755.15 $22.89 $634.33 $736.02 $24.97 $20.81 $604.12 $805.50 $70.75 $118.62 $20.81 $20.81 $654.47 $29.13 $805.50 $20.81 $20.81 $24.97 $29.13 $20.81 $20.81 $20.81 $22.68 $805.50 $855.84 $28.09 $755.15 $42.66 $28.09 $503.44 $654.47 $29.24 $29.24 $29.24 $29.24 $35.15 $21.85 $20.81 $35.15 $20.81 $20.81 $15.61 $15.61 $15.61 $15.61 $855.84 330104 86301 394 302 HC IMMUNOASSAY TUMOR CA 19-9 O "$1,023.99 " $20.81 $20.81 $20.81 $512.00 N/A N/A N/A $20.81 $39.54 $20.81 $20.81 $767.99 $22.89 $645.11 $748.54 $24.97 $20.81 $614.39 $819.19 $70.75 $118.62 $20.81 $20.81 $665.59 $29.13 $819.19 $20.81 $20.81 $24.97 $29.13 $20.81 $20.81 $20.81 $22.68 $819.19 $870.39 $28.09 $767.99 $42.66 $28.09 $512.00 $665.59 $29.24 $29.24 $29.24 $29.24 $35.15 $21.85 $20.81 $35.15 $20.81 $20.81 $15.61 $15.61 $15.61 $15.61 $870.39 330104 86304 394 302 HC IMMUNOASSAY TUMOR CA 125 O $704.06 $20.81 $20.81 $20.81 $352.03 N/A N/A N/A $20.81 $39.54 $20.81 $20.81 $528.04 $22.89 $443.56 $514.67 $24.97 $20.81 $422.44 $563.25 $70.75 $118.62 $20.81 $20.81 $457.64 $29.13 $563.25 $20.81 $20.81 $24.97 $29.13 $20.81 $20.81 $20.81 $22.68 $563.25 $598.45 $28.09 $528.04 $42.66 $28.09 $352.03 $457.64 $29.24 $29.24 $29.24 $29.24 $35.15 $21.85 $20.81 $35.15 $20.81 $20.81 $15.61 $15.61 $15.61 $15.61 $598.45 330104 86308 394 302 HC HETEROPHILE ANTIBODY SCREEN O $112.35 $5.18 $5.18 $4.73 $56.17 N/A N/A N/A $4.73 $9.84 $4.73 $5.18 $84.26 $5.70 $70.78 $82.13 $5.68 $4.73 $67.41 $89.88 $17.61 $29.53 $4.73 $5.18 $73.03 $6.62 $89.88 $4.73 $4.73 $5.68 $7.25 $4.73 $5.18 $5.18 $5.65 $89.88 $95.50 $6.39 $84.26 $9.70 $6.39 $56.17 $73.03 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $4.73 $4.73 $3.88 $3.88 $3.88 $3.88 $95.50 330104 86340 394 302 HC INTRINSIC FACTOR ANTIBODY O $557.47 $15.08 $15.08 $11.36 $278.74 N/A N/A N/A $11.36 $28.65 $11.36 $15.08 $418.10 $16.59 $351.21 $407.51 $13.63 $11.36 $334.48 $445.98 $51.27 $85.96 $11.36 $15.08 $362.36 $15.90 $445.98 $11.36 $11.36 $13.63 $21.11 $11.36 $15.08 $15.08 $16.44 $445.98 $473.85 $15.34 $418.10 $23.29 $15.34 $278.74 $362.36 $21.19 $21.19 $21.19 $21.19 $25.45 $15.83 $15.08 $25.45 $11.36 $11.36 $11.31 $11.31 $11.31 $11.31 $473.85 330104 86331 394 302 HC IMMUNODIFFUSION OUCHTERLONY O $190.46 $11.98 $11.98 N/A $95.23 N/A N/A N/A N/A $22.76 N/A $11.98 $142.84 $13.18 $119.99 $139.23 N/A N/A $114.28 $152.37 $40.73 $68.29 N/A $11.98 $123.80 N/A $152.37 N/A N/A N/A $16.77 N/A $11.98 $11.98 $13.06 $152.37 $161.89 N/A $142.84 N/A N/A $95.23 $123.80 $16.83 $16.83 $16.83 $16.83 $20.23 $12.58 $11.98 $20.23 N/A N/A $8.98 $8.98 $8.98 $8.98 $161.89 330104 86317 394 302 HC IMMUNOASSAY INFECTIOUS AGENT NOS O $205.44 $14.99 $14.99 N/A $102.72 N/A N/A N/A N/A $28.48 N/A $14.99 $154.08 $16.49 $129.43 $150.18 N/A N/A $123.26 $164.35 $50.97 $85.44 N/A $14.99 $133.54 N/A $164.35 N/A N/A N/A $20.99 N/A $14.99 $14.99 $16.34 $164.35 $174.62 N/A $154.08 N/A N/A $102.72 $133.54 $21.06 $21.06 $21.06 $21.06 $25.32 $15.74 $14.99 $25.32 N/A N/A $11.24 $11.24 $11.24 $11.24 $174.62 330104 86329 394 302 HC IMMUNODIFFUSION NES O $126.26 $14.05 $14.05 $12.50 $63.13 N/A N/A N/A $12.50 $26.70 $12.50 $14.05 $94.70 $15.46 $79.54 $92.30 $15.00 $12.50 $75.76 $101.01 $47.77 $80.09 $12.50 $14.05 $82.07 $17.50 $101.01 $12.50 $12.50 $15.00 $19.67 $12.50 $14.05 $14.05 $15.31 $101.01 $107.32 $16.88 $94.70 $25.62 $16.88 $63.13 $82.07 $19.74 $19.74 $19.74 $19.74 $23.72 $14.75 $14.05 $23.72 $12.50 $12.50 $10.54 $10.54 $10.54 $10.54 $107.32 330104 86332 394 302 HC IMMUNE COMPLEX ASSAY O $387.34 $24.37 $24.37 N/A $193.67 N/A N/A N/A N/A $46.30 N/A $24.37 $290.50 $26.81 $244.02 $283.15 N/A N/A $232.40 $309.87 $82.86 $138.91 N/A $24.37 $251.77 N/A $309.87 N/A N/A N/A $34.12 N/A $24.37 $24.37 $26.56 $309.87 $329.24 N/A $290.50 N/A N/A $193.67 $251.77 $34.24 $34.24 $34.24 $34.24 $41.16 $25.59 $24.37 $41.16 N/A N/A $18.28 $18.28 $18.28 $18.28 $329.24 330104 86334 394 302 HC IMMUNOFIX E-PHORESIS SERUM O $352.03 $22.34 $22.34 $22.34 $176.01 N/A N/A N/A $22.34 $42.45 $22.34 $22.34 $264.02 $24.57 $221.78 $257.33 $26.81 $22.34 $211.22 $281.62 $75.96 $127.34 $22.34 $22.34 $228.82 $31.28 $281.62 $22.34 $22.34 $26.81 $31.28 $22.34 $22.34 $22.34 $24.35 $281.62 $299.23 $30.16 $264.02 $45.80 $30.16 $176.01 $228.82 $31.39 $31.39 $31.39 $31.39 $37.73 $23.46 $22.34 $37.73 $22.34 $22.34 $16.75 $16.75 $16.75 $16.75 $299.23 330104 86255 394 302 HC FLUORESCENT ANTIBODY SCREEN O $466.52 $12.05 $12.05 $5.20 $233.26 N/A N/A N/A $5.20 $22.89 $5.20 $12.05 $349.89 $13.26 $293.91 $341.03 $6.24 $5.20 $279.91 $373.22 $40.97 $68.69 $5.20 $12.05 $303.24 $7.28 $373.22 $5.20 $5.20 $6.24 $16.87 $5.20 $12.05 $12.05 $13.13 $373.22 $396.54 $7.02 $349.89 $10.66 $7.02 $233.26 $303.24 $16.93 $16.93 $16.93 $16.93 $20.35 $12.65 $12.05 $20.35 $5.20 $5.20 $9.04 $9.04 $9.04 $5.20 $396.54 330104 86337 394 302 HC INSULIN ANTIBODIES O $169.06 $21.41 $21.41 $12.50 $84.53 N/A N/A N/A $12.50 $40.68 $12.50 $21.41 $126.80 $23.55 $106.51 $123.58 $15.00 $12.50 $101.44 $135.25 $72.79 $122.04 $12.50 $21.41 $109.89 $17.50 $135.25 $12.50 $12.50 $15.00 $29.97 $12.50 $21.41 $21.41 $23.34 $135.25 $143.70 $16.88 $126.80 $25.62 $16.88 $84.53 $109.89 $30.08 $30.08 $30.08 $30.08 $36.16 $22.48 $21.41 $36.16 $12.50 $12.50 $16.06 $16.06 $16.06 $12.50 $143.70 330104 86316 394 302 HC IMMUNOASSAY TUMOR OTHER O $330.63 $20.81 $20.81 N/A $165.31 N/A N/A N/A N/A $39.54 N/A $20.81 $247.97 $22.89 $208.30 $241.69 N/A N/A $198.38 $264.50 $70.75 $118.62 N/A $20.81 $214.91 N/A $264.50 N/A N/A N/A $29.13 N/A $20.81 $20.81 $22.68 $264.50 $281.04 N/A $247.97 N/A N/A $165.31 $214.91 $29.24 $29.24 $29.24 $29.24 $35.15 $21.85 $20.81 $35.15 N/A N/A $15.61 $15.61 $15.61 $15.61 $281.04 330104 86235 394 302 HC NUCLEAR ANTIGEN ANTIBODY O $568.17 $17.93 $17.93 $5.20 $284.08 N/A N/A N/A $5.20 $34.07 $5.20 $17.93 $426.13 $19.72 $357.95 $415.33 $6.24 $5.20 $340.90 $454.54 $60.96 $102.20 $5.20 $17.93 $369.31 $7.28 $454.54 $5.20 $5.20 $6.24 $25.10 $5.20 $17.93 $17.93 $19.54 $454.54 $482.94 $7.02 $426.13 $10.66 $7.02 $284.08 $369.31 $25.19 $25.19 $25.19 $25.19 $30.28 $18.83 $17.93 $30.28 $5.20 $5.20 $13.45 $13.45 $13.45 $5.20 $482.94 330104 86146 394 302 HC BETA-2 GLYCOPROTEIN ANTIBODY O $277.13 $25.45 $25.45 $7.82 $138.56 N/A N/A N/A $7.82 $48.35 $7.82 $25.45 $207.85 $28.00 $174.59 $202.58 $9.38 $7.82 $166.28 $221.70 $86.53 $145.06 $7.82 $25.45 $180.13 $10.95 $221.70 $7.82 $7.82 $9.38 $35.63 $7.82 $25.45 $25.45 $27.74 $221.70 $235.56 $10.56 $207.85 $16.03 $10.56 $138.56 $180.13 $35.76 $35.76 $35.76 $35.76 $42.96 $26.72 $25.45 $42.96 $7.82 $7.82 $19.09 $19.09 $19.09 $7.82 $235.56 330104 86225 394 302 HC DNA ANTIBODY NATIVE O $454.75 $13.74 $13.74 $5.20 $227.38 N/A N/A N/A $5.20 $26.11 $5.20 $13.74 $341.06 $15.11 $286.49 $332.42 $6.24 $5.20 $272.85 $363.80 $46.72 $78.32 $5.20 $13.74 $295.59 $7.28 $363.80 $5.20 $5.20 $6.24 $19.24 $5.20 $13.74 $13.74 $14.98 $363.80 $386.54 $7.02 $341.06 $10.66 $7.02 $227.38 $295.59 $19.30 $19.30 $19.30 $19.30 $23.20 $14.43 $13.74 $23.20 $5.20 $5.20 $10.30 $10.30 $10.30 $5.20 $386.54 330104 86021 394 302 HC WBC ANTIBODY IDENTIFICATION O $92.02 $15.05 $15.05 N/A $46.01 N/A N/A N/A N/A $28.59 N/A $15.05 $69.02 $16.56 $57.97 $67.27 N/A N/A $55.21 $73.62 $51.17 $85.79 N/A $15.05 $59.81 N/A $73.62 N/A N/A N/A $21.07 N/A $15.05 $15.05 $16.40 $73.62 $78.22 N/A $69.02 N/A N/A $46.01 $59.81 $21.15 $21.15 $21.15 $21.15 $25.43 $15.80 $15.05 $25.43 N/A N/A $11.29 $11.29 $11.29 $11.29 $85.79 330104 86003 394 302 HC ALLERGEN SPECIFIC IGE CRUDE XTRC EA O $84.53 $5.22 $5.22 $3.65 $42.27 N/A N/A N/A $3.65 $9.92 $3.65 $5.22 $63.40 $5.74 $53.25 $61.79 $4.38 $3.65 $50.72 $67.62 $17.75 $29.75 $3.65 $5.22 $54.94 $5.11 $67.62 $3.65 $3.65 $4.38 $7.31 $3.65 $5.22 $5.22 $5.69 $67.62 $71.85 $4.93 $63.40 $7.48 $4.93 $42.27 $54.94 $7.33 $7.33 $7.33 $7.33 $8.81 $5.48 $5.22 $8.81 $3.65 $3.65 $3.92 $3.92 $3.92 $3.65 $71.85 330104 86022 394 302 HC PLATELET ANTIBODIES O $572.45 $18.37 $18.37 N/A $286.23 N/A N/A N/A N/A $34.90 N/A $18.37 $429.34 $20.21 $360.64 $418.46 N/A N/A $343.47 $457.96 $62.46 $104.71 N/A $18.37 $372.09 N/A $457.96 N/A N/A N/A $25.72 N/A $18.37 $18.37 $20.02 $457.96 $486.58 N/A $429.34 N/A N/A $286.23 $372.09 $25.81 $25.81 $25.81 $25.81 $31.02 $19.29 $18.37 $31.02 N/A N/A $13.78 $13.78 $13.78 $13.78 $486.58 330104 86038 394 302 HC ANTINUCLEAR ANTIBODIES O $239.68 $12.09 $12.09 $5.20 $119.84 N/A N/A N/A $5.20 $22.97 $5.20 $12.09 $179.76 $13.30 $151.00 $175.21 $6.24 $5.20 $143.81 $191.74 $41.11 $68.91 $5.20 $12.09 $155.79 $7.28 $191.74 $5.20 $5.20 $6.24 $16.93 $5.20 $12.09 $12.09 $13.18 $191.74 $203.73 $7.02 $179.76 $10.66 $7.02 $119.84 $155.79 $16.99 $16.99 $16.99 $16.99 $20.41 $12.69 $12.09 $20.41 $5.20 $5.20 $9.07 $9.07 $9.07 $5.20 $203.73 330104 86039 394 302 HC ANTINUCLEAR ANTIBODIES (ANA) O $176.55 $11.16 $11.16 $5.20 $88.28 N/A N/A N/A $5.20 $21.20 $5.20 $11.16 $132.41 $12.28 $111.23 $129.06 $6.24 $5.20 $105.93 $141.24 $37.94 $63.61 $5.20 $11.16 $114.76 $7.28 $141.24 $5.20 $5.20 $6.24 $15.62 $5.20 $11.16 $11.16 $12.16 $141.24 $150.07 $7.02 $132.41 $10.66 $7.02 $88.28 $114.76 $15.68 $15.68 $15.68 $15.68 $18.85 $11.72 $11.16 $18.85 $5.20 $5.20 $8.37 $8.37 $8.37 $5.20 $150.07 330104 86060 394 302 HC ANTISTREPTOLYSIN O TITER O $117.70 $7.30 $7.30 $5.20 $58.85 N/A N/A N/A $5.20 $13.87 $5.20 $7.30 $88.28 $8.03 $74.15 $86.04 $6.24 $5.20 $70.62 $94.16 $24.82 $41.61 $5.20 $7.30 $76.51 $7.28 $94.16 $5.20 $5.20 $6.24 $10.22 $5.20 $7.30 $7.30 $7.96 $94.16 $100.05 $7.02 $88.28 $10.66 $7.02 $58.85 $76.51 $10.26 $10.26 $10.26 $10.26 $12.32 $7.67 $7.30 $12.32 $5.20 $5.20 $5.47 $5.47 $5.47 $5.20 $100.05 330104 86140 394 302 HC C-REACTIVE PROTEIN O $71.69 $5.18 $5.18 $4.10 $35.84 N/A N/A N/A $4.10 $9.84 $4.10 $5.18 $53.77 $5.70 $45.16 $52.41 $4.92 $4.10 $43.01 $57.35 $17.61 $29.53 $4.10 $5.18 $46.60 $5.74 $57.35 $4.10 $4.10 $4.92 $7.25 $4.10 $5.18 $5.18 $5.65 $57.35 $60.94 $5.54 $53.77 $8.40 $5.54 $35.84 $46.60 $7.28 $7.28 $7.28 $7.28 $8.74 $5.44 $5.18 $8.74 $4.10 $4.10 $3.88 $3.88 $3.88 $3.88 $60.94 330104 86141 394 302 HC C-REACTIVE PROTEIN HS O $162.64 $12.95 $12.95 $10.25 $81.32 N/A N/A N/A $10.25 $24.60 $10.25 $12.95 $121.98 $14.25 $102.46 $118.89 $12.30 $10.25 $97.58 $130.11 $44.03 $73.81 $10.25 $12.95 $105.72 $14.35 $130.11 $10.25 $10.25 $12.30 $18.13 $10.25 $12.95 $12.95 $14.12 $130.11 $138.24 $13.84 $121.98 $21.01 $13.84 $81.32 $105.72 $18.19 $18.19 $18.19 $18.19 $21.86 $13.60 $12.95 $21.86 $10.25 $10.25 $9.71 $9.71 $9.71 $9.71 $138.24 330104 86147 394 302 HC CARDIOLIPIN ANTIBODY EA IG O $277.13 $25.45 $25.45 $7.82 $138.56 N/A N/A N/A $7.82 $48.35 $7.82 $25.45 $207.85 $28.00 $174.59 $202.58 $9.38 $7.82 $166.28 $221.70 $86.53 $145.06 $7.82 $25.45 $180.13 $10.95 $221.70 $7.82 $7.82 $9.38 $35.63 $7.82 $25.45 $25.45 $27.74 $221.70 $235.56 $10.56 $207.85 $16.03 $10.56 $138.56 $180.13 $35.76 $35.76 $35.76 $35.76 $42.96 $26.72 $25.45 $42.96 $7.82 $7.82 $19.09 $19.09 $19.09 $7.82 $235.56 330104 86148 394 302 HC ANTI-PHOSPHOLIPID ANTIBODY O $176.55 $16.07 $16.07 $7.82 $88.28 N/A N/A N/A $7.82 $30.53 $7.82 $16.07 $132.41 $17.68 $111.23 $129.06 $9.38 $7.82 $105.93 $141.24 $54.64 $91.60 $7.82 $16.07 $114.76 $10.95 $141.24 $7.82 $7.82 $9.38 $22.50 $7.82 $16.07 $16.07 $17.52 $141.24 $150.07 $10.56 $132.41 $16.03 $10.56 $88.28 $114.76 $22.58 $22.58 $22.58 $22.58 $27.13 $16.87 $16.07 $27.13 $7.82 $7.82 $12.05 $12.05 $12.05 $7.82 $150.07 330104 86157 394 302 HC COLD AGGLUTININ TITER O $306.02 $8.06 $8.06 $5.20 $153.01 N/A N/A N/A $5.20 $15.31 $5.20 $8.06 $229.51 $8.87 $192.79 $223.70 $6.24 $5.20 $183.61 $244.82 $27.40 $45.94 $5.20 $8.06 $198.91 $7.28 $244.82 $5.20 $5.20 $6.24 $11.28 $5.20 $8.06 $8.06 $8.79 $244.82 $260.12 $7.02 $229.51 $10.66 $7.02 $153.01 $198.91 $11.32 $11.32 $11.32 $11.32 $13.62 $8.46 $8.06 $13.62 $5.20 $5.20 $6.04 $6.04 $6.04 $5.20 $260.12 330104 86160 394 302 HC COMPLEMENT ANTIGEN O $671.96 $12.00 $12.00 $10.50 $335.98 N/A N/A N/A $10.50 $22.80 $10.50 $12.00 $503.97 $13.20 $423.33 $491.20 $12.60 $10.50 $403.18 $537.57 $40.80 $68.40 $10.50 $12.00 $436.77 $14.70 $537.57 $10.50 $10.50 $12.60 $16.80 $10.50 $12.00 $12.00 $13.08 $537.57 $571.17 $14.18 $503.97 $21.52 $14.18 $335.98 $436.77 $16.86 $16.86 $16.86 $16.86 $20.27 $12.60 $12.00 $20.27 $10.50 $10.50 $9.00 $9.00 $9.00 $9.00 $571.17 330104 86161 394 302 HC COMPLEMENT/FUNCTION ACTIVITY O $84.53 $12.00 $12.00 $12.00 $42.27 N/A N/A N/A $12.00 $22.80 $12.00 $12.00 $63.40 $13.20 $53.25 $61.79 $14.40 $12.00 $50.72 $67.62 $40.80 $68.40 $12.00 $12.00 $54.94 $16.80 $67.62 $12.00 $12.00 $14.40 $16.80 $12.00 $12.00 $12.00 $13.08 $67.62 $71.85 $16.20 $63.40 $24.60 $16.20 $42.27 $54.94 $16.86 $16.86 $16.86 $16.86 $20.27 $12.60 $12.00 $20.27 $12.00 $12.00 $9.00 $9.00 $9.00 $9.00 $71.85 330104 86162 394 302 HC COMPLEMENT TOTAL (CH50) O $645.21 $20.32 $20.32 $19.39 $322.61 N/A N/A N/A $19.39 $38.61 $19.39 $20.32 $483.91 $22.35 $406.48 $471.65 $23.27 $19.39 $387.13 $516.17 $69.09 $115.82 $19.39 $20.32 $419.39 $27.15 $516.17 $19.39 $19.39 $23.27 $28.45 $19.39 $20.32 $20.32 $22.15 $516.17 $548.43 $26.18 $483.91 $39.75 $26.18 $322.61 $419.39 $28.55 $28.55 $28.55 $28.55 $34.31 $21.34 $20.32 $34.31 $19.39 $19.39 $15.24 $15.24 $15.24 $15.24 $548.43 330104 86215 394 302 HC DEOXYRIBONUCLEASE ANTIBODY O $166.92 $13.25 $13.25 $5.20 $83.46 N/A N/A N/A $5.20 $25.17 $5.20 $13.25 $125.19 $14.58 $105.16 $122.02 $6.24 $5.20 $100.15 $133.54 $45.05 $75.53 $5.20 $13.25 $108.50 $7.28 $133.54 $5.20 $5.20 $6.24 $18.55 $5.20 $13.25 $13.25 $14.44 $133.54 $141.88 $7.02 $125.19 $10.66 $7.02 $83.46 $108.50 $18.62 $18.62 $18.62 $18.62 $22.38 $13.91 $13.25 $22.38 $5.20 $5.20 $9.94 $9.94 $9.94 $5.20 $141.88 330104 86226 394 302 HC DNA ANTIBODY SINGLE STRAND O $191.53 $12.11 $12.11 N/A $95.77 N/A N/A N/A N/A $23.01 N/A $12.11 $143.65 $13.32 $120.66 $140.01 N/A N/A $114.92 $153.22 $41.17 $69.03 N/A $12.11 $124.49 N/A $153.22 N/A N/A N/A $16.95 N/A $12.11 $12.11 $13.20 $153.22 $162.80 N/A $143.65 N/A N/A $95.77 $124.49 $17.01 $17.01 $17.01 $17.01 $20.45 $12.72 $12.11 $20.45 N/A N/A $9.08 $9.08 $9.08 $9.08 $162.80 330104 86356 395 302 HC MONONUCLEAR CELL ANTIGEN O $192.60 $26.78 $26.78 N/A $96.30 N/A N/A N/A N/A $50.88 N/A $26.78 $144.45 $29.46 $121.34 $140.79 N/A N/A $115.56 $154.08 $91.05 $152.65 N/A $26.78 $125.19 N/A $154.08 N/A N/A N/A $37.49 N/A $26.78 $26.78 $29.19 $154.08 $163.71 N/A $144.45 N/A N/A $96.30 $125.19 $37.63 $37.63 $37.63 $37.63 $45.20 $28.12 $26.78 $45.20 N/A N/A $20.09 $20.09 $20.09 $20.09 $163.71 330104 86665 394 302 HC EPSTEIN-BARR CAPSID VCA O $284.62 $18.14 $18.14 $18.14 $142.31 N/A N/A N/A $18.14 $34.47 $18.14 $18.14 $213.47 $19.95 $179.31 $208.06 $21.77 $18.14 $170.77 $227.70 $61.68 $103.40 $18.14 $18.14 $185.00 $25.40 $227.70 $18.14 $18.14 $21.77 $25.40 $18.14 $18.14 $18.14 $19.77 $227.70 $241.93 $24.49 $213.47 $37.19 $24.49 $142.31 $185.00 $25.49 $25.49 $25.49 $25.49 $30.64 $19.05 $18.14 $30.64 $18.14 $18.14 $13.61 $13.61 $13.61 $13.61 $241.93 330104 86382 394 302 HC NEUTRALIZATION TEST VIRAL O $80.25 $16.91 $16.91 $5.00 $40.12 N/A N/A N/A $5.00 $32.13 $5.00 $16.91 $60.19 $18.60 $50.56 $58.66 $6.00 $5.00 $48.15 $64.20 $57.49 $96.39 $5.00 $16.91 $52.16 $7.00 $64.20 $5.00 $5.00 $6.00 $23.67 $5.00 $16.91 $16.91 $18.43 $64.20 $68.21 $6.75 $60.19 $10.25 $6.75 $40.12 $52.16 $23.76 $23.76 $23.76 $23.76 $28.56 $17.76 $16.91 $28.56 $5.00 $5.00 $12.68 $12.68 $12.68 $5.00 $96.39 330104 86666 394 302 HC EHRLICHIA ANTIBODY O $368.08 $10.18 $10.18 $8.03 $184.04 N/A N/A N/A $8.03 $19.34 $8.03 $10.18 $276.06 $11.20 $231.89 $269.07 $9.64 $8.03 $220.85 $294.46 $34.61 $58.03 $8.03 $10.18 $239.25 $11.24 $294.46 $8.03 $8.03 $9.64 $14.25 $8.03 $10.18 $10.18 $11.10 $294.46 $312.87 $10.84 $276.06 $16.46 $10.84 $184.04 $239.25 $14.30 $14.30 $14.30 $14.30 $17.18 $10.69 $10.18 $17.18 $8.03 $8.03 $7.63 $7.63 $7.63 $7.63 $312.87 330104 86671 394 302 HC FUNGUS NES ANTIBODY O $82.39 $12.25 $12.25 N/A $41.20 N/A N/A N/A N/A $23.27 N/A $12.25 $61.79 $13.48 $51.91 $60.23 N/A N/A $49.43 $65.91 $41.65 $69.83 N/A $12.25 $53.55 N/A $65.91 N/A N/A N/A $17.15 N/A $12.25 $12.25 $13.35 $65.91 $70.03 N/A $61.79 N/A N/A $41.20 $53.55 $17.21 $17.21 $17.21 $17.21 $20.70 $12.86 $12.25 $20.70 N/A N/A $9.19 $9.19 $9.19 $9.19 $70.03 330104 86677 394 302 HC HELICOBACTER PYLORI ANTIBODY O $186.18 $16.85 $16.85 $8.03 $93.09 N/A N/A N/A $8.03 $32.02 $8.03 $16.85 $139.63 $18.54 $117.29 $136.10 $9.64 $8.03 $111.71 $148.94 $57.29 $96.05 $8.03 $16.85 $121.02 $11.24 $148.94 $8.03 $8.03 $9.64 $23.59 $8.03 $16.85 $16.85 $18.37 $148.94 $158.25 $10.84 $139.63 $16.46 $10.84 $93.09 $121.02 $23.67 $23.67 $23.67 $23.67 $24.50 $17.69 $16.85 $24.50 $8.03 $8.03 $12.64 $12.64 $12.64 $8.03 $158.25 330104 86692 394 302 HC HEPATITIS DELTA AGENT ANTBDY O $191.53 $17.16 $17.16 $17.16 $95.77 N/A N/A N/A $17.16 $32.60 $17.16 $17.16 $143.65 $18.88 $120.66 $140.01 $20.59 $17.16 $114.92 $153.22 $58.34 $97.81 $17.16 $17.16 $124.49 $24.02 $153.22 $17.16 $17.16 $20.59 $24.02 $17.16 $17.16 $17.16 $18.70 $153.22 $162.80 $23.17 $143.65 $35.18 $23.17 $95.77 $124.49 $24.11 $24.11 $24.11 $24.11 $28.98 $18.02 $17.16 $28.98 $17.16 $17.16 $12.87 $12.87 $12.87 $12.87 $162.80 330104 86694 394 302 HC HERPES SIMPLEX NES ANTBDY O $453.68 $14.39 $14.39 N/A $226.84 N/A N/A N/A N/A $27.34 N/A $14.39 $340.26 $15.83 $285.82 $331.64 N/A N/A $272.21 $362.94 $48.93 $82.02 N/A $14.39 $294.89 N/A $362.94 N/A N/A N/A $20.15 N/A $14.39 $14.39 $15.69 $362.94 $385.63 N/A $340.26 N/A N/A $226.84 $294.89 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 N/A N/A $10.79 $10.79 $10.79 $10.79 $385.63 330104 86695 394 302 HC HERPES SIMPLEX TYPE 1 TEST O $419.44 $13.19 $13.19 N/A $209.72 N/A N/A N/A N/A $25.06 N/A $13.19 $314.58 $14.51 $264.25 $306.61 N/A N/A $251.66 $335.55 $44.85 $75.18 N/A $13.19 $272.64 N/A $335.55 N/A N/A N/A $18.47 N/A $13.19 $13.19 $14.38 $335.55 $356.52 N/A $314.58 N/A N/A $209.72 $272.64 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 N/A N/A $9.89 $9.89 $9.89 $9.89 $356.52 330104 86704 394 302 HC HEP B CORE ANTIBODY TOTAL O $340.26 $12.05 $12.05 $10.10 $170.13 N/A N/A N/A $10.10 $22.89 $10.10 $12.05 $255.19 $13.26 $214.36 $248.73 $12.12 $10.10 $204.16 $272.21 $40.97 $68.69 $10.10 $12.05 $221.17 $14.14 $272.21 $10.10 $10.10 $12.12 $16.87 $10.10 $12.05 $12.05 $13.13 $272.21 $289.22 $13.63 $255.19 $20.70 $13.63 $170.13 $221.17 $16.93 $16.93 $16.93 $16.93 $20.35 $12.65 $12.05 $20.35 $10.10 $10.10 $9.04 $9.04 $9.04 $9.04 $289.22 330104 86705 394 302 HC HEP B CORE ANTIBODY IGM O $186.18 $11.77 $11.77 $10.10 $93.09 N/A N/A N/A $10.10 $22.36 $10.10 $11.77 $139.63 $12.95 $117.29 $136.10 $12.12 $10.10 $111.71 $148.94 $40.02 $67.09 $10.10 $11.77 $121.02 $14.14 $148.94 $10.10 $10.10 $12.12 $16.48 $10.10 $11.77 $11.77 $12.83 $148.94 $158.25 $13.63 $139.63 $20.70 $13.63 $93.09 $121.02 $16.54 $16.54 $16.54 $16.54 $19.87 $12.36 $11.77 $19.87 $10.10 $10.10 $8.83 $8.83 $8.83 $8.83 $158.25 330104 86706 394 302 HC HEP B SURFACE ANTIBODY O $363.80 $10.74 $10.74 $10.10 $181.90 N/A N/A N/A $10.10 $20.41 $10.10 $10.74 $272.85 $11.81 $229.19 $265.94 $12.12 $10.10 $218.28 $291.04 $36.52 $61.22 $10.10 $10.74 $236.47 $14.14 $291.04 $10.10 $10.10 $12.12 $15.04 $10.10 $10.74 $10.74 $11.71 $291.04 $309.23 $13.63 $272.85 $20.70 $13.63 $181.90 $236.47 $15.09 $15.09 $15.09 $15.09 $18.14 $11.28 $10.74 $18.14 $10.10 $10.10 $8.05 $8.05 $8.05 $8.05 $309.23 330104 86707 394 302 HC HEPATITIS BE ANTIBODY O $548.91 $11.57 $11.57 $10.10 $274.45 N/A N/A N/A $10.10 $21.98 $10.10 $11.57 $411.68 $12.73 $345.81 $401.25 $12.12 $10.10 $329.35 $439.13 $39.34 $65.95 $10.10 $11.57 $356.79 $14.14 $439.13 $10.10 $10.10 $12.12 $16.20 $10.10 $11.57 $11.57 $12.61 $439.13 $466.57 $13.63 $411.68 $20.70 $13.63 $274.45 $356.79 $16.26 $16.26 $16.26 $16.26 $19.54 $12.15 $11.57 $19.54 $10.10 $10.10 $8.68 $8.68 $8.68 $8.68 $466.57 330104 86708 394 302 HC HEPATITIS A TOTAL ANTIBODY O $330.63 $12.39 $12.39 $10.00 $165.31 N/A N/A N/A $10.00 $23.54 $10.00 $12.39 $247.97 $13.63 $208.30 $241.69 $12.00 $10.00 $198.38 $264.50 $42.13 $70.62 $10.00 $12.39 $214.91 $14.00 $264.50 $10.00 $10.00 $12.00 $17.35 $10.00 $12.39 $12.39 $13.51 $264.50 $281.04 $13.50 $247.97 $20.50 $13.50 $165.31 $214.91 $17.41 $17.41 $17.41 $17.41 $20.92 $13.01 $12.39 $20.92 $10.00 $10.00 $9.29 $9.29 $9.29 $9.29 $281.04 330104 86709 394 302 HC HEPATITIS A IGM ANTIBODY O $210.79 $11.26 $11.26 $10.00 $105.39 N/A N/A N/A $10.00 $21.39 $10.00 $11.26 $158.09 $12.39 $132.80 $154.09 $12.00 $10.00 $126.47 $168.63 $38.28 $64.18 $10.00 $11.26 $137.01 $14.00 $168.63 $10.00 $10.00 $12.00 $15.76 $10.00 $11.26 $11.26 $12.27 $168.63 $179.17 $13.50 $158.09 $20.50 $13.50 $105.39 $137.01 $15.82 $15.82 $15.82 $15.82 $19.01 $11.82 $11.26 $19.01 $10.00 $10.00 $8.45 $8.45 $8.45 $8.45 $179.17 330104 86710 394 302 HC INFLUENZA VIRUS O $430.14 $13.55 $13.55 $13.55 $215.07 N/A N/A N/A $13.55 $25.75 $13.55 $13.55 $322.61 $14.91 $270.99 $314.43 $16.26 $13.55 $258.08 $344.11 $46.07 $77.23 $13.55 $13.55 $279.59 $18.97 $344.11 $13.55 $13.55 $16.26 $18.97 $13.55 $13.55 $13.55 $14.77 $344.11 $365.62 $18.29 $322.61 $27.78 $18.29 $215.07 $279.59 $19.04 $19.04 $19.04 $19.04 $22.90 $14.23 $13.55 $22.90 $13.55 $13.55 $10.16 $10.16 $10.16 $10.16 $365.62 330104 86689 394 302 HC HTLV/HIV CONFIRMJ ANTIBODY O $69.55 $19.35 $19.35 $19.35 $34.77 N/A N/A N/A $19.35 $36.77 $19.35 $19.35 $52.16 $21.29 $43.82 $50.84 $23.22 $19.35 $41.73 $55.64 $65.79 $110.30 $19.35 $19.35 $45.21 $27.09 $55.64 $19.35 $19.35 $23.22 $27.09 $19.35 $19.35 $19.35 $21.09 $55.64 $59.12 $26.12 $52.16 $39.67 $26.12 $34.77 $45.21 $27.19 $27.19 $27.19 $27.19 $32.68 $20.32 $19.35 $32.68 $19.35 $19.35 $14.51 $14.51 $14.51 $14.51 $110.30 330104 86711 394 302 HC JOHN CUNNINGHAM ANTIBODY O $606.69 $16.89 $16.89 N/A $303.35 N/A N/A N/A N/A $32.09 N/A $16.89 $455.02 $18.58 $382.21 $443.49 N/A N/A $364.01 $485.35 $57.43 $96.27 N/A $16.89 $394.35 N/A $485.35 N/A N/A N/A $23.65 N/A $16.89 $16.89 $18.41 $485.35 $515.69 N/A $455.02 N/A N/A $303.35 $394.35 $23.73 $23.73 $23.73 $23.73 $23.75 $17.73 $16.89 $23.75 N/A N/A $12.67 $12.67 $12.67 $12.67 $515.69 330104 86664 394 302 HC EPSTEIN-BARR NUCLEAR ANTIGEN O $241.82 $15.29 $15.29 $15.29 $120.91 N/A N/A N/A $15.29 $29.05 $15.29 $15.29 $181.37 $16.82 $152.35 $176.77 $18.35 $15.29 $145.09 $193.46 $51.99 $87.15 $15.29 $15.29 $157.18 $21.41 $193.46 $15.29 $15.29 $18.35 $21.41 $15.29 $15.29 $15.29 $16.67 $193.46 $205.55 $20.64 $181.37 $31.34 $20.64 $120.91 $157.18 $21.48 $21.48 $21.48 $21.48 $25.84 $16.05 $15.29 $25.84 $15.29 $15.29 $11.47 $11.47 $11.47 $11.47 $205.55 330104 86376 394 302 HC MICROSOMAL ANTIBODY EACH O $619.53 $14.55 $14.55 $14.55 $309.76 N/A N/A N/A $14.55 $27.64 $14.55 $14.55 $464.65 $16.01 $390.30 $452.88 $17.46 $14.55 $371.72 $495.62 $49.47 $82.94 $14.55 $14.55 $402.69 $20.37 $495.62 $14.55 $14.55 $17.46 $20.37 $14.55 $14.55 $14.55 $15.86 $495.62 $526.60 $19.64 $464.65 $29.83 $19.64 $309.76 $402.69 $20.44 $20.44 $20.44 $20.44 $24.58 $15.28 $14.55 $24.58 $14.55 $14.55 $10.91 $10.91 $10.91 $10.91 $526.60 330104 86663 394 302 HC EPSTEIN-BARR ANTIBODY O $207.58 $13.12 $13.12 $13.12 $103.79 N/A N/A N/A $13.12 $24.93 $13.12 $13.12 $155.69 $14.43 $130.78 $151.74 $15.74 $13.12 $124.55 $166.06 $44.61 $74.78 $13.12 $13.12 $134.93 $18.37 $166.06 $13.12 $13.12 $15.74 $18.37 $13.12 $13.12 $13.12 $14.30 $166.06 $176.44 $17.71 $155.69 $26.90 $17.71 $103.79 $134.93 $18.43 $18.43 $18.43 $18.43 $22.15 $13.78 $13.12 $22.15 $13.12 $13.12 $9.84 $9.84 $9.84 $9.84 $176.44 330104 86653 394 302 HC ENCEPHAL ANTIBODY ST LOUIS O $96.30 $13.19 $13.19 $8.03 $48.15 N/A N/A N/A $8.03 $25.06 $8.03 $13.19 $72.22 $14.51 $60.67 $70.40 $9.64 $8.03 $57.78 $77.04 $44.85 $75.18 $8.03 $13.19 $62.59 $11.24 $77.04 $8.03 $8.03 $9.64 $18.47 $8.03 $13.19 $13.19 $14.38 $77.04 $81.85 $10.84 $72.22 $16.46 $10.84 $48.15 $62.59 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 $8.03 $8.03 $9.89 $9.89 $9.89 $8.03 $81.85 330104 86406 394 302 HC PARTICLE AGGLUT ANTBDY TITR O $182.97 $10.64 $10.64 N/A $91.48 N/A N/A N/A N/A $20.22 N/A $10.64 $137.23 $11.70 $115.27 $133.75 N/A N/A $109.78 $146.38 $36.18 $60.65 N/A $10.64 $118.93 N/A $146.38 N/A N/A N/A $14.90 N/A $10.64 $10.64 $11.60 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $118.93 $14.95 $14.95 $14.95 $14.95 $17.96 $11.17 $10.64 $17.96 N/A N/A $7.98 $7.98 $7.98 $7.98 $155.52 330104 86431 394 302 HC RHEUMATOID FACTOR QUANT O $88.81 $5.67 $5.67 $5.20 $44.41 N/A N/A N/A $5.20 $10.77 $5.20 $5.67 $66.61 $6.24 $55.95 $64.92 $6.24 $5.20 $53.29 $71.05 $19.28 $32.32 $5.20 $5.67 $57.73 $7.28 $71.05 $5.20 $5.20 $6.24 $7.94 $5.20 $5.67 $5.67 $6.18 $71.05 $75.49 $7.02 $66.61 $10.66 $7.02 $44.41 $57.73 $7.97 $7.97 $7.97 $7.97 $9.58 $5.95 $5.67 $9.58 $5.20 $5.20 $4.25 $4.25 $4.25 $4.25 $75.49 330104 86603 394 302 HC ADENOVIRUS ANTIBODY O $449.40 $12.87 $12.87 $8.03 $224.70 N/A N/A N/A $8.03 $24.45 $8.03 $12.87 $337.05 $14.16 $283.12 $328.51 $9.64 $8.03 $269.64 $359.52 $43.76 $73.36 $8.03 $12.87 $292.11 $11.24 $359.52 $8.03 $8.03 $9.64 $18.02 $8.03 $12.87 $12.87 $14.03 $359.52 $381.99 $10.84 $337.05 $16.46 $10.84 $224.70 $292.11 $18.08 $18.08 $18.08 $18.08 $21.73 $13.51 $12.87 $21.73 $8.03 $8.03 $9.65 $9.65 $9.65 $8.03 $381.99 330104 86606 394 302 HC ASPERGILLUS ANTIBODY O $277.13 $15.05 $15.05 $8.03 $138.56 N/A N/A N/A $8.03 $28.59 $8.03 $15.05 $207.85 $16.56 $174.59 $202.58 $9.64 $8.03 $166.28 $221.70 $51.17 $85.79 $8.03 $15.05 $180.13 $11.24 $221.70 $8.03 $8.03 $9.64 $21.07 $8.03 $15.05 $15.05 $16.40 $221.70 $235.56 $10.84 $207.85 $16.46 $10.84 $138.56 $180.13 $21.15 $21.15 $21.15 $21.15 $25.43 $15.80 $15.05 $25.43 $8.03 $8.03 $11.29 $11.29 $11.29 $8.03 $235.56 330104 86609 394 302 HC BACTERIUM ANTIBODY O $186.18 $12.88 $12.88 N/A $93.09 N/A N/A N/A N/A $24.47 N/A $12.88 $139.63 $14.17 $117.29 $136.10 N/A N/A $111.71 $148.94 $43.79 $73.42 N/A $12.88 $121.02 N/A $148.94 N/A N/A N/A $18.03 N/A $12.88 $12.88 $14.04 $148.94 $158.25 N/A $139.63 N/A N/A $93.09 $121.02 $18.10 $18.10 $18.10 $18.10 $21.76 $13.52 $12.88 $21.76 N/A N/A $9.66 $9.66 $9.66 $9.66 $158.25 330104 86611 394 302 HC BARTONELLA ANTIBODY O $368.08 $10.18 $10.18 $8.03 $184.04 N/A N/A N/A $8.03 $19.34 $8.03 $10.18 $276.06 $11.20 $231.89 $269.07 $9.64 $8.03 $220.85 $294.46 $34.61 $58.03 $8.03 $10.18 $239.25 $11.24 $294.46 $8.03 $8.03 $9.64 $14.25 $8.03 $10.18 $10.18 $11.10 $294.46 $312.87 $10.84 $276.06 $16.46 $10.84 $184.04 $239.25 $14.30 $14.30 $14.30 $14.30 $17.18 $10.69 $10.18 $17.18 $8.03 $8.03 $7.63 $7.63 $7.63 $7.63 $312.87 330104 86617 394 302 HC LYME DISEASE ANTIBODY; CONFIRMATORY TEST O $490.06 $15.49 $15.49 $15.49 $245.03 N/A N/A N/A $15.49 $29.43 $15.49 $15.49 $367.55 $17.04 $308.74 $358.23 $18.59 $15.49 $294.04 $392.05 $52.67 $88.29 $15.49 $15.49 $318.54 $21.69 $392.05 $15.49 $15.49 $18.59 $21.69 $15.49 $15.49 $15.49 $16.88 $392.05 $416.55 $20.91 $367.55 $31.75 $20.91 $245.03 $318.54 $21.76 $21.76 $21.76 $21.76 $26.16 $16.26 $15.49 $26.16 $15.49 $15.49 $11.62 $11.62 $11.62 $11.62 $416.55 330104 86618 394 302 HC LYME DISEASE ANTIBODY O $570.31 $17.03 $17.03 $17.03 $285.15 N/A N/A N/A $17.03 $32.36 $17.03 $17.03 $427.73 $18.73 $359.30 $416.90 $20.44 $17.03 $342.19 $456.25 $57.90 $97.07 $17.03 $17.03 $370.70 $23.84 $456.25 $17.03 $17.03 $20.44 $23.84 $17.03 $17.03 $17.03 $18.56 $456.25 $484.76 $22.99 $427.73 $34.91 $22.99 $285.15 $370.70 $23.93 $23.93 $23.93 $23.93 $28.76 $17.88 $17.03 $28.76 $17.03 $17.03 $12.77 $12.77 $12.77 $12.77 $484.76 330104 86635 394 302 HC COCCIDIOIDES ANTIBODY O $238.61 $11.47 $11.47 $8.03 $119.31 N/A N/A N/A $8.03 $21.79 $8.03 $11.47 $178.96 $12.62 $150.32 $174.42 $9.64 $8.03 $143.17 $190.89 $39.00 $65.38 $8.03 $11.47 $155.10 $11.24 $190.89 $8.03 $8.03 $9.64 $16.06 $8.03 $11.47 $11.47 $12.50 $190.89 $202.82 $10.84 $178.96 $16.46 $10.84 $119.31 $155.10 $16.12 $16.12 $16.12 $16.12 $19.38 $12.04 $11.47 $19.38 $8.03 $8.03 $8.60 $8.60 $8.60 $8.03 $202.82 330104 86638 394 302 HC Q FEVER ANTIBODY O $527.51 $12.12 $12.12 $8.03 $263.75 N/A N/A N/A $8.03 $23.03 $8.03 $12.12 $395.63 $13.33 $332.33 $385.61 $9.64 $8.03 $316.51 $422.01 $41.21 $69.08 $8.03 $12.12 $342.88 $11.24 $422.01 $8.03 $8.03 $9.64 $16.97 $8.03 $12.12 $12.12 $13.21 $422.01 $448.38 $10.84 $395.63 $16.46 $10.84 $263.75 $342.88 $17.03 $17.03 $17.03 $17.03 $20.47 $12.73 $12.12 $20.47 $8.03 $8.03 $9.09 $9.09 $9.09 $8.03 $448.38 330104 86644 394 302 HC CMV ANTIBODY O $332.77 $14.39 $14.39 $14.39 $166.38 N/A N/A N/A $14.39 $27.34 $14.39 $14.39 $249.58 $15.83 $209.65 $243.25 $17.27 $14.39 $199.66 $266.22 $48.93 $82.02 $14.39 $14.39 $216.30 $20.15 $266.22 $14.39 $14.39 $17.27 $20.15 $14.39 $14.39 $14.39 $15.69 $266.22 $282.85 $19.43 $249.58 $29.50 $19.43 $166.38 $216.30 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 $14.39 $14.39 $10.79 $10.79 $10.79 $10.79 $282.85 330104 86645 394 302 HC CMV ANTIBODY IGM O $332.77 $16.85 $16.85 $8.03 $166.38 N/A N/A N/A $8.03 $32.02 $8.03 $16.85 $249.58 $18.54 $209.65 $243.25 $9.64 $8.03 $199.66 $266.22 $57.29 $96.05 $8.03 $16.85 $216.30 $11.24 $266.22 $8.03 $8.03 $9.64 $23.59 $8.03 $16.85 $16.85 $18.37 $266.22 $282.85 $10.84 $249.58 $16.46 $10.84 $166.38 $216.30 $23.67 $23.67 $23.67 $23.67 $28.44 $17.69 $16.85 $28.44 $8.03 $8.03 $12.64 $12.64 $12.64 $8.03 $282.85 330104 86648 394 302 HC DIPHTHERIA ANTIBODY O $53.50 $15.21 $15.21 N/A $26.75 N/A N/A N/A N/A $28.90 N/A $15.21 $40.12 $16.73 $33.70 $39.11 N/A N/A $32.10 $42.80 $51.71 $86.70 N/A $15.21 $34.77 N/A $42.80 N/A N/A N/A $21.29 N/A $15.21 $15.21 $16.58 $42.80 $45.48 N/A $40.12 N/A N/A $26.75 $34.77 $21.37 $21.37 $21.37 $21.37 $25.69 $15.97 $15.21 $25.69 N/A N/A $11.41 $11.41 $11.41 $11.41 $86.70 330104 86651 394 302 HC ENCEPHAL ANTIBODY CALIF O $96.30 $13.19 $13.19 $8.03 $48.15 N/A N/A N/A $8.03 $25.06 $8.03 $13.19 $72.22 $14.51 $60.67 $70.40 $9.64 $8.03 $57.78 $77.04 $44.85 $75.18 $8.03 $13.19 $62.59 $11.24 $77.04 $8.03 $8.03 $9.64 $18.47 $8.03 $13.19 $13.19 $14.38 $77.04 $81.85 $10.84 $72.22 $16.46 $10.84 $48.15 $62.59 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 $8.03 $8.03 $9.89 $9.89 $9.89 $8.03 $81.85 330104 86652 394 302 HC ENCEPHAL ANTIBODY EAST EQU O $96.30 $13.19 $13.19 $8.03 $48.15 N/A N/A N/A $8.03 $25.06 $8.03 $13.19 $72.22 $14.51 $60.67 $70.40 $9.64 $8.03 $57.78 $77.04 $44.85 $75.18 $8.03 $13.19 $62.59 $11.24 $77.04 $8.03 $8.03 $9.64 $18.47 $8.03 $13.19 $13.19 $14.38 $77.04 $81.85 $10.84 $72.22 $16.46 $10.84 $48.15 $62.59 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 $8.03 $8.03 $9.89 $9.89 $9.89 $8.03 $81.85 330104 86654 394 302 HC ENCEPHAL ANTIBODY WEST EQU O $466.52 $13.19 $13.19 $8.03 $233.26 N/A N/A N/A $8.03 $25.06 $8.03 $13.19 $349.89 $14.51 $293.91 $341.03 $9.64 $8.03 $279.91 $373.22 $44.85 $75.18 $8.03 $13.19 $303.24 $11.24 $373.22 $8.03 $8.03 $9.64 $18.47 $8.03 $13.19 $13.19 $14.38 $373.22 $396.54 $10.84 $349.89 $16.46 $10.84 $233.26 $303.24 $18.53 $18.53 $18.53 $18.53 $22.27 $13.85 $13.19 $22.27 $8.03 $8.03 $9.89 $9.89 $9.89 $8.03 $396.54 330104 86735 394 302 HC MUMPS ANTIBODY O $522.16 $13.05 $13.05 $8.03 $261.08 N/A N/A N/A $8.03 $24.80 $8.03 $13.05 $391.62 $14.36 $328.96 $381.70 $9.64 $8.03 $313.30 $417.73 $44.37 $74.39 $8.03 $13.05 $339.40 $11.24 $417.73 $8.03 $8.03 $9.64 $18.27 $8.03 $13.05 $13.05 $14.22 $417.73 $443.84 $10.84 $391.62 $16.46 $10.84 $261.08 $339.40 $18.34 $18.34 $18.34 $18.34 $22.04 $13.70 $13.05 $22.04 $8.03 $8.03 $9.79 $9.79 $9.79 $8.03 $443.84 330104 86727 394 302 HC LYMPH CHORIOMENINGITIS O $72.76 $12.87 $12.87 $8.03 $36.38 N/A N/A N/A $8.03 $24.45 $8.03 $12.87 $54.57 $14.16 $45.84 $53.19 $9.64 $8.03 $43.66 $58.21 $43.76 $73.36 $8.03 $12.87 $47.29 $11.24 $58.21 $8.03 $8.03 $9.64 $18.02 $8.03 $12.87 $12.87 $14.03 $58.21 $61.85 $10.84 $54.57 $16.46 $10.84 $36.38 $47.29 $18.08 $18.08 $18.08 $18.08 $21.73 $13.51 $12.87 $21.73 $8.03 $8.03 $9.65 $9.65 $9.65 $8.03 $73.36 330104 86747 394 302 HC PARVOVIRUS ANTIBODY O $475.08 $15.03 $15.03 $15.03 $237.54 N/A N/A N/A $15.03 $28.56 $15.03 $15.03 $356.31 $16.53 $299.30 $347.28 $18.04 $15.03 $285.05 $380.06 $51.10 $85.67 $15.03 $15.03 $308.80 $21.04 $380.06 $15.03 $15.03 $18.04 $21.04 $15.03 $15.03 $15.03 $16.38 $380.06 $403.82 $20.29 $356.31 $30.81 $20.29 $237.54 $308.80 $21.12 $21.12 $21.12 $21.12 $25.39 $15.78 $15.03 $25.39 $15.03 $15.03 $11.27 $11.27 $11.27 $11.27 $403.82 330104 86713 394 302 HC LEGIONELLA ANTIBODY O $722.25 $15.30 $15.30 $15.30 $361.12 N/A N/A N/A $15.30 $29.07 $15.30 $15.30 $541.69 $16.83 $455.02 $527.96 $18.36 $15.30 $433.35 $577.80 $52.02 $87.21 $15.30 $15.30 $469.46 $21.42 $577.80 $15.30 $15.30 $18.36 $21.42 $15.30 $15.30 $15.30 $16.68 $577.80 $613.91 $20.66 $541.69 $31.36 $20.66 $361.12 $469.46 $21.50 $21.50 $21.50 $21.50 $25.84 $16.07 $15.30 $25.84 $15.30 $15.30 $11.48 $11.48 $11.48 $11.48 $613.91 330104 87389 396 302 HC HIV-1 AG W/HIV-1 & HIV-2 AB O $250.38 $24.08 $24.08 $18.49 $125.19 N/A N/A N/A $18.49 $45.75 $18.49 $24.08 $187.78 $26.49 $157.74 $183.03 $22.19 $18.49 $150.23 $200.30 $81.87 $137.26 $18.49 $24.08 $162.75 $25.89 $200.30 $18.49 $18.49 $22.19 $33.71 $18.49 $24.08 $24.08 $26.25 $200.30 $212.82 $24.96 $187.78 $37.90 $24.96 $125.19 $162.75 $33.83 $33.83 $33.83 $33.83 $40.94 $25.28 $24.08 $40.94 $18.49 $18.49 $18.06 $18.06 $18.06 $18.06 $212.82 330104 86985 5672 499 302 HC SPLIT BLOOD OR PRODUCTS O $728.67 $188.66 $188.66 $46.95 $364.33 N/A N/A $186.77 $46.95 $358.45 $46.95 $188.66 $546.50 $207.53 $459.06 $532.66 $56.35 $46.95 $437.20 $582.94 $641.44 "$1,075.36 " $46.95 $188.66 $226.39 $65.74 $582.94 $46.95 $46.95 $56.35 $264.12 $46.95 $188.66 $188.66 $205.64 $582.94 $619.37 $46.95 $546.50 $96.26 $46.95 $364.33 $507.49 $265.07 $265.07 $265.07 $265.07 $17.92 $198.09 $188.66 $17.92 $46.95 $46.95 $141.49 $141.49 $141.49 $17.92 "$1,075.36 " 330104 86941 486 302 HC HEMOLYSINS/AGGLUTININS O $191.53 $12.11 $12.11 $10.27 $95.77 N/A N/A N/A $10.27 $23.01 $10.27 $12.11 $143.65 $13.32 $120.66 $140.01 $12.32 $10.27 $114.92 $153.22 $41.17 $69.03 $10.27 $12.11 $124.49 $14.38 $153.22 $10.27 $10.27 $12.32 $16.95 $10.27 $12.11 $12.11 $13.20 $153.22 $162.80 $13.86 $143.65 $21.05 $13.86 $95.77 $124.49 $17.01 $17.01 $17.01 $17.01 $20.45 $12.72 $12.11 $20.45 $10.27 $10.27 $9.08 $9.08 $9.08 $9.08 $162.80 330104 86922 5672 2043 302 HC COMPATIBILITY TEST ANTIGLOB O "$1,332.15 " $188.66 $188.66 N/A $666.08 N/A N/A $186.77 N/A $358.45 N/A $188.66 $999.11 $207.53 $839.25 $973.80 N/A N/A $799.29 "$1,065.72 " $641.44 "$1,075.36 " N/A $188.66 $226.39 N/A "$1,065.72 " N/A N/A N/A $264.12 N/A $188.66 $188.66 $205.64 "$1,065.72 " "$1,132.33 " N/A $999.11 N/A N/A $666.08 $507.49 $265.07 $265.07 $265.07 $265.07 $30.10 $198.09 $188.66 $30.10 N/A N/A $141.49 $141.49 $141.49 $30.10 "$1,132.33 " 330104 86920 5672 2043 302 HC COMPATIBILITY TEST SPIN O "$1,332.15 " $188.66 $188.66 N/A $666.08 N/A N/A $186.77 N/A $358.45 N/A $188.66 $999.11 $207.53 $839.25 $973.80 N/A N/A $799.29 "$1,065.72 " $641.44 "$1,075.36 " N/A $188.66 $226.39 N/A "$1,065.72 " N/A N/A N/A $264.12 N/A $188.66 $188.66 $205.64 "$1,065.72 " "$1,132.33 " N/A $999.11 N/A N/A $666.08 $507.49 $265.07 $265.07 $265.07 $265.07 $17.92 $198.09 $188.66 $17.92 N/A N/A $141.49 $141.49 $141.49 $17.92 "$1,132.33 " 330104 86902 5673 486 302 HC BLOOD TYPE ANTIGEN DONOR EA O "$1,308.61 " $388.85 $388.85 $47.59 $654.30 N/A N/A $384.96 $47.59 $738.81 $47.59 $388.85 $981.46 $427.73 $824.42 $956.59 $57.11 $47.59 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $47.59 $388.85 $466.62 $66.63 "$1,046.89 " $47.59 $47.59 $57.11 $544.39 $47.59 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $47.59 $981.46 $97.56 $47.59 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $6.46 $408.29 $388.85 $6.46 $47.59 $47.59 $291.64 $291.64 $291.64 $6.46 "$2,216.43 " 330104 86812 486 302 HC HLA TYPING A B OR C; SINGLE ANTIGEN O $584.22 $25.81 $25.81 $47.59 $292.11 N/A N/A N/A $47.59 $49.04 $47.59 $25.81 $438.17 $28.39 $368.06 $427.06 $57.11 $47.59 $350.53 $467.38 $87.75 $147.12 $47.59 $25.81 $379.74 $66.63 $467.38 $47.59 $47.59 $57.11 $36.13 $47.59 $25.81 $25.81 $28.13 $467.38 $496.59 $64.25 $438.17 $97.56 $64.25 $292.11 $379.74 $36.26 $36.26 $36.26 $36.26 $43.58 $27.10 $25.81 $43.58 $47.59 $47.59 $19.36 $19.36 $19.36 $19.36 $496.59 330104 86804 394 302 HC HEP C AB TEST CONFIRM O $226.84 $15.49 $15.49 $15.49 $113.42 N/A N/A N/A $15.49 $29.43 $15.49 $15.49 $170.13 $17.04 $142.91 $165.82 $18.59 $15.49 $136.10 $181.47 $52.67 $88.29 $15.49 $15.49 $147.45 $21.69 $181.47 $15.49 $15.49 $18.59 $21.69 $15.49 $15.49 $15.49 $16.88 $181.47 $192.81 $20.91 $170.13 $31.75 $20.91 $113.42 $147.45 $21.76 $21.76 $21.76 $21.76 $26.16 $16.26 $15.49 $26.16 $15.49 $15.49 $11.62 $11.62 $11.62 $11.62 $192.81 330104 86803 394 302 HC HEPATITIS C AB TEST O $276.06 $14.27 $14.27 $10.00 $138.03 N/A N/A N/A $10.00 $27.11 $10.00 $14.27 $207.05 $15.70 $173.92 $201.80 $12.00 $10.00 $165.64 $220.85 $48.52 $81.34 $10.00 $14.27 $179.44 $14.00 $220.85 $10.00 $10.00 $12.00 $19.98 $10.00 $14.27 $14.27 $15.55 $220.85 $234.65 $13.50 $207.05 $20.50 $13.50 $138.03 $179.44 $20.05 $20.05 $20.05 $20.05 $24.10 $14.98 $14.27 $24.10 $10.00 $10.00 $10.70 $10.70 $10.70 $10.00 $234.65 330104 86800 394 302 HC THYROGLOBULIN ANTIBODY O $512.53 $15.91 $15.91 $13.35 $256.26 N/A N/A N/A $13.35 $30.23 $13.35 $15.91 $384.40 $17.50 $322.89 $374.66 $16.02 $13.35 $307.52 $410.02 $54.09 $90.69 $13.35 $15.91 $333.14 $18.69 $410.02 $13.35 $13.35 $16.02 $22.27 $13.35 $15.91 $15.91 $17.34 $410.02 $435.65 $18.02 $384.40 $27.37 $18.02 $256.26 $333.14 $22.35 $22.35 $22.35 $22.35 $26.86 $16.71 $15.91 $26.86 $13.35 $13.35 $11.93 $11.93 $11.93 $11.93 $435.65 330104 86885 5672 486 302 HC ANTIHUMAN GLOBULIN INDIR QUAL EA REAGENT CELL O $662.33 $188.66 $188.66 $47.59 $331.17 N/A N/A $186.77 $47.59 $358.45 $47.59 $188.66 $496.75 $207.53 $417.27 $484.16 $57.11 $47.59 $397.40 $529.86 $641.44 "$1,075.36 " $47.59 $188.66 $226.39 $66.63 $529.86 $47.59 $47.59 $57.11 $264.12 $47.59 $188.66 $188.66 $205.64 $529.86 $562.98 $47.59 $496.75 $97.56 $47.59 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $9.67 $198.09 $188.66 $9.67 $47.59 $47.59 $141.49 $141.49 $141.49 $9.67 "$1,075.36 " 330104 86789 394 302 HC WEST NILE VIRUS ANTIBODY O $166.92 $14.39 $14.39 $14.39 $83.46 N/A N/A N/A $14.39 $27.34 $14.39 $14.39 $125.19 $15.83 $105.16 $122.02 $17.27 $14.39 $100.15 $133.54 $48.93 $82.02 $14.39 $14.39 $108.50 $20.15 $133.54 $14.39 $14.39 $17.27 $20.15 $14.39 $14.39 $14.39 $15.69 $133.54 $141.88 $19.43 $125.19 $29.50 $19.43 $83.46 $108.50 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 $14.39 $14.39 $10.79 $10.79 $10.79 $10.79 $141.88 330104 86753 394 302 HC PROTOZOA ANTIBODY NOS O $186.18 $12.39 $12.39 N/A $93.09 N/A N/A N/A N/A $23.54 N/A $12.39 $139.63 $13.63 $117.29 $136.10 N/A N/A $111.71 $148.94 $42.13 $70.62 N/A $12.39 $121.02 N/A $148.94 N/A N/A N/A $17.35 N/A $12.39 $12.39 $13.51 $148.94 $158.25 N/A $139.63 N/A N/A $93.09 $121.02 $17.41 $17.41 $17.41 $17.41 $20.92 $13.01 $12.39 $20.92 N/A N/A $9.29 $9.29 $9.29 $9.29 $158.25 330104 86790 394 302 HC VIRUS ANTIBODY NOS O $186.18 $12.88 $12.88 N/A $93.09 N/A N/A N/A N/A $24.47 N/A $12.88 $139.63 $14.17 $117.29 $136.10 N/A N/A $111.71 $148.94 $43.79 $73.42 N/A $12.88 $121.02 N/A $148.94 N/A N/A N/A $18.03 N/A $12.88 $12.88 $14.04 $148.94 $158.25 N/A $139.63 N/A N/A $93.09 $121.02 $18.10 $18.10 $18.10 $18.10 $21.76 $13.52 $12.88 $21.76 N/A N/A $9.66 $9.66 $9.66 $9.66 $158.25 330104 86762 394 302 HC RUBELLA ANTIBODY O $814.27 $14.39 $14.39 $14.39 $407.13 N/A N/A N/A $14.39 $27.34 $14.39 $14.39 $610.70 $15.83 $512.99 $595.23 $17.27 $14.39 $488.56 $651.42 $48.93 $82.02 $14.39 $14.39 $529.28 $20.15 $651.42 $14.39 $14.39 $17.27 $20.15 $14.39 $14.39 $14.39 $15.69 $651.42 $692.13 $19.43 $610.70 $29.50 $19.43 $407.13 $529.28 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 $14.39 $14.39 $10.79 $10.79 $10.79 $10.79 $692.13 330104 86765 394 302 HC RUBEOLA ANTIBODY O $284.62 $12.88 $12.88 $12.88 $142.31 N/A N/A N/A $12.88 $24.47 $12.88 $12.88 $213.47 $14.17 $179.31 $208.06 $15.46 $12.88 $170.77 $227.70 $43.79 $73.42 $12.88 $12.88 $185.00 $18.03 $227.70 $12.88 $12.88 $15.46 $18.03 $12.88 $12.88 $12.88 $14.04 $227.70 $241.93 $17.39 $213.47 $26.40 $17.39 $142.31 $185.00 $18.10 $18.10 $18.10 $18.10 $21.76 $13.52 $12.88 $21.76 $12.88 $12.88 $9.66 $9.66 $9.66 $9.66 $241.93 330104 86774 394 302 HC TETANUS ANTIBODY O $53.50 $14.80 $14.80 N/A $26.75 N/A N/A N/A N/A $28.12 N/A $14.80 $40.12 $16.28 $33.70 $39.11 N/A N/A $32.10 $42.80 $50.32 $84.36 N/A $14.80 $34.77 N/A $42.80 N/A N/A N/A $20.72 N/A $14.80 $14.80 $16.13 $42.80 $45.48 N/A $40.12 N/A N/A $26.75 $34.77 $20.79 $20.79 $20.79 $20.79 $24.98 $15.54 $14.80 $24.98 N/A N/A $11.10 $11.10 $11.10 $11.10 $84.36 330104 86757 394 302 HC RICKETTSIA ANTIBODY O $306.02 $19.35 $19.35 $19.35 $153.01 N/A N/A N/A $19.35 $36.77 $19.35 $19.35 $229.51 $21.29 $192.79 $223.70 $23.22 $19.35 $183.61 $244.82 $65.79 $110.30 $19.35 $19.35 $198.91 $27.09 $244.82 $19.35 $19.35 $23.22 $27.09 $19.35 $19.35 $19.35 $21.09 $244.82 $260.12 $26.12 $229.51 $39.67 $26.12 $153.01 $198.91 $27.19 $27.19 $27.19 $27.19 $32.68 $20.32 $19.35 $32.68 $19.35 $19.35 $14.51 $14.51 $14.51 $14.51 $260.12 330104 86778 394 302 HC TOXOPLASMA ANTIBODY IGM O $434.42 $14.41 $14.41 $14.12 $217.21 N/A N/A N/A $14.12 $27.38 $14.12 $14.41 $325.81 $15.85 $273.68 $317.56 $16.94 $14.12 $260.65 $347.54 $48.99 $82.14 $14.12 $14.41 $282.37 $19.77 $347.54 $14.12 $14.12 $16.94 $20.17 $14.12 $14.41 $14.41 $15.71 $347.54 $369.26 $19.06 $325.81 $28.95 $19.06 $217.21 $282.37 $20.25 $20.25 $20.25 $20.25 $24.32 $15.13 $14.41 $24.32 $14.12 $14.12 $10.81 $10.81 $10.81 $10.81 $369.26 330104 86780 394 302 HC TREPONEMA PALLIDUM O $186.18 $13.24 $13.24 $12.63 $93.09 N/A N/A N/A $12.63 $25.16 $12.63 $13.24 $139.63 $14.56 $117.29 $136.10 $15.16 $12.63 $111.71 $148.94 $45.02 $75.47 $12.63 $13.24 $121.02 $17.68 $148.94 $12.63 $12.63 $15.16 $18.54 $12.63 $13.24 $13.24 $14.43 $148.94 $158.25 $17.05 $139.63 $25.89 $17.05 $93.09 $121.02 $18.60 $18.60 $18.60 $18.60 $22.36 $13.90 $13.24 $22.36 $12.63 $12.63 $9.93 $9.93 $9.93 $9.93 $158.25 330104 86787 394 302 HC VARICELLA-ZOSTER ANTIBODY O $186.18 $12.88 $12.88 $8.03 $93.09 N/A N/A N/A $8.03 $24.47 $8.03 $12.88 $139.63 $14.17 $117.29 $136.10 $9.64 $8.03 $111.71 $148.94 $43.79 $73.42 $8.03 $12.88 $121.02 $11.24 $148.94 $8.03 $8.03 $9.64 $18.03 $8.03 $12.88 $12.88 $14.04 $148.94 $158.25 $10.84 $139.63 $16.46 $10.84 $93.09 $121.02 $18.10 $18.10 $18.10 $18.10 $21.76 $13.52 $12.88 $21.76 $8.03 $8.03 $9.66 $9.66 $9.66 $8.03 $158.25 330104 86788 394 302 HC WEST NILE VIRUS AB IGM O $72.76 $16.85 $16.85 $8.03 $36.38 N/A N/A N/A $8.03 $32.02 $8.03 $16.85 $54.57 $18.54 $45.84 $53.19 $9.64 $8.03 $43.66 $58.21 $57.29 $96.05 $8.03 $16.85 $47.29 $11.24 $58.21 $8.03 $8.03 $9.64 $23.59 $8.03 $16.85 $16.85 $18.37 $58.21 $61.85 $10.84 $54.57 $16.46 $10.84 $36.38 $47.29 $23.67 $23.67 $23.67 $23.67 $28.44 $17.69 $16.85 $28.44 $8.03 $8.03 $12.64 $12.64 $12.64 $8.03 $96.05 330104 86777 394 302 HC TOXOPLASMA ANTIBODY O $390.55 $14.39 $14.39 $14.39 $195.28 N/A N/A N/A $14.39 $27.34 $14.39 $14.39 $292.91 $15.83 $246.05 $285.49 $17.27 $14.39 $234.33 $312.44 $48.93 $82.02 $14.39 $14.39 $253.86 $20.15 $312.44 $14.39 $14.39 $17.27 $20.15 $14.39 $14.39 $14.39 $15.69 $312.44 $331.97 $19.43 $292.91 $29.50 $19.43 $195.28 $253.86 $20.22 $20.22 $20.22 $20.22 $24.30 $15.11 $14.39 $24.30 $14.39 $14.39 $10.79 $10.79 $10.79 $10.79 $331.97 330104 86738 394 302 HC MYCOPLASMA ANTIBODY O $439.77 $13.24 $13.24 $13.24 $219.88 N/A N/A N/A $13.24 $25.16 $13.24 $13.24 $329.83 $14.56 $277.06 $321.47 $15.89 $13.24 $263.86 $351.82 $45.02 $75.47 $13.24 $13.24 $285.85 $18.54 $351.82 $13.24 $13.24 $15.89 $18.54 $13.24 $13.24 $13.24 $14.43 $351.82 $373.80 $17.87 $329.83 $27.14 $17.87 $219.88 $285.85 $18.60 $18.60 $18.60 $18.60 $22.37 $13.90 $13.24 $22.37 $13.24 $13.24 $9.93 $9.93 $9.93 $9.93 $373.80 330104 85597 406 305 HC PHOSPHOLIPID PLTLT NEUTRALIZ O $80.25 $17.98 $17.98 N/A $40.12 N/A N/A N/A N/A $34.16 N/A $17.98 $60.19 $19.78 $50.56 $58.66 N/A N/A $48.15 $64.20 $61.13 $102.49 N/A $17.98 $52.16 N/A $64.20 N/A N/A N/A $25.17 N/A $17.98 $17.98 $19.60 $64.20 $68.21 N/A $60.19 N/A N/A $40.12 $52.16 $25.26 $25.26 $25.26 $25.26 $30.36 $18.88 $17.98 $30.36 N/A N/A $13.48 $13.48 $13.48 $13.48 $102.49 330104 85306 406 305 HC CLOT INHIBIT PROT S FREE O $227.91 $15.32 $15.32 $15.32 $113.95 N/A N/A N/A $15.32 $29.11 $15.32 $15.32 $170.93 $16.85 $143.58 $166.60 $18.38 $15.32 $136.75 $182.33 $52.09 $87.32 $15.32 $15.32 $148.14 $21.45 $182.33 $15.32 $15.32 $18.38 $21.45 $15.32 $15.32 $15.32 $16.70 $182.33 $193.72 $20.68 $170.93 $31.41 $20.68 $113.95 $148.14 $21.52 $21.52 $21.52 $21.52 $25.87 $16.09 $15.32 $25.87 $15.32 $15.32 $11.49 $11.49 $11.49 $11.49 $193.72 330104 85307 408 305 HC ASSAY ACTIVATED PROTEIN C O $227.91 $15.32 $15.32 $14.73 $113.95 N/A N/A N/A $14.73 $29.11 $14.73 $15.32 $170.93 $16.85 $143.58 $166.60 $17.68 $14.73 $136.75 $182.33 $52.09 $87.32 $14.73 $15.32 $148.14 $20.62 $182.33 $14.73 $14.73 $17.68 $21.45 $14.73 $15.32 $15.32 $16.70 $182.33 $193.72 $19.89 $170.93 $30.20 $19.89 $113.95 $148.14 $21.52 $21.52 $21.52 $21.52 $25.87 $16.09 $15.32 $25.87 $14.73 $14.73 $11.49 $11.49 $11.49 $11.49 $193.72 330104 85335 406 305 HC FACTOR INHIBITOR TEST O $859.21 $12.87 $12.87 $12.87 $429.61 N/A N/A N/A $12.87 $24.45 $12.87 $12.87 $644.41 $14.16 $541.30 $628.08 $15.44 $12.87 $515.53 $687.37 $43.76 $73.36 $12.87 $12.87 $558.49 $18.02 $687.37 $12.87 $12.87 $15.44 $18.02 $12.87 $12.87 $12.87 $14.03 $687.37 $730.33 $17.37 $644.41 $26.38 $17.37 $429.61 $558.49 $18.08 $18.08 $18.08 $18.08 $21.74 $13.51 $12.87 $21.74 $12.87 $12.87 $9.65 $9.65 $9.65 $9.65 $730.33 330104 85362 406 305 HC FIBRIN DEGRADATION PRODUCTS O $112.35 $6.89 $6.89 $6.89 $56.17 N/A N/A N/A $6.89 $13.09 $6.89 $6.89 $84.26 $7.58 $70.78 $82.13 $8.27 $6.89 $67.41 $89.88 $23.43 $39.27 $6.89 $6.89 $73.03 $9.65 $89.88 $6.89 $6.89 $8.27 $9.65 $6.89 $6.89 $6.89 $7.51 $89.88 $95.50 $9.30 $84.26 $14.12 $9.30 $56.17 $73.03 $9.68 $9.68 $9.68 $9.68 $11.63 $7.23 $6.89 $11.63 $6.89 $6.89 $5.17 $5.17 $5.17 $5.17 $95.50 330104 85379 406 305 HC D-DIMER - QUAN O $129.47 $10.18 $10.18 $10.18 $64.73 N/A N/A N/A $10.18 $19.34 $10.18 $10.18 $97.10 $11.20 $81.57 $94.64 $12.22 $10.18 $77.68 $103.58 $34.61 $58.03 $10.18 $10.18 $84.16 $14.25 $103.58 $10.18 $10.18 $12.22 $14.25 $10.18 $10.18 $10.18 $11.10 $103.58 $110.05 $13.74 $97.10 $20.87 $13.74 $64.73 $84.16 $14.30 $14.30 $14.30 $14.30 $17.18 $10.69 $10.18 $17.18 $10.18 $10.18 $7.63 $7.63 $7.63 $7.63 $110.05 330104 85384 406 305 HC FIBRINOGEN ACTIVITY O $226.84 $9.72 $9.72 $6.90 $113.42 N/A N/A N/A $6.90 $18.47 $6.90 $9.72 $170.13 $10.69 $142.91 $165.82 $8.28 $6.90 $136.10 $181.47 $33.05 $55.40 $6.90 $9.72 $147.45 $9.66 $181.47 $6.90 $6.90 $8.28 $13.61 $6.90 $9.72 $9.72 $10.59 $181.47 $192.81 $9.32 $170.13 $14.14 $9.32 $113.42 $147.45 $13.66 $13.66 $13.66 $13.66 $14.34 $10.21 $9.72 $14.34 $6.90 $6.90 $7.29 $7.29 $7.29 $6.90 $192.81 330104 85397 407 305 HC CLOTTING FUNCT ACTIVITY O $129.47 $30.86 $30.86 $9.40 $64.73 N/A N/A N/A $9.40 $58.63 $9.40 $30.86 $97.10 $33.95 $81.57 $94.64 $11.28 $9.40 $77.68 $103.58 $104.92 $175.90 $9.40 $30.86 $84.16 $13.16 $103.58 $9.40 $9.40 $11.28 $43.20 $9.40 $30.86 $30.86 $33.64 $103.58 $110.05 $12.69 $97.10 $19.27 $12.69 $64.73 $84.16 $43.36 $43.36 $43.36 $43.36 $38.75 $32.40 $30.86 $38.75 $9.40 $9.40 $23.14 $23.14 $23.14 $9.40 $175.90 330104 85460 408 305 HC HEMOGLOBIN FETAL O $69.55 $7.73 $7.73 $7.73 $34.77 N/A N/A N/A $7.73 $14.69 $7.73 $7.73 $52.16 $8.50 $43.82 $50.84 $9.28 $7.73 $41.73 $55.64 $26.28 $44.06 $7.73 $7.73 $45.21 $10.82 $55.64 $7.73 $7.73 $9.28 $10.82 $7.73 $7.73 $7.73 $8.43 $55.64 $59.12 $10.44 $52.16 $15.85 $10.44 $34.77 $45.21 $10.86 $10.86 $10.86 $10.86 $13.07 $8.12 $7.73 $13.07 $7.73 $7.73 $5.80 $5.80 $5.80 $5.80 $59.12 330104 99000 304 305 HC SPECIMEN HANDLING OFFICE-LAB O $28.89 N/A N/A $40.26 $14.45 N/A N/A N/A $40.26 N/A $40.26 N/A $21.67 N/A $18.20 $21.12 $48.31 $40.26 $17.33 $23.11 N/A N/A $40.26 N/A $18.78 $56.37 $23.11 $40.26 $40.26 $48.31 N/A $40.26 N/A N/A N/A $23.11 $24.56 $54.35 $21.67 $82.54 $54.35 $14.45 $18.78 N/A N/A N/A N/A $8.16 N/A N/A $8.16 $40.26 $40.26 N/A N/A N/A $8.16 $82.54 330104 85610 406 305 HC PROTHROMBIN TIME O $142.31 $4.29 $4.29 $3.91 $71.16 N/A N/A N/A $3.91 $8.15 $3.91 $4.29 $106.73 $4.72 $89.66 $104.03 $4.69 $3.91 $85.39 $113.85 $14.59 $24.45 $3.91 $4.29 $92.50 $5.47 $113.85 $3.91 $3.91 $4.69 $6.01 $3.91 $4.29 $4.29 $4.68 $113.85 $120.96 $5.28 $106.73 $8.02 $5.28 $71.16 $92.50 $6.03 $6.03 $6.03 $6.03 $6.64 $4.50 $4.29 $6.64 $3.91 $3.91 $3.22 $3.22 $3.22 $3.22 $120.96 330104 85613 406 305 HC RUSSELL VIPER VENOM DILUTED O $151.94 $9.58 $9.58 $7.82 $75.97 N/A N/A N/A $7.82 $18.20 $7.82 $9.58 $113.95 $10.54 $95.72 $111.07 $9.38 $7.82 $91.16 $121.55 $32.57 $54.61 $7.82 $9.58 $98.76 $10.95 $121.55 $7.82 $7.82 $9.38 $13.41 $7.82 $9.58 $9.58 $10.44 $121.55 $129.15 $10.56 $113.95 $16.03 $10.56 $75.97 $98.76 $13.46 $13.46 $13.46 $13.46 $16.16 $10.06 $9.58 $16.16 $7.82 $7.82 $7.19 $7.19 $7.19 $7.19 $129.15 330104 85651 408 305 HC RBC SED RATE NONAUTOMATED O $84.53 $4.27 $4.27 $2.00 $42.27 N/A N/A N/A $2.00 $8.11 $2.00 $4.27 $63.40 $4.70 $53.25 $61.79 $2.40 $2.00 $50.72 $67.62 $14.52 $24.34 $2.00 $4.27 $54.94 $2.80 $67.62 $2.00 $2.00 $2.40 $5.98 $2.00 $4.27 $4.27 $4.65 $67.62 $71.85 $2.70 $63.40 $4.10 $2.70 $42.27 $54.94 $6.00 $6.00 $6.00 $6.00 $6.00 $4.48 $4.27 $6.00 $2.00 $2.00 $3.20 $3.20 $3.20 $2.00 $71.85 330104 85660 408 305 HC RBC SICKLE CELL TEST O $87.74 $5.51 $5.51 N/A $43.87 N/A N/A N/A N/A $10.47 N/A $5.51 $65.80 $6.06 $55.28 $64.14 N/A N/A $52.64 $70.19 $18.73 $31.41 N/A $5.51 $57.03 N/A $70.19 N/A N/A N/A $7.71 N/A $5.51 $5.51 $6.01 $70.19 $74.58 N/A $65.80 N/A N/A $43.87 $57.03 $7.74 $7.74 $7.74 $7.74 $9.31 $5.79 $5.51 $9.31 N/A N/A $4.13 $4.13 $4.13 $4.13 $74.58 330104 85670 406 305 HC THROMBIN TIME PLASMA O $182.97 $5.77 $5.77 $5.30 $91.48 N/A N/A N/A $5.30 $10.96 $5.30 $5.77 $137.23 $6.35 $115.27 $133.75 $6.36 $5.30 $109.78 $146.38 $19.62 $32.89 $5.30 $5.77 $118.93 $7.42 $146.38 $5.30 $5.30 $6.36 $8.08 $5.30 $5.77 $5.77 $6.29 $146.38 $155.52 $7.16 $137.23 $10.86 $7.16 $91.48 $118.93 $8.11 $8.11 $8.11 $8.11 $9.76 $6.06 $5.77 $9.76 $5.30 $5.30 $4.33 $4.33 $4.33 $4.33 $155.52 330104 85730 406 305 HC THROMBOPLASTIN TIME PART (PTT);PLASMA/WHLE BLD O $142.31 $6.01 $6.01 $6.01 $71.16 N/A N/A N/A $6.01 $11.42 $6.01 $6.01 $106.73 $6.61 $89.66 $104.03 $7.21 $6.01 $85.39 $113.85 $20.43 $34.26 $6.01 $6.01 $92.50 $8.41 $113.85 $6.01 $6.01 $7.21 $8.41 $6.01 $6.01 $6.01 $6.55 $113.85 $120.96 $8.11 $106.73 $12.32 $8.11 $71.16 $92.50 $8.44 $8.44 $8.44 $8.44 $10.14 $6.31 $6.01 $10.14 $6.01 $6.01 $4.51 $4.51 $4.51 $4.51 $120.96 330104 85732 406 305 HC THROMBOPLASTIN TIME PARTIAL (PTT); SUBST PLASMA EA O $108.07 $6.47 $6.47 $6.19 $54.03 N/A N/A N/A $6.19 $12.29 $6.19 $6.47 $81.05 $7.12 $68.08 $79.00 $7.43 $6.19 $64.84 $86.46 $22.00 $36.88 $6.19 $6.47 $70.25 $8.67 $86.46 $6.19 $6.19 $7.43 $9.06 $6.19 $6.47 $6.47 $7.05 $86.46 $91.86 $8.36 $81.05 $12.69 $8.36 $54.03 $70.25 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $6.19 $6.19 $4.85 $4.85 $4.85 $4.85 $91.86 330104 85810 408 305 HC BLOOD VISCOSITY EXAMINATION O $300.67 $11.67 $11.67 $11.67 $150.34 N/A N/A N/A $11.67 $22.17 $11.67 $11.67 $225.50 $12.84 $189.42 $219.79 $14.00 $11.67 $180.40 $240.54 $39.68 $66.52 $11.67 $11.67 $195.44 $16.34 $240.54 $11.67 $11.67 $14.00 $16.34 $11.67 $11.67 $11.67 $12.72 $240.54 $255.57 $15.75 $225.50 $23.92 $15.75 $150.34 $195.44 $16.40 $16.40 $16.40 $16.40 $19.72 $12.25 $11.67 $19.72 $11.67 $11.67 $8.75 $8.75 $8.75 $8.75 $255.57 330104 89055 390 305 HC LEUKOCYTE COUNTFECAL O $71.69 $4.27 $4.27 $3.40 $35.84 N/A N/A N/A $3.40 $8.11 $3.40 $4.27 $53.77 $4.70 $45.16 $52.41 $4.08 $3.40 $43.01 $57.35 $14.52 $24.34 $3.40 $4.27 $46.60 $4.76 $57.35 $3.40 $3.40 $4.08 $5.98 $3.40 $4.27 $4.27 $4.65 $57.35 $60.94 $4.59 $53.77 $6.97 $4.59 $35.84 $46.60 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 $3.40 $3.40 $3.20 $3.20 $3.20 $3.20 $60.94 330104 89190 390 305 HC NASAL SMEAR FOR EOSINOPHILS O $142.31 $5.79 $5.79 $4.70 $71.16 N/A N/A N/A $4.70 $11.00 $4.70 $5.79 $106.73 $6.37 $89.66 $104.03 $5.64 $4.70 $85.39 $113.85 $19.69 $33.00 $4.70 $5.79 $92.50 $6.58 $113.85 $4.70 $4.70 $5.64 $8.11 $4.70 $5.79 $5.79 $6.31 $113.85 $120.96 $6.35 $106.73 $9.63 $6.35 $71.16 $92.50 $8.13 $8.13 $8.13 $8.13 $8.02 $6.08 $5.79 $8.02 $4.70 $4.70 $4.34 $4.34 $4.34 $4.34 $120.96 330104 85305 406 305 HC CLOT INHIBIT PROT S TOTAL O $185.11 $11.61 $11.61 $11.61 $92.56 N/A N/A N/A $11.61 $22.06 $11.61 $11.61 $138.83 $12.77 $116.62 $135.32 $13.93 $11.61 $111.07 $148.09 $39.47 $66.18 $11.61 $11.61 $120.32 $16.25 $148.09 $11.61 $11.61 $13.93 $16.25 $11.61 $11.61 $11.61 $12.65 $148.09 $157.34 $15.67 $138.83 $23.80 $15.67 $92.56 $120.32 $16.31 $16.31 $16.31 $16.31 $19.58 $12.19 $11.61 $19.58 $11.61 $11.61 $8.71 $8.71 $8.71 $8.71 $157.34 330104 85598 406 305 HC HEXAGNAL PHOSPH PLTLT NEUTRL O $155.15 $17.98 $17.98 N/A $77.58 N/A N/A N/A N/A $34.16 N/A $17.98 $116.36 $19.78 $97.74 $113.41 N/A N/A $93.09 $124.12 $61.13 $102.49 N/A $17.98 $100.85 N/A $124.12 N/A N/A N/A $25.17 N/A $17.98 $17.98 $19.60 $124.12 $131.88 N/A $116.36 N/A N/A $77.58 $100.85 $25.26 $25.26 $25.26 $25.26 $30.36 $18.88 $17.98 $30.36 N/A N/A $13.48 $13.48 $13.48 $13.48 $131.88 330104 85303 406 305 HC CLOT INHIBIT PROT C ACTIVITY O $219.35 $13.84 $13.84 $13.84 $109.67 N/A N/A N/A $13.84 $26.30 $13.84 $13.84 $164.51 $15.22 $138.19 $160.34 $16.61 $13.84 $131.61 $175.48 $47.06 $78.89 $13.84 $13.84 $142.58 $19.38 $175.48 $13.84 $13.84 $16.61 $19.38 $13.84 $13.84 $13.84 $15.09 $175.48 $186.45 $18.68 $164.51 $28.37 $18.68 $109.67 $142.58 $19.45 $19.45 $19.45 $19.45 $23.35 $14.53 $13.84 $23.35 $13.84 $13.84 $10.38 $10.38 $10.38 $10.38 $186.45 330104 85230 406 305 HC CLOT FACTOR VII PROCONVERTIN O $760.77 $17.90 $17.90 $17.90 $380.38 N/A N/A N/A $17.90 $34.01 $17.90 $17.90 $570.58 $19.69 $479.29 $556.12 $21.48 $17.90 $456.46 $608.62 $60.86 $102.03 $17.90 $17.90 $494.50 $25.06 $608.62 $17.90 $17.90 $21.48 $25.06 $17.90 $17.90 $17.90 $19.51 $608.62 $646.65 $24.16 $570.58 $36.69 $24.16 $380.38 $494.50 $25.15 $25.15 $25.15 $25.15 $30.24 $18.79 $17.90 $30.24 $17.90 $17.90 $13.42 $13.42 $13.42 $13.42 $646.65 330104 85301 406 305 HC ANTITHROMBIN III ANTIGEN O $146.59 $10.81 $10.81 $10.81 $73.30 N/A N/A N/A $10.81 $20.54 $10.81 $10.81 $109.94 $11.89 $92.35 $107.16 $12.97 $10.81 $87.95 $117.27 $36.75 $61.62 $10.81 $10.81 $95.28 $15.13 $117.27 $10.81 $10.81 $12.97 $15.13 $10.81 $10.81 $10.81 $11.78 $117.27 $124.60 $14.59 $109.94 $22.16 $14.59 $73.30 $95.28 $15.19 $15.19 $15.19 $15.19 $18.25 $11.35 $10.81 $18.25 $10.81 $10.81 $8.11 $8.11 $8.11 $8.11 $124.60 330104 85007 408 305 HC BL SMEAR W/DIFF WBC COUNT O $71.69 $3.80 $3.80 $1.43 $35.84 N/A N/A N/A $1.43 $7.22 $1.43 $3.80 $53.77 $4.18 $45.16 $52.41 $1.72 $1.43 $43.01 $57.35 $12.92 $21.66 $1.43 $3.80 $46.60 $2.00 $57.35 $1.43 $1.43 $1.72 $5.32 $1.43 $3.80 $3.80 $4.14 $57.35 $60.94 $1.93 $53.77 $2.93 $1.93 $35.84 $46.60 $5.34 $5.34 $5.34 $5.34 $5.81 $3.99 $3.80 $5.81 $1.43 $1.43 $2.85 $2.85 $2.85 $1.43 $60.94 330104 85008 408 305 HC BL SMEAR W/O DIFF WBC COUNT O $306.02 $3.43 $3.43 N/A $153.01 N/A N/A N/A N/A $6.52 N/A $3.43 $229.51 $3.77 $192.79 $223.70 N/A N/A $183.61 $244.82 $11.66 $19.55 N/A $3.43 $198.91 N/A $244.82 N/A N/A N/A $4.80 N/A $3.43 $3.43 $3.74 $244.82 $260.12 N/A $229.51 N/A N/A $153.01 $198.91 $4.82 $4.82 $4.82 $4.82 $5.81 $3.60 $3.43 $5.81 N/A N/A $2.57 $2.57 $2.57 $2.57 $260.12 330104 85014 408 305 HC HEMATOCRIT O $37.45 $2.37 $2.37 $2.00 $18.73 N/A N/A N/A $2.00 $4.50 $2.00 $2.37 $28.09 $2.61 $23.59 $27.38 $2.40 $2.00 $22.47 $29.96 $8.06 $13.51 $2.00 $2.37 $24.34 $2.80 $29.96 $2.00 $2.00 $2.40 $3.32 $2.00 $2.37 $2.37 $2.58 $29.96 $31.83 $2.70 $28.09 $4.10 $2.70 $18.73 $24.34 $3.33 $3.33 $3.33 $3.33 $4.00 $2.49 $2.37 $4.00 $2.00 $2.00 $1.78 $1.78 $1.78 $1.78 $31.83 330104 85018 408 305 HC HEMOGLOBIN O $131.61 $2.37 $2.37 $2.00 $65.81 N/A N/A N/A $2.00 $4.50 $2.00 $2.37 $98.71 $2.61 $82.91 $96.21 $2.40 $2.00 $78.97 $105.29 $8.06 $13.51 $2.00 $2.37 $85.55 $2.80 $105.29 $2.00 $2.00 $2.40 $3.32 $2.00 $2.37 $2.37 $2.58 $105.29 $111.87 $2.70 $98.71 $4.10 $2.70 $65.81 $85.55 $3.33 $3.33 $3.33 $3.33 $4.00 $2.49 $2.37 $4.00 $2.00 $2.00 $1.78 $1.78 $1.78 $1.78 $111.87 330104 85025 408 305 HC COMPLETE CBC W/AUTO DIFF WBC O $121.98 $7.77 $7.77 $3.17 $60.99 N/A N/A N/A $3.17 $14.76 $3.17 $7.77 $91.48 $8.55 $76.85 $89.17 $3.80 $3.17 $73.19 $97.58 $26.42 $44.29 $3.17 $7.77 $79.29 $4.44 $97.58 $3.17 $3.17 $3.80 $10.88 $3.17 $7.77 $7.77 $8.47 $97.58 $103.68 $4.28 $91.48 $6.50 $4.28 $60.99 $79.29 $10.92 $10.92 $10.92 $10.92 $13.13 $8.16 $7.77 $13.13 $3.17 $3.17 $5.83 $5.83 $5.83 $3.17 $103.68 330104 85027 408 305 HC COMPLETE CBC AUTOMATED O $97.37 $6.47 $6.47 $3.17 $48.69 N/A N/A N/A $3.17 $12.29 $3.17 $6.47 $73.03 $7.12 $61.34 $71.18 $3.80 $3.17 $58.42 $77.90 $22.00 $36.88 $3.17 $6.47 $63.29 $4.44 $77.90 $3.17 $3.17 $3.80 $9.06 $3.17 $6.47 $6.47 $7.05 $77.90 $82.76 $4.28 $73.03 $6.50 $4.28 $48.69 $63.29 $9.09 $9.09 $9.09 $9.09 $10.93 $6.79 $6.47 $10.93 $3.17 $3.17 $4.85 $4.85 $4.85 $3.17 $82.76 330104 85041 408 305 HC AUTOMATED RBC COUNT O $52.43 $3.02 $3.02 $3.02 $26.21 N/A N/A N/A $3.02 $5.74 $3.02 $3.02 $39.32 $3.32 $33.03 $38.33 $3.62 $3.02 $31.46 $41.94 $10.27 $17.21 $3.02 $3.02 $34.08 $4.23 $41.94 $3.02 $3.02 $3.62 $4.23 $3.02 $3.02 $3.02 $3.29 $41.94 $44.57 $4.08 $39.32 $6.19 $4.08 $26.21 $34.08 $4.24 $4.24 $4.24 $4.24 $5.09 $3.17 $3.02 $5.09 $3.02 $3.02 $2.27 $2.27 $2.27 $2.27 $44.57 330104 85045 408 305 HC AUTOMATED RETICULOCYTE COUNT O $64.20 $3.99 $3.99 $3.17 $32.10 N/A N/A N/A $3.17 $7.58 $3.17 $3.99 $48.15 $4.39 $40.45 $46.93 $3.80 $3.17 $38.52 $51.36 $13.57 $22.74 $3.17 $3.99 $41.73 $4.44 $51.36 $3.17 $3.17 $3.80 $5.59 $3.17 $3.99 $3.99 $4.35 $51.36 $54.57 $4.28 $48.15 $6.50 $4.28 $32.10 $41.73 $5.61 $5.61 $5.61 $5.61 $6.76 $4.19 $3.99 $6.76 $3.17 $3.17 $2.99 $2.99 $2.99 $2.99 $54.57 330104 85048 408 305 HC AUTOMATED LEUKOCYTE COUNT O $131.61 $2.54 $2.54 $2.54 $65.81 N/A N/A N/A $2.54 $4.83 $2.54 $2.54 $98.71 $2.79 $82.91 $96.21 $3.05 $2.54 $78.97 $105.29 $8.64 $14.48 $2.54 $2.54 $85.55 $3.56 $105.29 $2.54 $2.54 $3.05 $3.56 $2.54 $2.54 $2.54 $2.77 $105.29 $111.87 $3.43 $98.71 $5.21 $3.43 $65.81 $85.55 $3.57 $3.57 $3.57 $3.57 $4.28 $2.67 $2.54 $4.28 $2.54 $2.54 $1.91 $1.91 $1.91 $1.91 $111.87 330104 85049 408 305 HC AUTOMATED PLATELET COUNT O $72.76 $4.48 $4.48 $3.17 $36.38 N/A N/A N/A $3.17 $8.51 $3.17 $4.48 $54.57 $4.93 $45.84 $53.19 $3.80 $3.17 $43.66 $58.21 $15.23 $25.54 $3.17 $4.48 $47.29 $4.44 $58.21 $3.17 $3.17 $3.80 $6.27 $3.17 $4.48 $4.48 $4.88 $58.21 $61.85 $4.28 $54.57 $6.50 $4.28 $36.38 $47.29 $6.29 $6.29 $6.29 $6.29 $7.55 $4.70 $4.48 $7.55 $3.17 $3.17 $3.36 $3.36 $3.36 $3.17 $61.85 330104 85210 406 305 HC CLOT FACTOR II PROTHROM SPEC O "$1,013.29 " $12.98 $12.98 $12.98 $506.64 N/A N/A N/A $12.98 $24.66 $12.98 $12.98 $759.97 $14.28 $638.37 $740.71 $15.58 $12.98 $607.97 $810.63 $44.13 $73.99 $12.98 $12.98 $658.64 $18.17 $810.63 $12.98 $12.98 $15.58 $18.17 $12.98 $12.98 $12.98 $14.15 $810.63 $861.30 $17.52 $759.97 $26.61 $17.52 $506.64 $658.64 $18.24 $18.24 $18.24 $18.24 $21.92 $13.63 $12.98 $21.92 $12.98 $12.98 $9.73 $9.73 $9.73 $9.73 $861.30 330104 85220 406 305 HC BLOOC CLOT FACTOR V TEST O $686.94 $17.65 $17.65 $17.65 $343.47 N/A N/A N/A $17.65 $33.53 $17.65 $17.65 $515.21 $19.41 $432.77 $502.15 $21.18 $17.65 $412.16 $549.55 $60.01 $100.60 $17.65 $17.65 $446.51 $24.71 $549.55 $17.65 $17.65 $21.18 $24.71 $17.65 $17.65 $17.65 $19.24 $549.55 $583.90 $23.83 $515.21 $36.18 $23.83 $343.47 $446.51 $24.80 $24.80 $24.80 $24.80 $29.80 $18.53 $17.65 $29.80 $17.65 $17.65 $13.24 $13.24 $13.24 $13.24 $583.90 330104 85240 406 305 HC CLOT FACTOR VIII AHG 1 STAGE O "$1,277.58 " $17.90 $17.90 $9.40 $638.79 N/A N/A N/A $9.40 $34.01 $9.40 $17.90 $958.18 $19.69 $804.88 $933.91 $11.28 $9.40 $766.55 "$1,022.06 " $60.86 $102.03 $9.40 $17.90 $830.43 $13.16 "$1,022.06 " $9.40 $9.40 $11.28 $25.06 $9.40 $17.90 $17.90 $19.51 "$1,022.06 " "$1,085.94 " $12.69 $958.18 $19.27 $12.69 $638.79 $830.43 $25.15 $25.15 $25.15 $25.15 $30.24 $18.79 $17.90 $30.24 $9.40 $9.40 $13.42 $13.42 $13.42 $9.40 "$1,085.94 " 330104 85246 407 305 HC CLOT FACTOR VIII VW ANTIGEN O $142.31 $22.94 $22.94 $9.40 $71.16 N/A N/A N/A $9.40 $43.59 $9.40 $22.94 $106.73 $25.23 $89.66 $104.03 $11.28 $9.40 $85.39 $113.85 $78.00 $130.76 $9.40 $22.94 $92.50 $13.16 $113.85 $9.40 $9.40 $11.28 $32.12 $9.40 $22.94 $22.94 $25.00 $113.85 $120.96 $12.69 $106.73 $19.27 $12.69 $71.16 $92.50 $32.23 $32.23 $32.23 $32.23 $38.75 $24.09 $22.94 $38.75 $9.40 $9.40 $17.21 $17.21 $17.21 $9.40 $130.76 330104 85247 407 305 HC CLOT FACTOR VIII MULTIMETRIC O $361.66 $22.94 $22.94 $11.77 $180.83 N/A N/A N/A $11.77 $43.59 $11.77 $22.94 $271.25 $25.23 $227.85 $264.37 $14.12 $11.77 $217.00 $289.33 $78.00 $130.76 $11.77 $22.94 $235.08 $16.48 $289.33 $11.77 $11.77 $14.12 $32.12 $11.77 $22.94 $22.94 $25.00 $289.33 $307.41 $15.89 $271.25 $24.13 $15.89 $180.83 $235.08 $32.23 $32.23 $32.23 $32.23 $38.75 $24.09 $22.94 $38.75 $11.77 $11.77 $17.21 $17.21 $17.21 $11.77 $307.41 330104 85250 407 305 HC CLOT FACTOR IX PTC/CHRSTMAS O $760.77 $19.04 $19.04 $19.04 $380.38 N/A N/A N/A $19.04 $36.18 $19.04 $19.04 $570.58 $20.94 $479.29 $556.12 $22.85 $19.04 $456.46 $608.62 $64.74 $108.53 $19.04 $19.04 $494.50 $26.66 $608.62 $19.04 $19.04 $22.85 $26.66 $19.04 $19.04 $19.04 $20.75 $608.62 $646.65 $25.70 $570.58 $39.03 $25.70 $380.38 $494.50 $26.75 $26.75 $26.75 $26.75 $32.16 $19.99 $19.04 $32.16 $19.04 $19.04 $14.28 $14.28 $14.28 $14.28 $646.65 330104 85260 406 305 HC CLOT FACTOR X STUART-POWER O $760.77 $17.90 $17.90 $17.90 $380.38 N/A N/A N/A $17.90 $34.01 $17.90 $17.90 $570.58 $19.69 $479.29 $556.12 $21.48 $17.90 $456.46 $608.62 $60.86 $102.03 $17.90 $17.90 $494.50 $25.06 $608.62 $17.90 $17.90 $21.48 $25.06 $17.90 $17.90 $17.90 $19.51 $608.62 $646.65 $24.16 $570.58 $36.69 $24.16 $380.38 $494.50 $25.15 $25.15 $25.15 $25.15 $30.24 $18.79 $17.90 $30.24 $17.90 $17.90 $13.42 $13.42 $13.42 $13.42 $646.65 330104 85270 406 305 HC CLOT FACTOR XI PTA O $760.77 $17.90 $17.90 $17.90 $380.38 N/A N/A N/A $17.90 $34.01 $17.90 $17.90 $570.58 $19.69 $479.29 $556.12 $21.48 $17.90 $456.46 $608.62 $60.86 $102.03 $17.90 $17.90 $494.50 $25.06 $608.62 $17.90 $17.90 $21.48 $25.06 $17.90 $17.90 $17.90 $19.51 $608.62 $646.65 $24.16 $570.58 $36.69 $24.16 $380.38 $494.50 $25.15 $25.15 $25.15 $25.15 $30.24 $18.79 $17.90 $30.24 $17.90 $17.90 $13.42 $13.42 $13.42 $13.42 $646.65 330104 85290 406 305 HC CLOT FACTOR XIII FIBRIN STAB O $151.94 $16.34 $16.34 $7.93 $75.97 N/A N/A N/A $7.93 $31.05 $7.93 $16.34 $113.95 $17.97 $95.72 $111.07 $9.52 $7.93 $91.16 $121.55 $55.56 $93.14 $7.93 $16.34 $98.76 $11.10 $121.55 $7.93 $7.93 $9.52 $22.88 $7.93 $16.34 $16.34 $17.81 $121.55 $129.15 $10.71 $113.95 $16.26 $10.71 $75.97 $98.76 $22.96 $22.96 $22.96 $22.96 $27.60 $17.16 $16.34 $27.60 $7.93 $7.93 $12.25 $12.25 $12.25 $7.93 $129.15 330104 85291 406 305 HC CLOT FACTOR XIII FIBRIN SCRN O $117.70 $9.11 $9.11 $7.10 $58.85 N/A N/A N/A $7.10 $17.31 $7.10 $9.11 $88.28 $10.02 $74.15 $86.04 $8.52 $7.10 $70.62 $94.16 $30.97 $51.93 $7.10 $9.11 $76.51 $9.94 $94.16 $7.10 $7.10 $8.52 $12.75 $7.10 $9.11 $9.11 $9.93 $94.16 $100.05 $9.59 $88.28 $14.55 $9.59 $58.85 $76.51 $12.80 $12.80 $12.80 $12.80 $15.01 $9.57 $9.11 $15.01 $7.10 $7.10 $6.83 $6.83 $6.83 $6.83 $100.05 330104 85300 406 305 HC ANTITHROMBIN III ACTIVITY O $311.37 $11.85 $11.85 $9.43 $155.69 N/A N/A N/A $9.43 $22.51 $9.43 $11.85 $233.53 $13.04 $196.16 $227.61 $11.32 $9.43 $186.82 $249.10 $40.29 $67.55 $9.43 $11.85 $202.39 $13.20 $249.10 $9.43 $9.43 $11.32 $16.59 $9.43 $11.85 $11.85 $12.92 $249.10 $264.66 $12.73 $233.53 $19.33 $12.73 $155.69 $202.39 $16.65 $16.65 $16.65 $16.65 $20.02 $12.44 $11.85 $20.02 $9.43 $9.43 $8.89 $8.89 $8.89 $8.89 $264.66 330104 85302 406 305 HC CLOT INHIBIT PROT C ANTIGEN O $190.46 $12.01 $12.01 $12.01 $95.23 N/A N/A N/A $12.01 $22.82 $12.01 $12.01 $142.84 $13.21 $119.99 $139.23 $14.41 $12.01 $114.28 $152.37 $40.83 $68.46 $12.01 $12.01 $123.80 $16.81 $152.37 $12.01 $12.01 $14.41 $16.81 $12.01 $12.01 $12.01 $13.09 $152.37 $161.89 $16.21 $142.84 $24.62 $16.21 $95.23 $123.80 $16.87 $16.87 $16.87 $16.87 $20.30 $12.61 $12.01 $20.30 $12.01 $12.01 $9.01 $9.01 $9.01 $9.01 $161.89 330104 85280 407 305 HC CLOT FACTOR XII HAGEMAN O $760.77 $19.35 $19.35 $19.35 $380.38 N/A N/A N/A $19.35 $36.77 $19.35 $19.35 $570.58 $21.29 $479.29 $556.12 $23.22 $19.35 $456.46 $608.62 $65.79 $110.30 $19.35 $19.35 $494.50 $27.09 $608.62 $19.35 $19.35 $23.22 $27.09 $19.35 $19.35 $19.35 $21.09 $608.62 $646.65 $26.12 $570.58 $39.67 $26.12 $380.38 $494.50 $27.19 $27.19 $27.19 $27.19 $32.66 $20.32 $19.35 $32.66 $19.35 $19.35 $14.51 $14.51 $14.51 $14.51 $646.65 330104 85245 407 305 HC CLOT FACTOR VIII VW RISTOCTN O $942.67 $22.94 $22.94 $9.40 $471.33 N/A N/A N/A $9.40 $43.59 $9.40 $22.94 $707.00 $25.23 $593.88 $689.09 $11.28 $9.40 $565.60 $754.14 $78.00 $130.76 $9.40 $22.94 $612.74 $13.16 $754.14 $9.40 $9.40 $11.28 $32.12 $9.40 $22.94 $22.94 $25.00 $754.14 $801.27 $12.69 $707.00 $19.27 $12.69 $471.33 $612.74 $32.23 $32.23 $32.23 $32.23 $38.75 $24.09 $22.94 $38.75 $9.40 $9.40 $17.21 $17.21 $17.21 $9.40 $801.27 330104 87449 396 306 HC AG DETECT NOS EIA MULT O $590.64 $11.98 $11.98 $5.20 $295.32 N/A N/A N/A $5.20 $22.76 $5.20 $11.98 $442.98 $13.18 $372.10 $431.76 $6.24 $5.20 $354.38 $472.51 $40.73 $68.29 $5.20 $11.98 $383.92 $7.28 $472.51 $5.20 $5.20 $6.24 $16.77 $5.20 $11.98 $11.98 $13.06 $472.51 $502.04 $7.02 $442.98 $10.66 $7.02 $295.32 $383.92 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $5.20 $5.20 $8.98 $8.98 $8.98 $5.20 $502.04 330104 87184 396 306 HC MICROBE SUSCEPTIBLE DISK O $151.94 $7.48 $7.48 $6.59 $75.97 N/A N/A N/A $6.59 $14.21 $6.59 $7.48 $113.95 $8.23 $95.72 $111.07 $7.91 $6.59 $91.16 $121.55 $25.43 $42.64 $6.59 $7.48 $98.76 $9.23 $121.55 $6.59 $6.59 $7.91 $10.47 $6.59 $7.48 $7.48 $8.15 $121.55 $129.15 $8.90 $113.95 $13.51 $8.90 $75.97 $98.76 $10.51 $10.51 $10.51 $10.51 $11.65 $7.85 $7.48 $11.65 $6.59 $6.59 $5.61 $5.61 $5.61 $5.61 $129.15 330104 87186 396 306 HC MICROBE SUSCEPTIBLE MIC O $160.50 $8.65 $8.65 $6.59 $80.25 N/A N/A N/A $6.59 $16.43 $6.59 $8.65 $120.38 $9.52 $101.11 $117.33 $7.91 $6.59 $96.30 $128.40 $29.41 $49.31 $6.59 $8.65 $104.33 $9.23 $128.40 $6.59 $6.59 $7.91 $12.11 $6.59 $8.65 $8.65 $9.43 $128.40 $136.42 $8.90 $120.38 $13.51 $8.90 $80.25 $104.33 $12.15 $12.15 $12.15 $12.15 $14.60 $9.08 $8.65 $14.60 $6.59 $6.59 $6.49 $6.49 $6.49 $6.49 $136.42 330104 87188 396 306 HC SENSITIVITY - MACROBROTH EA AGNT O $88.81 $6.64 $6.64 $4.50 $44.41 N/A N/A N/A $4.50 $12.62 $4.50 $6.64 $66.61 $7.30 $55.95 $64.92 $5.40 $4.50 $53.29 $71.05 $22.58 $37.85 $4.50 $6.64 $57.73 $6.30 $71.05 $4.50 $4.50 $5.40 $9.30 $4.50 $6.64 $6.64 $7.24 $71.05 $75.49 $6.08 $66.61 $9.22 $6.08 $44.41 $57.73 $9.33 $9.33 $9.33 $9.33 $11.21 $6.97 $6.64 $11.21 $4.50 $4.50 $4.98 $4.98 $4.98 $4.50 $75.49 330104 87205 396 306 HC SMEAR GRAM STAIN O $129.47 $4.27 $4.27 $3.40 $64.73 N/A N/A N/A $3.40 $8.11 $3.40 $4.27 $97.10 $4.70 $81.57 $94.64 $4.08 $3.40 $77.68 $103.58 $14.52 $24.34 $3.40 $4.27 $84.16 $4.76 $103.58 $3.40 $3.40 $4.08 $5.98 $3.40 $4.27 $4.27 $4.65 $103.58 $110.05 $4.59 $97.10 $6.97 $4.59 $64.73 $84.16 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 $3.40 $3.40 $3.20 $3.20 $3.20 $3.20 $110.05 330104 87206 396 306 HC SMEAR FLUORESCENT/ACID STAI O $182.97 $5.39 $5.39 $5.39 $91.48 N/A N/A N/A $5.39 $10.24 $5.39 $5.39 $137.23 $5.93 $115.27 $133.75 $6.47 $5.39 $109.78 $146.38 $18.33 $30.72 $5.39 $5.39 $118.93 $7.55 $146.38 $5.39 $5.39 $6.47 $7.55 $5.39 $5.39 $5.39 $5.88 $146.38 $155.52 $7.28 $137.23 $11.05 $7.28 $91.48 $118.93 $7.57 $7.57 $7.57 $7.57 $9.07 $5.66 $5.39 $9.07 $5.39 $5.39 $4.04 $4.04 $4.04 $4.04 $155.52 330104 87220 396 306 HC TISSUE EXAM FOR FUNGI O $121.98 $4.27 $4.27 N/A $60.99 N/A N/A N/A N/A $8.11 N/A $4.27 $91.48 $4.70 $76.85 $89.17 N/A N/A $73.19 $97.58 $14.52 $24.34 N/A $4.27 $79.29 N/A $97.58 N/A N/A N/A $5.98 N/A $4.27 $4.27 $4.65 $97.58 $103.68 N/A $91.48 N/A N/A $60.99 $79.29 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 N/A N/A $3.20 $3.20 $3.20 $3.20 $103.68 330104 87252 396 306 HC VIRUS INOCULATION TISSUE O $409.81 $26.07 $26.07 $26.07 $204.91 N/A N/A N/A $26.07 $49.53 $26.07 $26.07 $307.36 $28.68 $258.18 $299.57 $31.28 $26.07 $245.89 $327.85 $88.64 $148.60 $26.07 $26.07 $266.38 $36.50 $327.85 $26.07 $26.07 $31.28 $36.50 $26.07 $26.07 $26.07 $28.42 $327.85 $348.34 $35.19 $307.36 $53.44 $35.19 $204.91 $266.38 $36.63 $36.63 $36.63 $36.63 $44.02 $27.37 $26.07 $44.02 $26.07 $26.07 $19.55 $19.55 $19.55 $19.55 $348.34 330104 87253 396 306 HC VIRUS INOCULATE TISSUE ADDL O $318.86 $20.20 $20.20 $20.20 $159.43 N/A N/A N/A $20.20 $38.38 $20.20 $20.20 $239.15 $22.22 $200.88 $233.09 $24.24 $20.20 $191.32 $255.09 $68.68 $115.14 $20.20 $20.20 $207.26 $28.28 $255.09 $20.20 $20.20 $24.24 $28.28 $20.20 $20.20 $20.20 $22.02 $255.09 $271.03 $27.27 $239.15 $41.41 $27.27 $159.43 $207.26 $28.38 $28.38 $28.38 $28.38 $34.10 $21.21 $20.20 $34.10 $20.20 $20.20 $15.15 $15.15 $15.15 $15.15 $271.03 330104 87254 396 306 HC VIRUS INOCULATION SHELL VIA O $616.32 $19.56 $19.56 $6.76 $308.16 N/A N/A N/A $6.76 $37.16 $6.76 $19.56 $462.24 $21.52 $388.28 $450.53 $8.11 $6.76 $369.79 $493.06 $66.50 $111.49 $6.76 $19.56 $400.61 $9.46 $493.06 $6.76 $6.76 $8.11 $27.38 $6.76 $19.56 $19.56 $21.32 $493.06 $523.87 $9.13 $462.24 $13.86 $9.13 $308.16 $400.61 $27.48 $27.48 $27.48 $27.48 $33.02 $20.54 $19.56 $33.02 $6.76 $6.76 $14.67 $14.67 $14.67 $6.76 $523.87 330104 87255 397 306 HC VIRUS IDNON-IMMUNOLOGIC METHOD O $535.00 $33.86 $33.86 $6.76 $267.50 N/A N/A N/A $6.76 $64.33 $6.76 $33.86 $401.25 $37.25 $337.05 $391.08 $8.11 $6.76 $321.00 $428.00 $115.12 $193.00 $6.76 $33.86 $347.75 $9.46 $428.00 $6.76 $6.76 $8.11 $47.40 $6.76 $33.86 $33.86 $36.91 $428.00 $454.75 $9.13 $401.25 $13.86 $9.13 $267.50 $347.75 $47.57 $47.57 $47.57 $47.57 $57.19 $35.55 $33.86 $57.19 $6.76 $6.76 $25.39 $25.39 $25.39 $6.76 $454.75 330104 87281 396 306 HC PNEUMOCYSTIS CARINII AG IF O $97.37 $11.98 $11.98 $8.03 $48.69 N/A N/A N/A $8.03 $22.76 $8.03 $11.98 $73.03 $13.18 $61.34 $71.18 $9.64 $8.03 $58.42 $77.90 $40.73 $68.29 $8.03 $11.98 $63.29 $11.24 $77.90 $8.03 $8.03 $9.64 $16.77 $8.03 $11.98 $11.98 $13.06 $77.90 $82.76 $10.84 $73.03 $16.46 $10.84 $48.69 $63.29 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $8.03 $8.03 $8.98 $8.98 $8.98 $8.03 $82.76 330104 87290 396 306 HC VARICELLA ZOSTER AG IF O $103.79 $13.42 $13.42 $8.03 $51.90 N/A N/A N/A $8.03 $25.50 $8.03 $13.42 $77.84 $14.76 $65.39 $75.87 $9.64 $8.03 $62.27 $83.03 $45.63 $76.49 $8.03 $13.42 $67.46 $11.24 $83.03 $8.03 $8.03 $9.64 $18.79 $8.03 $13.42 $13.42 $14.63 $83.03 $88.22 $10.84 $77.84 $16.46 $10.84 $51.90 $67.46 $18.86 $18.86 $18.86 $18.86 $20.26 $14.09 $13.42 $20.26 $8.03 $8.03 $10.06 $10.06 $10.06 $8.03 $88.22 330104 87299 396 306 HC ANTIBODY DETECTION NOS IF O $142.31 $16.10 $16.10 $16.10 $71.16 N/A N/A N/A $16.10 $30.59 $16.10 $16.10 $106.73 $17.71 $89.66 $104.03 $19.32 $16.10 $85.39 $113.85 $54.74 $91.77 $16.10 $16.10 $92.50 $22.54 $113.85 $16.10 $16.10 $19.32 $22.54 $16.10 $16.10 $16.10 $17.55 $113.85 $120.96 $21.74 $106.73 $33.01 $21.74 $71.16 $92.50 $22.62 $22.62 $22.62 $22.62 $20.26 $16.91 $16.10 $20.26 $16.10 $16.10 $12.08 $12.08 $12.08 $12.08 $120.96 330104 87305 396 306 HC FUNGUS NES ANTIBODY O $361.66 $11.98 $11.98 $8.03 $180.83 N/A N/A N/A $8.03 $22.76 $8.03 $11.98 $271.25 $13.18 $227.85 $264.37 $9.64 $8.03 $217.00 $289.33 $40.73 $68.29 $8.03 $11.98 $235.08 $11.24 $289.33 $8.03 $8.03 $9.64 $16.77 $8.03 $11.98 $11.98 $13.06 $289.33 $307.41 $10.84 $271.25 $16.46 $10.84 $180.83 $235.08 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $8.03 $8.03 $8.98 $8.98 $8.98 $8.03 $307.41 330104 87329 396 306 HC GIARDIA AG EIA O $190.46 $11.98 $11.98 $11.98 $95.23 N/A N/A N/A $11.98 $22.76 $11.98 $11.98 $142.84 $13.18 $119.99 $139.23 $14.38 $11.98 $114.28 $152.37 $40.73 $68.29 $11.98 $11.98 $123.80 $16.77 $152.37 $11.98 $11.98 $14.38 $16.77 $11.98 $11.98 $11.98 $13.06 $152.37 $161.89 $16.17 $142.84 $24.56 $16.17 $95.23 $123.80 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $11.98 $11.98 $8.98 $8.98 $8.98 $8.98 $161.89 330104 87177 396 306 HC OVA AND PARASITES SMEARS O $143.38 $8.90 $8.90 $8.90 $71.69 N/A N/A N/A $8.90 $16.91 $8.90 $8.90 $107.53 $9.79 $90.33 $104.81 $10.68 $8.90 $86.03 $114.70 $30.26 $50.73 $8.90 $8.90 $93.20 $12.46 $114.70 $8.90 $8.90 $10.68 $12.46 $8.90 $8.90 $8.90 $9.70 $114.70 $121.87 $12.02 $107.53 $18.24 $12.02 $71.69 $93.20 $12.50 $12.50 $12.50 $12.50 $15.02 $9.35 $8.90 $15.02 $8.90 $8.90 $6.68 $6.68 $6.68 $6.68 $121.87 330104 87332 396 306 "HC CYTOMEGALOVIRUS AG,EIA" O $142.31 $11.98 $11.98 $11.98 $71.16 N/A N/A N/A $11.98 $22.76 $11.98 $11.98 $106.73 $13.18 $89.66 $104.03 $14.38 $11.98 $85.39 $113.85 $40.73 $68.29 $11.98 $11.98 $92.50 $16.77 $113.85 $11.98 $11.98 $14.38 $16.77 $11.98 $11.98 $11.98 $13.06 $113.85 $120.96 $16.17 $106.73 $24.56 $16.17 $71.16 $92.50 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $11.98 $11.98 $8.98 $8.98 $8.98 $8.98 $120.96 330104 87168 396 306 HC MACROSCOPIC EXAM ARTHROPOD O $79.18 $4.27 $4.27 N/A $39.59 N/A N/A N/A N/A $8.11 N/A $4.27 $59.39 $4.70 $49.88 $57.88 N/A N/A $47.51 $63.34 $14.52 $24.34 N/A $4.27 $51.47 N/A $63.34 N/A N/A N/A $5.98 N/A $4.27 $4.27 $4.65 $63.34 $67.30 N/A $59.39 N/A N/A $39.59 $51.47 $6.00 $6.00 $6.00 $6.00 $7.21 $4.48 $4.27 $7.21 N/A N/A $3.20 $3.20 $3.20 $3.20 $67.30 330104 87149 396 306 HC DNA/RNA DIRECT PROBE O $318.86 $20.05 $20.05 N/A $159.43 N/A N/A N/A N/A $38.09 N/A $20.05 $239.15 $22.06 $200.88 $233.09 N/A N/A $191.32 $255.09 $68.17 $114.29 N/A $20.05 $207.26 N/A $255.09 N/A N/A N/A $28.07 N/A $20.05 $20.05 $21.85 $255.09 $271.03 N/A $239.15 N/A N/A $159.43 $207.26 $28.17 $28.17 $28.17 $28.17 $33.86 $21.05 $20.05 $33.86 N/A N/A $15.04 $15.04 $15.04 $15.04 $271.03 330104 87040 396 306 HC BLOOD CULTURE FOR BACTERIA O $340.26 $10.32 $10.32 $8.15 $170.13 N/A N/A N/A $8.15 $19.61 $8.15 $10.32 $255.19 $11.35 $214.36 $248.73 $9.78 $8.15 $204.16 $272.21 $35.09 $58.82 $8.15 $10.32 $221.17 $11.41 $272.21 $8.15 $8.15 $9.78 $14.45 $8.15 $10.32 $10.32 $11.25 $272.21 $289.22 $11.00 $255.19 $16.71 $11.00 $170.13 $221.17 $14.50 $14.50 $14.50 $14.50 $17.44 $10.84 $10.32 $17.44 $8.15 $8.15 $7.74 $7.74 $7.74 $7.74 $289.22 330104 87045 396 306 HC FECES CULTURE AEROBIC BACT O $306.02 $9.44 $9.44 $8.15 $153.01 N/A N/A N/A $8.15 $17.94 $8.15 $9.44 $229.51 $10.38 $192.79 $223.70 $9.78 $8.15 $183.61 $244.82 $32.10 $53.81 $8.15 $9.44 $198.91 $11.41 $244.82 $8.15 $8.15 $9.78 $13.22 $8.15 $9.44 $9.44 $10.29 $244.82 $260.12 $11.00 $229.51 $16.71 $11.00 $153.01 $198.91 $13.26 $13.26 $13.26 $13.26 $15.94 $9.91 $9.44 $15.94 $8.15 $8.15 $7.08 $7.08 $7.08 $7.08 $260.12 330104 87070 396 306 HC CULTURE OTHR SPECIMN AEROBIC O $206.51 $8.62 $8.62 $8.15 $103.25 N/A N/A N/A $8.15 $16.38 $8.15 $8.62 $154.88 $9.48 $130.10 $150.96 $9.78 $8.15 $123.91 $165.21 $29.31 $49.13 $8.15 $8.62 $134.23 $11.41 $165.21 $8.15 $8.15 $9.78 $12.07 $8.15 $8.62 $8.62 $9.40 $165.21 $175.53 $11.00 $154.88 $16.71 $11.00 $103.25 $134.23 $12.11 $12.11 $12.11 $12.11 $14.54 $9.05 $8.62 $14.54 $8.15 $8.15 $6.46 $6.46 $6.46 $6.46 $175.53 330104 87076 396 306 HC CULTURE ANAEROBE IDENT EACH O $189.39 $8.08 $8.08 $8.08 $94.69 N/A N/A N/A $8.08 $15.35 $8.08 $8.08 $142.04 $8.89 $119.32 $138.44 $9.70 $8.08 $113.63 $151.51 $27.47 $46.06 $8.08 $8.08 $123.10 $11.31 $151.51 $8.08 $8.08 $9.70 $11.31 $8.08 $8.08 $8.08 $8.81 $151.51 $160.98 $10.91 $142.04 $16.56 $10.91 $94.69 $123.10 $11.35 $11.35 $11.35 $11.35 $13.64 $8.48 $8.08 $13.64 $8.08 $8.08 $6.06 $6.06 $6.06 $6.06 $160.98 330104 87077 396 306 HC CULTURE AEROBIC IDENTIFY O $129.47 $8.08 $8.08 $8.08 $64.73 N/A N/A N/A $8.08 $15.35 $8.08 $8.08 $97.10 $8.89 $81.57 $94.64 $9.70 $8.08 $77.68 $103.58 $27.47 $46.06 $8.08 $8.08 $84.16 $11.31 $103.58 $8.08 $8.08 $9.70 $11.31 $8.08 $8.08 $8.08 $8.81 $103.58 $110.05 $10.91 $97.10 $16.56 $10.91 $64.73 $84.16 $11.35 $11.35 $11.35 $11.35 $13.64 $8.48 $8.08 $13.64 $8.08 $8.08 $6.06 $6.06 $6.06 $6.06 $110.05 330104 87081 396 306 HC CULTURE SCREEN ONLY O $142.31 $6.63 $6.63 $5.20 $71.16 N/A N/A N/A $5.20 $12.60 $5.20 $6.63 $106.73 $7.29 $89.66 $104.03 $6.24 $5.20 $85.39 $113.85 $22.54 $37.79 $5.20 $6.63 $92.50 $7.28 $113.85 $5.20 $5.20 $6.24 $9.28 $5.20 $6.63 $6.63 $7.23 $113.85 $120.96 $7.02 $106.73 $10.66 $7.02 $71.16 $92.50 $9.32 $9.32 $9.32 $9.32 $11.20 $6.96 $6.63 $11.20 $5.20 $5.20 $4.97 $4.97 $4.97 $4.97 $120.96 330104 87086 396 306 HC URINE CULTURE/COLONY COUNT O $206.51 $8.07 $8.07 $8.07 $103.25 N/A N/A N/A $8.07 $15.33 $8.07 $8.07 $154.88 $8.88 $130.10 $150.96 $9.68 $8.07 $123.91 $165.21 $27.44 $46.00 $8.07 $8.07 $134.23 $11.30 $165.21 $8.07 $8.07 $9.68 $11.30 $8.07 $8.07 $8.07 $8.80 $165.21 $175.53 $10.89 $154.88 $16.54 $10.89 $103.25 $134.23 $11.34 $11.34 $11.34 $11.34 $13.63 $8.47 $8.07 $13.63 $8.07 $8.07 $6.05 $6.05 $6.05 $6.05 $175.53 330104 87101 396 306 HC SKIN FUNGI CULTURE O $125.19 $7.71 $7.71 $7.71 $62.59 N/A N/A N/A $7.71 $14.65 $7.71 $7.71 $93.89 $8.48 $78.87 $91.51 $9.25 $7.71 $75.11 $100.15 $26.21 $43.95 $7.71 $7.71 $81.37 $10.79 $100.15 $7.71 $7.71 $9.25 $10.79 $7.71 $7.71 $7.71 $8.40 $100.15 $106.41 $10.41 $93.89 $15.81 $10.41 $62.59 $81.37 $10.83 $10.83 $10.83 $10.83 $13.03 $8.10 $7.71 $13.03 $7.71 $7.71 $5.78 $5.78 $5.78 $5.78 $106.41 330104 87102 396 306 HC FUNGUS ISOLATION CULTURE O $289.97 $8.41 $8.41 $8.41 $144.99 N/A N/A N/A $8.41 $15.98 $8.41 $8.41 $217.48 $9.25 $182.68 $211.97 $10.09 $8.41 $173.98 $231.98 $28.59 $47.94 $8.41 $8.41 $188.48 $11.77 $231.98 $8.41 $8.41 $10.09 $11.77 $8.41 $8.41 $8.41 $9.17 $231.98 $246.47 $11.35 $217.48 $17.24 $11.35 $144.99 $188.48 $11.82 $11.82 $11.82 $11.82 $14.20 $8.83 $8.41 $14.20 $8.41 $8.41 $6.31 $6.31 $6.31 $6.31 $246.47 330104 87103 396 306 HC BLOOD FUNGUS CULTURE O $125.19 $20.46 $20.46 $11.37 $62.59 N/A N/A N/A $11.37 $38.87 $11.37 $20.46 $93.89 $22.51 $78.87 $91.51 $13.64 $11.37 $75.11 $100.15 $69.56 $116.62 $11.37 $20.46 $81.37 $15.92 $100.15 $11.37 $11.37 $13.64 $28.64 $11.37 $20.46 $20.46 $22.30 $100.15 $106.41 $15.35 $93.89 $23.31 $15.35 $62.59 $81.37 $28.75 $28.75 $28.75 $28.75 $15.23 $21.48 $20.46 $15.23 $11.37 $11.37 $15.35 $15.35 $15.35 $11.37 $116.62 330104 87106 396 306 HC FUNGI IDENTIFICATION YEAST O $166.92 $10.32 $10.32 $9.70 $83.46 N/A N/A N/A $9.70 $19.61 $9.70 $10.32 $125.19 $11.35 $105.16 $122.02 $11.64 $9.70 $100.15 $133.54 $35.09 $58.82 $9.70 $10.32 $108.50 $13.58 $133.54 $9.70 $9.70 $11.64 $14.45 $9.70 $10.32 $10.32 $11.25 $133.54 $141.88 $13.10 $125.19 $19.88 $13.10 $83.46 $108.50 $14.50 $14.50 $14.50 $14.50 $17.44 $10.84 $10.32 $17.44 $9.70 $9.70 $7.74 $7.74 $7.74 $7.74 $141.88 330104 87107 396 306 HC FUNGI IDENTIFICATION MOLD O $340.26 $10.32 $10.32 $9.70 $170.13 N/A N/A N/A $9.70 $19.61 $9.70 $10.32 $255.19 $11.35 $214.36 $248.73 $11.64 $9.70 $204.16 $272.21 $35.09 $58.82 $9.70 $10.32 $221.17 $13.58 $272.21 $9.70 $9.70 $11.64 $14.45 $9.70 $10.32 $10.32 $11.25 $272.21 $289.22 $13.10 $255.19 $19.88 $13.10 $170.13 $221.17 $14.50 $14.50 $14.50 $14.50 $17.44 $10.84 $10.32 $17.44 $9.70 $9.70 $7.74 $7.74 $7.74 $7.74 $289.22 330104 87110 396 306 HC CHLAMYDIA CULTURE O $142.31 $19.60 $19.60 $8.15 $71.16 N/A N/A N/A $8.15 $37.24 $8.15 $19.60 $106.73 $21.56 $89.66 $104.03 $9.78 $8.15 $85.39 $113.85 $66.64 $111.72 $8.15 $19.60 $92.50 $11.41 $113.85 $8.15 $8.15 $9.78 $27.44 $8.15 $19.60 $19.60 $21.36 $113.85 $120.96 $11.00 $106.73 $16.71 $11.00 $71.16 $92.50 $27.54 $27.54 $27.54 $27.54 $33.08 $20.58 $19.60 $33.08 $8.15 $8.15 $14.70 $14.70 $14.70 $8.15 $120.96 330104 87116 396 306 HC MYCOBACTERIA CULTURE O $175.48 $10.80 $10.80 $10.80 $87.74 N/A N/A N/A $10.80 $20.52 $10.80 $10.80 $131.61 $11.88 $110.55 $128.28 $12.96 $10.80 $105.29 $140.38 $36.72 $61.56 $10.80 $10.80 $114.06 $15.12 $140.38 $10.80 $10.80 $12.96 $15.12 $10.80 $10.80 $10.80 $11.77 $140.38 $149.16 $14.58 $131.61 $22.14 $14.58 $87.74 $114.06 $15.17 $15.17 $15.17 $15.17 $18.25 $11.34 $10.80 $18.25 $10.80 $10.80 $8.10 $8.10 $8.10 $8.10 $149.16 330104 87140 396 306 HC CULTURE TYPING IMMUNOFLUORESCENT EACH ANTISERUM O $88.81 $5.57 $5.57 N/A $44.41 N/A N/A N/A N/A $10.58 N/A $5.57 $66.61 $6.13 $55.95 $64.92 N/A N/A $53.29 $71.05 $18.94 $31.75 N/A $5.57 $57.73 N/A $71.05 N/A N/A N/A $7.80 N/A $5.57 $5.57 $6.07 $71.05 $75.49 N/A $66.61 N/A N/A $44.41 $57.73 $7.83 $7.83 $7.83 $7.83 $9.41 $5.85 $5.57 $9.41 N/A N/A $4.18 $4.18 $4.18 $4.18 $75.49 330104 87153 388 306 HC DNA/RNA SEQUENCING O "$1,145.97 " $115.36 $115.36 $61.77 $572.99 N/A N/A N/A $61.77 $219.18 $61.77 $115.36 $859.48 $126.90 $721.96 $837.70 $74.12 $61.77 $687.58 $916.78 $392.22 $657.55 $61.77 $115.36 $744.88 $86.47 $916.78 $61.77 $61.77 $74.12 $161.50 $61.77 $115.36 $115.36 $125.74 $916.78 $974.07 $83.38 $859.48 $126.62 $83.38 $572.99 $744.88 $162.08 $162.08 $162.08 $162.08 $194.80 $121.13 $115.36 $194.80 $61.77 $61.77 $86.52 $86.52 $86.52 $61.77 $974.07 330104 87015 396 306 HC SPECIMEN INFECT AGNT CONCNTJ O $111.28 $6.68 $6.68 $3.25 $55.64 N/A N/A N/A $3.25 $12.69 $3.25 $6.68 $83.46 $7.35 $70.11 $81.35 $3.90 $3.25 $66.77 $89.02 $22.71 $38.08 $3.25 $6.68 $72.33 $4.55 $89.02 $3.25 $3.25 $3.90 $9.35 $3.25 $6.68 $6.68 $7.28 $89.02 $94.59 $4.39 $83.46 $6.66 $4.39 $55.64 $72.33 $9.39 $9.39 $9.39 $9.39 $11.28 $7.01 $6.68 $11.28 $3.25 $3.25 $5.01 $5.01 $5.01 $3.25 $94.59 330104 87337 396 306 HC IAAD IA ENTAMOEBA HISTOLYTICA GRP O $418.37 $11.98 $11.98 $8.03 $209.19 N/A N/A N/A $8.03 $22.76 $8.03 $11.98 $313.78 $13.18 $263.57 $305.83 $9.64 $8.03 $251.02 $334.70 $40.73 $68.29 $8.03 $11.98 $271.94 $11.24 $334.70 $8.03 $8.03 $9.64 $16.77 $8.03 $11.98 $11.98 $13.06 $334.70 $355.61 $10.84 $313.78 $16.46 $10.84 $209.19 $271.94 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $8.03 $8.03 $8.98 $8.98 $8.98 $8.03 $355.61 330104 87340 396 306 HC HEPATITIS B SURFACE AG EIA O $296.39 $10.33 $10.33 $10.33 $148.19 N/A N/A N/A $10.33 $19.63 $10.33 $10.33 $222.29 $11.36 $186.73 $216.66 $12.40 $10.33 $177.83 $237.11 $35.12 $58.88 $10.33 $10.33 $192.65 $14.46 $237.11 $10.33 $10.33 $12.40 $14.46 $10.33 $10.33 $10.33 $11.26 $237.11 $251.93 $13.95 $222.29 $21.18 $13.95 $148.19 $192.65 $14.51 $14.51 $14.51 $14.51 $17.44 $10.85 $10.33 $17.44 $10.33 $10.33 $7.75 $7.75 $7.75 $7.75 $251.93 330104 87590 396 306 HC N.GONORRHOEAE DNA DIR PROB O $316.72 $26.88 $26.88 $8.03 $158.36 N/A N/A N/A $8.03 $51.07 $8.03 $26.88 $237.54 $29.57 $199.53 $231.52 $9.64 $8.03 $190.03 $253.38 $91.39 $153.22 $8.03 $26.88 $205.87 $11.24 $253.38 $8.03 $8.03 $9.64 $37.63 $8.03 $26.88 $26.88 $29.30 $253.38 $269.21 $10.84 $237.54 $16.46 $10.84 $158.36 $205.87 $37.77 $37.77 $37.77 $37.77 $33.86 $28.22 $26.88 $33.86 $8.03 $8.03 $20.16 $20.16 $20.16 $8.03 $269.21 330104 87591 397 306 HC N.GONORRHOEAE DNA AMP PROB O $466.52 $35.09 $35.09 $21.43 $233.26 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $349.89 $38.60 $293.91 $341.03 $25.72 $21.43 $279.91 $373.22 $119.31 $200.01 $21.43 $35.09 $303.24 $30.00 $373.22 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $373.22 $396.54 $28.93 $349.89 $43.93 $28.93 $233.26 $303.24 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $396.54 330104 87623 397 306 HC HPV LOW-RISK TYPES O $552.12 $35.09 $35.09 $27.85 $276.06 N/A N/A N/A $27.85 $66.67 $27.85 $35.09 $414.09 $38.60 $347.84 $403.60 $33.42 $27.85 $331.27 $441.70 $119.31 $200.01 $27.85 $35.09 $358.88 $38.99 $441.70 $27.85 $27.85 $33.42 $49.13 $27.85 $35.09 $35.09 $38.25 $441.70 $469.30 $37.60 $414.09 $57.09 $37.60 $276.06 $358.88 $49.30 $49.30 $49.30 $49.30 $57.31 $36.84 $35.09 $57.31 $27.85 $27.85 $26.32 $26.32 $26.32 $26.32 $469.30 330104 87624 397 306 HC HPV HIGH-RISK TYPES O $273.92 $35.09 $35.09 $27.85 $136.96 N/A N/A N/A $27.85 $66.67 $27.85 $35.09 $205.44 $38.60 $172.57 $200.24 $33.42 $27.85 $164.35 $219.14 $119.31 $200.01 $27.85 $35.09 $178.05 $38.99 $219.14 $27.85 $27.85 $33.42 $49.13 $27.85 $35.09 $35.09 $38.25 $219.14 $232.83 $37.60 $205.44 $57.09 $37.60 $136.96 $178.05 $49.30 $49.30 $49.30 $49.30 $57.31 $36.84 $35.09 $57.31 $27.85 $27.85 $26.32 $26.32 $26.32 $26.32 $232.83 330104 87625 397 306 HC HPV TYPES 16 & 18 ONLY O $155.15 $40.55 $40.55 $27.85 $77.58 N/A N/A N/A $27.85 $77.04 $27.85 $40.55 $116.36 $44.61 $97.74 $113.41 $33.42 $27.85 $93.09 $124.12 $137.87 $231.13 $27.85 $40.55 $100.85 $38.99 $124.12 $27.85 $27.85 $33.42 $56.77 $27.85 $40.55 $40.55 $44.20 $124.12 $131.88 $37.60 $116.36 $57.09 $37.60 $77.58 $100.85 $56.97 $56.97 $56.97 $56.97 $57.31 $42.58 $40.55 $57.31 $27.85 $27.85 $30.41 $30.41 $30.41 $27.85 $231.13 330104 87631 388 306 HC RESP VIRUS 3-5 TARGETS O $393.76 $142.63 $142.63 $96.31 $196.88 N/A N/A N/A $96.31 $271.00 $96.31 $142.63 $295.32 $156.89 $248.07 $287.84 $115.57 $96.31 $236.26 $315.01 $484.94 $812.99 $96.31 $142.63 $255.94 $134.83 $315.01 $96.31 $96.31 $115.57 $199.68 $96.31 $142.63 $142.63 $155.47 $315.01 $334.70 $130.02 $295.32 $197.44 $130.02 $196.88 $255.94 $200.40 $200.40 $200.40 $200.40 $211.61 $149.76 $142.63 $211.61 $96.31 $96.31 $106.97 $106.97 $106.97 $96.31 $812.99 330104 87635 397 306 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ O $189.39 $51.31 $51.31 $51.31 $94.69 N/A N/A N/A $51.31 $97.49 $51.31 $51.31 $142.04 $56.44 $119.32 $138.44 $61.57 $51.31 $113.63 $151.51 $174.45 $292.47 $51.31 $51.31 $123.10 $71.83 $151.51 $51.31 $51.31 $61.57 $71.83 $51.31 $51.31 $51.31 $55.93 $151.51 $160.98 $69.27 $142.04 $105.19 $69.27 $94.69 $123.10 $72.09 $72.09 $72.09 $72.09 N/A $53.88 $51.31 $126.32 $51.31 $51.31 $38.48 $38.48 $38.48 $38.48 $292.47 330104 87661 397 306 HB TRICHOMONAS VAGINALIS AMPLIF O $149.80 $35.09 $35.09 $21.43 $74.90 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $112.35 $38.60 $94.37 $109.50 $25.72 $21.43 $89.88 $119.84 $119.31 $200.01 $21.43 $35.09 $97.37 $30.00 $119.84 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $119.84 $127.33 $28.93 $112.35 $43.93 $28.93 $74.90 $97.37 $49.30 $49.30 $49.30 $49.30 $57.44 $36.84 $35.09 $57.44 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $200.01 330104 87798 397 306 HC DETECT AGENT NOS DNA AMP O "$1,101.03 " $35.09 $35.09 N/A $550.51 N/A N/A N/A N/A $66.67 N/A $35.09 $825.77 $38.60 $693.65 $804.85 N/A N/A $660.62 $880.82 $119.31 $200.01 N/A $35.09 $715.67 N/A $880.82 N/A N/A N/A $49.13 N/A $35.09 $35.09 $38.25 $880.82 $935.88 N/A $825.77 N/A N/A $550.51 $715.67 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 N/A N/A $26.32 $26.32 $26.32 $26.32 $935.88 330104 87799 397 306 HC DETECT AGENT NOS DNA QUANT O $836.74 $42.84 $42.84 N/A $418.37 N/A N/A N/A N/A $81.40 N/A $42.84 $627.56 $47.12 $527.15 $611.66 N/A N/A $502.04 $669.39 $145.66 $244.19 N/A $42.84 $543.88 N/A $669.39 N/A N/A N/A $59.98 N/A $42.84 $42.84 $46.70 $669.39 $711.23 N/A $627.56 N/A N/A $418.37 $543.88 $60.19 $60.19 $60.19 $60.19 $72.34 $44.98 $42.84 $72.34 N/A N/A $32.13 $32.13 $32.13 $32.13 $711.23 330104 87801 397 306 HC DETECT AGNT MULT DNA AMPLI O $812.13 $70.20 $70.20 $40.00 $406.06 N/A N/A N/A $40.00 $133.38 $40.00 $70.20 $609.10 $77.22 $511.64 $593.67 $48.00 $40.00 $487.28 $649.70 $238.68 $400.14 $40.00 $70.20 $527.88 $56.00 $649.70 $40.00 $40.00 $48.00 $98.28 $40.00 $70.20 $70.20 $76.52 $649.70 $690.31 $54.00 $609.10 $82.00 $54.00 $406.06 $527.88 $98.63 $98.63 $98.63 $98.63 $118.54 $73.71 $70.20 $118.54 $40.00 $40.00 $52.65 $52.65 $52.65 $40.00 $690.31 330104 87811 396 306 HC IAADIADOO SEVERE AQT RESPIR SYND CORONAVIRUS O $169.06 $41.38 $41.38 $41.38 $84.53 N/A N/A N/A $41.38 $78.62 $41.38 $41.38 $126.80 $45.52 $106.51 $123.58 $49.66 $41.38 $101.44 $135.25 $140.69 $235.87 $41.38 $41.38 $109.89 $57.93 $135.25 $41.38 $41.38 $49.66 $57.93 $41.38 $41.38 $41.38 $45.10 $135.25 $143.70 $55.86 $126.80 $84.83 $55.86 $84.53 $109.89 $58.14 $58.14 $58.14 $58.14 N/A $43.45 $41.38 $112.76 $41.38 $41.38 $31.04 $31.04 $31.04 $31.04 $235.87 330104 87880 396 306 HC STREP A ASSAY W/OPTIC O $185.11 $16.53 $16.53 $3.75 $92.56 N/A N/A N/A $3.75 $31.41 $3.75 $16.53 $138.83 $18.18 $116.62 $135.32 $4.50 $3.75 $111.07 $148.09 $56.20 $94.22 $3.75 $16.53 $120.32 $5.25 $148.09 $3.75 $3.75 $4.50 $23.14 $3.75 $16.53 $16.53 $18.02 $148.09 $157.34 $5.06 $138.83 $7.69 $5.06 $92.56 $120.32 $23.22 $23.22 $23.22 $23.22 $20.26 $17.36 $16.53 $20.26 $3.75 $3.75 $12.40 $12.40 $12.40 $3.75 $157.34 330104 87899 396 306 HC AGENT NOS ASSAY W/OPTIC O $418.37 $16.07 $16.07 $8.03 $209.19 N/A N/A N/A $8.03 $30.53 $8.03 $16.07 $313.78 $17.68 $263.57 $305.83 $9.64 $8.03 $251.02 $334.70 $54.64 $91.60 $8.03 $16.07 $271.94 $11.24 $334.70 $8.03 $8.03 $9.64 $22.50 $8.03 $16.07 $16.07 $17.52 $334.70 $355.61 $10.84 $313.78 $16.46 $10.84 $209.19 $271.94 $22.58 $22.58 $22.58 $22.58 $20.26 $16.87 $16.07 $20.26 $8.03 $8.03 $12.05 $12.05 $12.05 $8.03 $355.61 330104 87902 386 306 HC GENOTYPE DNA/RNA HEP C O "$4,603.14 " $257.45 $257.45 $257.45 "$2,301.57 " N/A N/A N/A $257.45 $489.15 $257.45 $257.45 "$3,452.36 " $283.19 "$2,899.98 " "$3,364.90 " $308.94 $257.45 "$2,761.88 " "$3,682.51 " $875.33 "$1,467.46 " $257.45 $257.45 "$2,992.04 " $360.43 "$3,682.51 " $257.45 $257.45 $308.94 $360.43 $257.45 $257.45 $257.45 $280.62 "$3,682.51 " "$3,912.67 " $347.56 "$3,452.36 " $527.77 $347.56 "$2,301.57 " "$2,992.04 " $361.72 $361.72 $361.72 $361.72 $434.74 $270.32 $257.45 $434.74 $257.45 $257.45 $193.09 $193.09 $193.09 $193.09 "$3,912.67 " 330104 87563 397 306 HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH O $133.75 $35.09 $35.09 $21.43 $66.88 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $100.31 $38.60 $84.26 $97.77 $25.72 $21.43 $80.25 $107.00 $119.31 $200.01 $21.43 $35.09 $86.94 $30.00 $107.00 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $107.00 $113.69 $28.93 $100.31 $43.93 $28.93 $66.88 $86.94 $49.30 $49.30 $49.30 $49.30 $42.11 $36.84 $35.09 $42.11 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $200.01 330104 87338 396 306 HC HPYLORI STOOL EIA O $227.91 $14.38 $14.38 $8.03 $113.95 N/A N/A N/A $8.03 $27.32 $8.03 $14.38 $170.93 $15.82 $143.58 $166.60 $9.64 $8.03 $136.75 $182.33 $48.89 $81.97 $8.03 $14.38 $148.14 $11.24 $182.33 $8.03 $8.03 $9.64 $20.13 $8.03 $14.38 $14.38 $15.67 $182.33 $193.72 $10.84 $170.93 $16.46 $10.84 $113.95 $148.14 $20.20 $20.20 $20.20 $20.20 $24.29 $15.10 $14.38 $24.29 $8.03 $8.03 $10.79 $10.79 $10.79 $8.03 $193.72 330104 87556 397 306 HC M.TUBERCULO DNA AMP PROBE O $659.12 $41.68 $41.68 $41.68 $329.56 N/A N/A N/A $41.68 $79.19 $41.68 $41.68 $494.34 $45.85 $415.25 $481.82 $50.02 $41.68 $395.47 $527.30 $141.71 $237.58 $41.68 $41.68 $428.43 $58.35 $527.30 $41.68 $41.68 $50.02 $58.35 $41.68 $41.68 $41.68 $45.43 $527.30 $560.25 $56.27 $494.34 $85.44 $56.27 $329.56 $428.43 $58.56 $58.56 $58.56 $58.56 $59.27 $43.76 $41.68 $59.27 $41.68 $41.68 $31.26 $31.26 $31.26 $31.26 $560.25 330104 87529 397 306 HC HSV DNA AMP PROBE O $169.06 $35.09 $35.09 $32.15 $84.53 N/A N/A N/A $32.15 $66.67 $32.15 $35.09 $126.80 $38.60 $106.51 $123.58 $38.58 $32.15 $101.44 $135.25 $119.31 $200.01 $32.15 $35.09 $109.89 $45.01 $135.25 $32.15 $32.15 $38.58 $49.13 $32.15 $35.09 $35.09 $38.25 $135.25 $143.70 $43.40 $126.80 $65.91 $43.40 $84.53 $109.89 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $32.15 $32.15 $26.32 $26.32 $26.32 $26.32 $200.01 330104 87341 396 306 HC HEPATITIS B SURFACE AG EIA NEUTRALIZATION O $124.12 $10.33 $10.33 $10.33 $62.06 N/A N/A N/A $10.33 $19.63 $10.33 $10.33 $93.09 $11.36 $78.20 $90.73 $12.40 $10.33 $74.47 $99.30 $35.12 $58.88 $10.33 $10.33 $80.68 $14.46 $99.30 $10.33 $10.33 $12.40 $14.46 $10.33 $10.33 $10.33 $11.26 $99.30 $105.50 $13.95 $93.09 $21.18 $13.95 $62.06 $80.68 $14.51 $14.51 $14.51 $14.51 $17.44 $10.85 $10.33 $17.44 $10.33 $10.33 $7.75 $7.75 $7.75 $7.75 $105.50 330104 87350 396 306 HC HEPATITIS BE AG EIA O $548.91 $11.53 $11.53 $10.10 $274.45 N/A N/A N/A $10.10 $21.91 $10.10 $11.53 $411.68 $12.68 $345.81 $401.25 $12.12 $10.10 $329.35 $439.13 $39.20 $65.72 $10.10 $11.53 $356.79 $14.14 $439.13 $10.10 $10.10 $12.12 $16.14 $10.10 $11.53 $11.53 $12.57 $439.13 $466.57 $13.63 $411.68 $20.70 $13.63 $274.45 $356.79 $16.20 $16.20 $16.20 $16.20 $19.46 $12.11 $11.53 $19.46 $10.10 $10.10 $8.65 $8.65 $8.65 $8.65 $466.57 330104 87385 396 306 HC HISTOPLASMA CAPSUL AG EIA O $146.59 $13.25 $13.25 $12.41 $73.30 N/A N/A N/A $12.41 $25.17 $12.41 $13.25 $109.94 $14.58 $92.35 $107.16 $14.89 $12.41 $87.95 $117.27 $45.05 $75.53 $12.41 $13.25 $95.28 $17.37 $117.27 $12.41 $12.41 $14.89 $18.55 $12.41 $13.25 $13.25 $14.44 $117.27 $124.60 $16.75 $109.94 $25.44 $16.75 $73.30 $95.28 $18.62 $18.62 $18.62 $18.62 $20.26 $13.91 $13.25 $20.26 $12.41 $12.41 $9.94 $9.94 $9.94 $9.94 $124.60 330104 87425 396 306 HC ROTAVIRUS AG EIA O $185.11 $11.98 $11.98 $11.98 $92.56 N/A N/A N/A $11.98 $22.76 $11.98 $11.98 $138.83 $13.18 $116.62 $135.32 $14.38 $11.98 $111.07 $148.09 $40.73 $68.29 $11.98 $11.98 $120.32 $16.77 $148.09 $11.98 $11.98 $14.38 $16.77 $11.98 $11.98 $11.98 $13.06 $148.09 $157.34 $16.17 $138.83 $24.56 $16.17 $92.56 $120.32 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $11.98 $11.98 $8.98 $8.98 $8.98 $8.98 $157.34 330104 87427 396 306 HC SHIGA-LIKE TOXIN AG EIA O $134.82 $11.98 $11.98 $11.98 $67.41 N/A N/A N/A $11.98 $22.76 $11.98 $11.98 $101.11 $13.18 $84.94 $98.55 $14.38 $11.98 $80.89 $107.86 $40.73 $68.29 $11.98 $11.98 $87.63 $16.77 $107.86 $11.98 $11.98 $14.38 $16.77 $11.98 $11.98 $11.98 $13.06 $107.86 $114.60 $16.17 $101.11 $24.56 $16.17 $67.41 $87.63 $16.83 $16.83 $16.83 $16.83 $20.26 $12.58 $11.98 $20.26 $11.98 $11.98 $8.98 $8.98 $8.98 $8.98 $114.60 330104 87471 397 306 HC BARTONELLA DNA AMP PROBE O $435.49 $35.09 $35.09 N/A $217.75 N/A N/A N/A N/A $66.67 N/A $35.09 $326.62 $38.60 $274.36 $318.34 N/A N/A $261.29 $348.39 $119.31 $200.01 N/A $35.09 $283.07 N/A $348.39 N/A N/A N/A $49.13 N/A $35.09 $35.09 $38.25 $348.39 $370.17 N/A $326.62 N/A N/A $217.75 $283.07 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 N/A N/A $26.32 $26.32 $26.32 $26.32 $370.17 330104 87476 397 306 HC LYME DIS DNA AMP PROBE O $861.35 $35.09 $35.09 $21.43 $430.68 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $646.01 $38.60 $542.65 $629.65 $25.72 $21.43 $516.81 $689.08 $119.31 $200.01 $21.43 $35.09 $559.88 $30.00 $689.08 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $689.08 $732.15 $28.93 $646.01 $43.93 $28.93 $430.68 $559.88 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $732.15 330104 87481 397 306 HC CANDIDA DNA AMP PROBE O $117.70 $35.09 $35.09 N/A $58.85 N/A N/A N/A N/A $66.67 N/A $35.09 $88.28 $38.60 $74.15 $86.04 N/A N/A $70.62 $94.16 $119.31 $200.01 N/A $35.09 $76.51 N/A $94.16 N/A N/A N/A $49.13 N/A $35.09 $35.09 $38.25 $94.16 $100.05 N/A $88.28 N/A N/A $58.85 $76.51 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 N/A N/A $26.32 $26.32 $26.32 $26.32 $200.01 330104 87490 396 306 HC CHYLMD TRACH DNA DIR PROBE O $316.72 $22.75 $22.75 $8.03 $158.36 N/A N/A N/A $8.03 $43.23 $8.03 $22.75 $237.54 $25.03 $199.53 $231.52 $9.64 $8.03 $190.03 $253.38 $77.35 $129.68 $8.03 $22.75 $205.87 $11.24 $253.38 $8.03 $8.03 $9.64 $31.85 $8.03 $22.75 $22.75 $24.80 $253.38 $269.21 $10.84 $237.54 $16.46 $10.84 $158.36 $205.87 $31.96 $31.96 $31.96 $31.96 $33.86 $23.89 $22.75 $33.86 $8.03 $8.03 $17.06 $17.06 $17.06 $8.03 $269.21 330104 87491 397 306 HC CHYLMD TRACH DNA AMP PROBE O $466.52 $35.09 $35.09 $21.43 $233.26 N/A N/A N/A $21.43 $66.67 $21.43 $35.09 $349.89 $38.60 $293.91 $341.03 $25.72 $21.43 $279.91 $373.22 $119.31 $200.01 $21.43 $35.09 $303.24 $30.00 $373.22 $21.43 $21.43 $25.72 $49.13 $21.43 $35.09 $35.09 $38.25 $373.22 $396.54 $28.93 $349.89 $43.93 $28.93 $233.26 $303.24 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $21.43 $21.43 $26.32 $26.32 $26.32 $21.43 $396.54 330104 87493 397 306 HC C DIFF AMPLIFIED PROBE O $419.44 $37.27 $37.27 N/A $209.72 N/A N/A N/A N/A $70.81 N/A $37.27 $314.58 $41.00 $264.25 $306.61 N/A N/A $251.66 $335.55 $126.72 $212.44 N/A $37.27 $272.64 N/A $335.55 N/A N/A N/A $52.18 N/A $37.27 $37.27 $40.62 $335.55 $356.52 N/A $314.58 N/A N/A $209.72 $272.64 $52.36 $52.36 $52.36 $52.36 $59.27 $39.13 $37.27 $59.27 N/A N/A $27.95 $27.95 $27.95 $27.95 $356.52 330104 87496 397 306 HC CYTOMEG DNA AMP PROBE O $263.22 $35.09 $35.09 $23.39 $131.61 N/A N/A N/A $23.39 $66.67 $23.39 $35.09 $197.42 $38.60 $165.83 $192.41 $28.07 $23.39 $157.93 $210.58 $119.31 $200.01 $23.39 $35.09 $171.09 $32.75 $210.58 $23.39 $23.39 $28.07 $49.13 $23.39 $35.09 $35.09 $38.25 $210.58 $223.74 $31.58 $197.42 $47.95 $31.58 $131.61 $171.09 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $23.39 $23.39 $26.32 $26.32 $26.32 $23.39 $223.74 330104 87497 397 306 HC CYTOMEG DNA QUANT O $625.95 $42.84 $42.84 $28.56 $312.98 N/A N/A N/A $28.56 $81.40 $28.56 $42.84 $469.46 $47.12 $394.35 $457.57 $34.27 $28.56 $375.57 $500.76 $145.66 $244.19 $28.56 $42.84 $406.87 $39.98 $500.76 $28.56 $28.56 $34.27 $59.98 $28.56 $42.84 $42.84 $46.70 $500.76 $532.06 $38.56 $469.46 $58.55 $38.56 $312.98 $406.87 $60.19 $60.19 $60.19 $60.19 $72.34 $44.98 $42.84 $72.34 $28.56 $28.56 $32.13 $32.13 $32.13 $28.56 $532.06 330104 87517 397 306 HC HEPATITIS B DNA QUANT O $671.96 $42.84 $42.84 N/A $335.98 N/A N/A N/A N/A $81.40 N/A $42.84 $503.97 $47.12 $423.33 $491.20 N/A N/A $403.18 $537.57 $145.66 $244.19 N/A $42.84 $436.77 N/A $537.57 N/A N/A N/A $59.98 N/A $42.84 $42.84 $46.70 $537.57 $571.17 N/A $503.97 N/A N/A $335.98 $436.77 $60.19 $60.19 $60.19 $60.19 $72.34 $44.98 $42.84 $72.34 N/A N/A $32.13 $32.13 $32.13 $32.13 $571.17 330104 87522 397 306 HC HEPATITIS C REVRS TRNSCRPJ O "$1,258.32 " $42.84 $42.84 $42.84 $629.16 N/A N/A N/A $42.84 $81.40 $42.84 $42.84 $943.74 $47.12 $792.74 $919.83 $51.41 $42.84 $754.99 "$1,006.66 " $145.66 $244.19 $42.84 $42.84 $817.91 $59.98 "$1,006.66 " $42.84 $42.84 $51.41 $59.98 $42.84 $42.84 $42.84 $46.70 "$1,006.66 " "$1,069.57 " $57.83 $943.74 $87.82 $57.83 $629.16 $817.91 $60.19 $60.19 $60.19 $60.19 $72.34 $44.98 $42.84 $72.34 $42.84 $42.84 $32.13 $32.13 $32.13 $32.13 "$1,069.57 " 330104 87536 397 306 HC HIV-1 QUANT&REVRSE TRNSCRPJ O "$1,319.31 " $85.10 $85.10 $85.10 $659.65 N/A N/A N/A $85.10 $161.69 $85.10 $85.10 $989.48 $93.61 $831.17 $964.42 $102.12 $85.10 $791.59 "$1,055.45 " $289.34 $485.07 $85.10 $85.10 $857.55 $119.14 "$1,055.45 " $85.10 $85.10 $102.12 $119.14 $85.10 $85.10 $85.10 $92.76 "$1,055.45 " "$1,121.41 " $114.89 $989.48 $174.45 $114.89 $659.65 $857.55 $119.57 $119.57 $119.57 $119.57 $143.70 $89.36 $85.10 $143.70 $85.10 $85.10 $63.82 $63.82 $63.82 $63.82 "$1,121.41 " 330104 87521 397 306 HC HEPATITIS C PROBE&RVRS TRNSC O $449.40 $35.09 $35.09 $35.09 $224.70 N/A N/A N/A $35.09 $66.67 $35.09 $35.09 $337.05 $38.60 $283.12 $328.51 $42.11 $35.09 $269.64 $359.52 $119.31 $200.01 $35.09 $35.09 $292.11 $49.13 $359.52 $35.09 $35.09 $42.11 $49.13 $35.09 $35.09 $35.09 $38.25 $359.52 $381.99 $47.37 $337.05 $71.93 $47.37 $224.70 $292.11 $49.30 $49.30 $49.30 $49.30 $59.27 $36.84 $35.09 $59.27 $35.09 $35.09 $26.32 $26.32 $26.32 $26.32 $381.99 330104 87046 396 306 HC STOOL CULTR AEROBIC BACT EA O $306.02 $9.44 $9.44 $2.95 $153.01 N/A N/A N/A $2.95 $17.94 $2.95 $9.44 $229.51 $10.38 $192.79 $223.70 $3.54 $2.95 $183.61 $244.82 $32.10 $53.81 $2.95 $9.44 $198.91 $4.13 $244.82 $2.95 $2.95 $3.54 $13.22 $2.95 $9.44 $9.44 $10.29 $244.82 $260.12 $3.98 $229.51 $6.05 $3.98 $153.01 $198.91 $13.26 $13.26 $13.26 $13.26 $15.94 $9.91 $9.44 $15.94 $2.95 $2.95 $7.08 $7.08 $7.08 $2.95 $260.12 330104 87635 397 306 HC IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ- CEPHEID O $202.23 $51.31 $51.31 $51.31 $101.11 N/A N/A N/A $51.31 $97.49 $51.31 $51.31 $151.67 $56.44 $127.40 $147.83 $61.57 $51.31 $121.34 $161.78 $174.45 $292.47 $51.31 $51.31 $131.45 $71.83 $161.78 $51.31 $51.31 $61.57 $71.83 $51.31 $51.31 $51.31 $55.93 $161.78 $171.90 $69.27 $151.67 $105.19 $69.27 $101.11 $131.45 $72.09 $72.09 $72.09 $72.09 N/A $53.88 $51.31 $134.89 $51.31 $51.31 $38.48 $38.48 $38.48 $38.48 $292.47 330104 86360 395 309 HC T CELL ABSOLUTE COUNT/RATIO O $739.37 $46.98 $46.98 $46.98 $369.69 N/A N/A N/A $46.98 $89.26 $46.98 $46.98 $554.53 $51.68 $465.80 $540.48 $56.38 $46.98 $443.62 $591.50 $159.73 $267.79 $46.98 $46.98 $480.59 $65.77 $591.50 $46.98 $46.98 $56.38 $65.77 $46.98 $46.98 $46.98 $51.21 $591.50 $628.46 $63.42 $554.53 $96.31 $63.42 $369.69 $480.59 $66.01 $66.01 $66.01 $66.01 $79.34 $49.33 $46.98 $79.34 $46.98 $46.98 $35.23 $35.23 $35.23 $35.23 $628.46 330104 88237 308 310 HC TISSUE CULTURE BONE MARROW O $404.46 $143.75 $143.75 $100.03 $202.23 N/A N/A N/A $100.03 $273.12 $100.03 $143.75 $303.34 $158.12 $254.81 $295.66 $120.04 $100.03 $242.68 $323.57 $488.75 $819.38 $100.03 $143.75 $262.90 $140.04 $323.57 $100.03 $100.03 $120.04 $201.25 $100.03 $143.75 $143.75 $156.69 $323.57 $343.79 $135.04 $303.34 $205.06 $135.04 $202.23 $262.90 $201.97 $201.97 $201.97 $201.97 $213.29 $150.94 $143.75 $213.29 $100.03 $100.03 $107.81 $107.81 $107.81 $100.03 $819.38 330104 88233 308 310 HC TISSUE CULTURE SKIN/BIOPSY O $939.46 $140.73 $140.73 $131.91 $469.73 N/A N/A N/A $131.91 $267.39 $131.91 $140.73 $704.60 $154.80 $591.86 $686.75 $158.29 $131.91 $563.68 $751.57 $478.48 $802.16 $131.91 $140.73 $610.65 $184.67 $751.57 $131.91 $131.91 $158.29 $197.02 $131.91 $140.73 $140.73 $153.40 $751.57 $798.54 $178.08 $704.60 $270.42 $178.08 $469.73 $610.65 $197.73 $197.73 $197.73 $197.73 $237.65 $147.77 $140.73 $237.65 $131.91 $131.91 $105.55 $105.55 $105.55 $105.55 $802.16 330104 88230 308 310 HC TISSUE CULTURE LYMPHOCYTE O $326.35 $116.49 $116.49 $40.00 $163.18 N/A N/A N/A $40.00 $221.33 $40.00 $116.49 $244.76 $128.14 $205.60 $238.56 $48.00 $40.00 $195.81 $261.08 $396.07 $663.99 $40.00 $116.49 $212.13 $56.00 $261.08 $40.00 $40.00 $48.00 $163.09 $40.00 $116.49 $116.49 $126.97 $261.08 $277.40 $54.00 $244.76 $82.00 $54.00 $163.18 $212.13 $163.67 $163.67 $163.67 $163.67 $196.73 $122.31 $116.49 $196.73 $40.00 $40.00 $87.37 $87.37 $87.37 $40.00 $663.99 330104 88175 392 310 HC CYTOPATCER/VAGTHIN LAYERMAN RESINTER O $419.44 $26.61 $26.61 $26.61 $209.72 N/A N/A N/A $26.61 $50.56 $26.61 $26.61 $314.58 $29.27 $264.25 $306.61 $31.93 $26.61 $251.66 $335.55 $90.47 $151.68 $26.61 $26.61 $272.64 $37.25 $335.55 $26.61 $26.61 $31.93 $37.25 $26.61 $26.61 $26.61 $29.00 $335.55 $356.52 $35.92 $314.58 $54.55 $35.92 $209.72 $272.64 $37.39 $37.39 $37.39 $37.39 $44.74 $27.94 $26.61 $44.74 $26.61 $26.61 $19.96 $19.96 $19.96 $19.96 $356.52 330104 85097 5674 2044 310 HC BONE MARROW INTERPRETATION O $606.69 $931.61 $931.61 $20.22 $303.35 $68.03 $61.50 $922.29 $20.22 "$1,770.06 " $20.22 $931.61 $455.02 "$1,024.77 " $382.21 $443.49 $24.26 $20.22 $364.01 $485.35 "$3,167.47 " "$5,310.18 " $20.22 $931.61 "$1,117.93 " $28.31 $485.35 $20.22 $20.22 $24.26 "$1,304.25 " $20.22 $931.61 $931.61 "$1,015.46 " $485.35 $515.69 $20.22 $455.02 $41.45 $20.22 $303.35 "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $43.78 $978.19 $931.61 $43.78 $20.22 $20.22 $698.71 $698.71 $698.71 $20.22 "$5,310.18 " 330104 82725 400 310 HC ASSAY OF BLOOD FATTY ACIDS O $208.65 $18.77 $18.77 N/A $104.33 N/A N/A N/A N/A $35.66 N/A $18.77 $156.49 $20.65 $131.45 $152.52 N/A N/A $125.19 $166.92 $63.82 $106.99 N/A $18.77 $135.62 N/A $166.92 N/A N/A N/A $26.28 N/A $18.77 $18.77 $20.46 $166.92 $177.35 N/A $156.49 N/A N/A $104.33 $135.62 $26.37 $26.37 $26.37 $26.37 $22.49 $19.71 $18.77 $22.49 N/A N/A $14.08 $14.08 $14.08 $14.08 $177.35 330104 81554 2045 310 HC PULM DS IPF MRNA 190 GEN ALG O $169.06 "$5,520.00 " "$5,520.00 " N/A $84.53 N/A N/A N/A N/A "$10,488.00 " N/A "$5,520.00 " $126.80 "$6,072.00 " $106.51 $123.58 N/A N/A $101.44 $135.25 "$18,768.00 " "$31,464.00 " N/A "$5,520.00 " $109.89 N/A $135.25 N/A N/A N/A "$7,728.00 " N/A "$5,520.00 " "$5,520.00 " "$6,016.80 " $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 "$7,755.60 " "$7,755.60 " "$7,755.60 " "$7,755.60 " N/A "$5,796.00 " "$5,520.00 " $112.76 N/A N/A "$4,140.00 " "$4,140.00 " "$4,140.00 " $84.53 "$31,464.00 " 330104 81546 2045 310 "HC ONC THYR MRNA 10,196 GEN ALG" O $169.06 "$3,600.00 " "$3,600.00 " N/A $84.53 N/A N/A N/A N/A "$6,840.00 " N/A "$3,600.00 " $126.80 "$3,960.00 " $106.51 $123.58 N/A N/A $101.44 $135.25 "$12,240.00 " "$20,520.00 " N/A "$3,600.00 " $109.89 N/A $135.25 N/A N/A N/A "$5,040.00 " N/A "$3,600.00 " "$3,600.00 " "$3,924.00 " $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 "$5,058.00 " "$5,058.00 " "$5,058.00 " "$5,058.00 " N/A "$3,780.00 " "$3,600.00 " $112.76 N/A N/A "$2,700.00 " "$2,700.00 " "$2,700.00 " $84.53 "$20,520.00 " 330104 81529 2045 310 HC ONC CUTAN MLNMA MRNA 31 GENE O $169.06 "$7,193.00 " "$7,193.00 " N/A $84.53 N/A N/A N/A N/A "$13,666.70 " N/A "$7,193.00 " $126.80 "$7,912.30 " $106.51 $123.58 N/A N/A $101.44 $135.25 "$24,456.20 " "$41,000.10 " N/A "$7,193.00 " $109.89 N/A $135.25 N/A N/A N/A "$10,070.20 " N/A "$7,193.00 " "$7,193.00 " "$7,840.37 " $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 "$10,106.17 " "$10,106.17 " "$10,106.17 " "$10,106.17 " N/A "$7,552.65 " "$7,193.00 " $112.76 N/A N/A "$5,394.75 " "$5,394.75 " "$5,394.75 " $84.53 "$41,000.10 " 330104 81514 386 310 HC NFCT DS BV&VAGINITIS DNA ALG O $169.06 $262.99 $262.99 N/A $84.53 N/A N/A N/A N/A $499.68 N/A $262.99 $126.80 $289.29 $106.51 $123.58 N/A N/A $101.44 $135.25 $894.17 "$1,499.04 " N/A $262.99 $109.89 N/A $135.25 N/A N/A N/A $368.19 N/A $262.99 $262.99 $286.66 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $369.50 $369.50 $369.50 $369.50 N/A $276.14 $262.99 $112.76 N/A N/A $197.24 $197.24 $197.24 $84.53 "$1,499.04 " 330104 81513 386 310 HC NFCT DS BV RNA VAG FLU ALG O $169.06 $142.63 $142.63 N/A $84.53 N/A N/A N/A N/A $271.00 N/A $142.63 $126.80 $156.89 $106.51 $123.58 N/A N/A $101.44 $135.25 $484.94 $812.99 N/A $142.63 $109.89 N/A $135.25 N/A N/A N/A $199.68 N/A $142.63 $142.63 $155.47 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $200.40 $200.40 $200.40 $200.40 N/A $149.76 $142.63 $112.76 N/A N/A $106.97 $106.97 $106.97 $84.53 $812.99 330104 81450 2044 310 HC TARGETED GENOMIC SEQ ANALYS HEMATOLYMPHO O "$3,229.26 " $759.53 $759.53 N/A "$1,614.63 " N/A N/A N/A N/A "$1,443.11 " N/A $759.53 "$2,421.95 " $835.48 "$2,034.43 " "$2,360.59 " N/A N/A "$1,937.56 " "$2,583.41 " "$2,582.40 " "$4,329.32 " N/A $759.53 "$2,099.02 " N/A "$2,583.41 " N/A N/A N/A "$1,063.34 " N/A $759.53 $759.53 $827.89 "$2,583.41 " "$2,744.87 " N/A "$2,421.95 " N/A N/A "$1,614.63 " "$2,099.02 " "$1,067.14 " "$1,067.14 " "$1,067.14 " "$1,067.14 " $107.80 $797.51 $759.53 $107.80 N/A N/A $569.65 $569.65 $569.65 $107.80 "$4,329.32 " 330104 81419 2045 310 HC EPILEPSY GEN SEQ ALYS PANEL O $169.06 "$2,448.56 " "$2,448.56 " N/A $84.53 N/A N/A N/A N/A "$4,652.26 " N/A "$2,448.56 " $126.80 "$2,693.42 " $106.51 $123.58 N/A N/A $101.44 $135.25 "$8,325.10 " "$13,956.79 " N/A "$2,448.56 " $109.89 N/A $135.25 N/A N/A N/A "$3,427.98 " N/A "$2,448.56 " "$2,448.56 " "$2,668.93 " $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 "$3,440.23 " "$3,440.23 " "$3,440.23 " "$3,440.23 " N/A "$2,570.99 " "$2,448.56 " $112.76 N/A N/A "$1,836.42 " "$1,836.42 " "$1,836.42 " $84.53 "$13,956.79 " 330104 81404 386 310 HC MOPATH PROCEDURE LEVEL 5 O $177.62 $274.83 $274.83 N/A $88.81 N/A N/A N/A N/A $522.18 N/A $274.83 $133.22 $302.31 $111.90 $129.84 N/A N/A $106.57 $142.10 $934.42 "$1,566.53 " N/A $274.83 $115.45 N/A $142.10 N/A N/A N/A $384.76 N/A $274.83 $274.83 $299.56 $142.10 $150.98 N/A $133.22 N/A N/A $88.81 $115.45 $386.14 $386.14 $386.14 $386.14 $329.80 $288.57 $274.83 $329.80 N/A N/A $206.12 $206.12 $206.12 $88.81 "$1,566.53 " 330104 81206 386 310 HC BCR/ABL1 GENE MAJOR BP O $524.30 $163.96 $163.96 $163.96 $262.15 N/A N/A N/A $163.96 $311.52 $163.96 $163.96 $393.22 $180.36 $330.31 $383.26 $196.75 $163.96 $314.58 $419.44 $557.46 $934.57 $163.96 $163.96 $340.79 $229.54 $419.44 $163.96 $163.96 $196.75 $229.54 $163.96 $163.96 $163.96 $178.72 $419.44 $445.65 $221.35 $393.22 $336.12 $221.35 $262.15 $340.79 $230.36 $230.36 $230.36 $230.36 $268.43 $172.16 $163.96 $268.43 $163.96 $163.96 $122.97 $122.97 $122.97 $122.97 $934.57 330104 81403 386 310 HC MOPATH PROCEDURE LEVEL 4 O $177.62 $185.20 $185.20 N/A $88.81 N/A N/A N/A N/A $351.88 N/A $185.20 $133.22 $203.72 $111.90 $129.84 N/A N/A $106.57 $142.10 $629.68 "$1,055.64 " N/A $185.20 $115.45 N/A $142.10 N/A N/A N/A $259.28 N/A $185.20 $185.20 $201.87 $142.10 $150.98 N/A $133.22 N/A N/A $88.81 $115.45 $260.21 $260.21 $260.21 $260.21 $222.24 $194.46 $185.20 $222.24 N/A N/A $138.90 $138.90 $138.90 $88.81 "$1,055.64 " 330104 81402 386 310 HC MOPATH PROCEDURE LEVEL 3 O $642.00 $150.33 $150.33 N/A $321.00 N/A N/A N/A N/A $285.63 N/A $150.33 $481.50 $165.36 $404.46 $469.30 N/A N/A $385.20 $513.60 $511.12 $856.88 N/A $150.33 $417.30 N/A $513.60 N/A N/A N/A $210.46 N/A $150.33 $150.33 $163.86 $513.60 $545.70 N/A $481.50 N/A N/A $321.00 $417.30 $211.21 $211.21 $211.21 $211.21 $180.40 $157.85 $150.33 $180.40 N/A N/A $112.75 $112.75 $112.75 $112.75 $856.88 330104 88264 386 310 HC CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS O "$1,951.68 " $144.61 $144.61 N/A $975.84 N/A N/A N/A N/A $274.76 N/A $144.61 "$1,463.76 " $159.07 "$1,229.56 " "$1,426.68 " N/A N/A "$1,171.01 " "$1,561.34 " $491.67 $824.28 N/A $144.61 "$1,268.59 " N/A "$1,561.34 " N/A N/A N/A $202.45 N/A $144.61 $144.61 $157.62 "$1,561.34 " "$1,658.93 " N/A "$1,463.76 " N/A N/A $975.84 "$1,268.59 " $203.18 $203.18 $203.18 $203.18 $210.48 $151.84 $144.61 $210.48 N/A N/A $108.46 $108.46 $108.46 $108.46 "$1,658.93 " 330104 88267 386 310 HC CHROMOSOME ANALYS PLACENTA O $728.67 $188.57 $188.57 $90.00 $364.33 N/A N/A N/A $90.00 $358.28 $90.00 $188.57 $546.50 $207.43 $459.06 $532.66 $108.00 $90.00 $437.20 $582.94 $641.14 "$1,074.85 " $90.00 $188.57 $473.64 $126.00 $582.94 $90.00 $90.00 $108.00 $264.00 $90.00 $188.57 $188.57 $205.54 $582.94 $619.37 $121.50 $546.50 $184.50 $121.50 $364.33 $473.64 $264.94 $264.94 $264.94 $264.94 $303.58 $198.00 $188.57 $303.58 $90.00 $90.00 $141.43 $141.43 $141.43 $90.00 "$1,074.85 " 330104 81207 386 310 HC BCR/ABL1 GENE MINOR BP O $524.30 $144.84 $144.84 $144.84 $262.15 N/A N/A N/A $144.84 $275.20 $144.84 $144.84 $393.22 $159.32 $330.31 $383.26 $173.81 $144.84 $314.58 $419.44 $492.46 $825.59 $144.84 $144.84 $340.79 $202.78 $419.44 $144.84 $144.84 $173.81 $202.78 $144.84 $144.84 $144.84 $157.88 $419.44 $445.65 $195.53 $393.22 $296.92 $195.53 $262.15 $340.79 $203.50 $203.50 $203.50 $203.50 $237.11 $152.08 $144.84 $237.11 $144.84 $144.84 $108.63 $108.63 $108.63 $108.63 $825.59 330104 88300 5731 305 310 HC SURGICAL PATH GROSS LEVEL 1 O $226.84 $29.95 $29.95 $57.35 $113.42 $25.04 $22.64 $29.65 $57.35 $56.90 $57.35 $29.95 $170.13 $32.94 $142.91 $165.82 $68.82 $57.35 $136.10 $181.47 $101.81 $170.69 $57.35 $29.95 $35.93 $80.29 $181.47 $57.35 $57.35 $68.82 $41.92 $57.35 $29.95 $29.95 $32.64 $181.47 $192.81 $57.35 $170.13 $117.57 $57.35 $113.42 $80.55 $42.07 $42.07 $42.07 $42.07 $20.48 $31.44 $29.95 $20.48 $57.35 $57.35 $22.46 $22.46 $22.46 $20.48 $192.81 330104 81168 386 310 HC CCND1/IGH TRANSLOCATION ALYS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81175 2044 310 HC ASXL1 FULL GENE SEQUENCE O "$2,912.54 " $676.50 $676.50 N/A "$1,456.27 " N/A N/A N/A N/A "$1,285.35 " N/A $676.50 "$2,184.40 " $744.15 "$1,834.90 " "$2,129.07 " N/A N/A "$1,747.52 " "$2,330.03 " "$2,300.10 " "$3,856.05 " N/A $676.50 "$1,893.15 " N/A "$2,330.03 " N/A N/A N/A $947.10 N/A $676.50 $676.50 $737.39 "$2,330.03 " "$2,475.66 " N/A "$2,184.40 " N/A N/A "$1,456.27 " "$1,893.15 " $950.48 $950.48 $950.48 $950.48 $848.42 $710.33 $676.50 $848.42 N/A N/A $507.38 $507.38 $507.38 $507.38 "$3,856.05 " 330104 81191 386 310 HC NTRK1 TRANSLOCATION ANALYSIS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81192 386 310 HC NTRK2 TRANSLOCATION ANALYSIS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81193 386 310 HC NTRK3 TRANSLOCATION ANALYSIS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81194 387 310 HC NTRK TRANSLOCATION ANALYSIS O $169.06 $518.28 $518.28 $310.97 $84.53 N/A N/A N/A $310.97 $984.73 $310.97 $518.28 $126.80 $570.11 $106.51 $123.58 $373.16 $310.97 $101.44 $135.25 "$1,762.15 " "$2,954.20 " $310.97 $518.28 $109.89 $435.36 $135.25 $310.97 $310.97 $373.16 $725.59 $310.97 $518.28 $518.28 $564.93 $135.25 $143.70 $419.81 $126.80 $637.49 $419.81 $84.53 $109.89 $728.18 $728.18 $728.18 $728.18 N/A $544.19 $518.28 $112.76 $310.97 $310.97 $388.71 $388.71 $388.71 $84.53 "$2,954.20 " 330104 88323 5671 158 310 HC MICROSLIDE CONSULTATION;REQUIRING SLIDE PREP O $204.37 $60.15 $60.15 N/A $102.19 $162.36 $146.77 $59.55 N/A $114.29 N/A $60.15 $153.28 $66.17 $128.75 $149.39 N/A N/A $122.62 $163.50 $204.53 $342.88 N/A $60.15 $72.19 N/A $163.50 N/A N/A N/A $84.22 N/A $60.15 $60.15 $65.57 $163.50 $173.71 N/A $153.28 N/A N/A $102.19 $161.82 $84.52 $84.52 $84.52 $84.52 $43.78 $63.16 $60.15 $43.78 N/A N/A $45.12 $45.12 $45.12 $43.78 $342.88 330104 88319 5674 306 310 HC ENZYME HISTOCHEMISTRY O "$2,895.42 " $931.61 $931.61 $35.19 "$1,447.71 " $205.30 $185.59 $922.29 $35.19 "$1,770.06 " $35.19 $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " $42.23 $35.19 "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " $35.19 $931.61 "$1,117.93 " $49.27 "$2,316.34 " $35.19 $35.19 $42.23 "$1,304.25 " $35.19 $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " $35.19 "$2,171.57 " $72.14 $35.19 "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $43.78 $978.19 $931.61 $43.78 $35.19 $35.19 $698.71 $698.71 $698.71 $35.19 "$5,310.18 " 330104 88314 306 310 HC HISTOCHEMICAL STAINS ADD-ON O $449.40 N/A N/A $80.82 $224.70 $136.57 $123.46 $108.16 $80.82 N/A $80.82 N/A $337.05 N/A $283.12 $328.51 $96.99 $80.82 $269.64 $359.52 N/A N/A $80.82 N/A $292.11 $113.15 $359.52 $80.82 $80.82 $96.99 N/A $80.82 N/A N/A N/A $359.52 $381.99 $109.11 $337.05 $165.68 $109.11 $224.70 $292.11 N/A N/A N/A N/A $20.48 N/A N/A $20.48 $80.82 $80.82 N/A N/A N/A $20.48 $381.99 330104 88313 5732 305 310 HC SPECIAL STAINS GROUP 2 O $260.01 $40.74 $40.74 $9.88 $130.00 $124.61 $112.65 $40.34 $9.88 $77.41 $9.88 $40.74 $195.01 $44.82 $163.81 $190.07 $11.86 $9.88 $156.01 $208.01 $138.53 $232.24 $9.88 $40.74 $48.89 $13.83 $208.01 $9.88 $9.88 $11.86 $57.04 $9.88 $40.74 $40.74 $44.41 $208.01 $221.01 $9.88 $195.01 $20.25 $9.88 $130.00 $109.60 $57.24 $57.24 $57.24 $57.24 $20.48 $42.78 $40.74 $20.48 $9.88 $9.88 $30.56 $30.56 $30.56 $9.88 $232.24 330104 88312 5671 305 310 HC SPECIAL STAINS GROUP 1 O $300.67 $60.15 $60.15 $13.18 $150.34 $169.35 $153.09 $59.55 $13.18 $114.29 $13.18 $60.15 $225.50 $66.17 $189.42 $219.79 $15.82 $13.18 $180.40 $240.54 $204.53 $342.88 $13.18 $60.15 $72.19 $18.45 $240.54 $13.18 $13.18 $15.82 $84.22 $13.18 $60.15 $60.15 $65.57 $240.54 $255.57 $13.18 $225.50 $27.02 $13.18 $150.34 $161.82 $84.52 $84.52 $84.52 $84.52 $20.48 $63.16 $60.15 $20.48 $13.18 $13.18 $45.12 $45.12 $45.12 $13.18 $342.88 330104 88311 305 310 HC DECALCIFY TISSUE O $249.31 N/A N/A $57.35 $124.66 $30.66 $27.72 $24.28 $57.35 N/A $57.35 N/A $186.98 N/A $157.07 $182.25 $68.82 $57.35 $149.59 $199.45 N/A N/A $57.35 N/A $162.05 $80.29 $199.45 $57.35 $57.35 $68.82 N/A $57.35 N/A N/A N/A $199.45 $211.91 $77.43 $186.98 $117.57 $77.43 $124.66 $162.05 N/A N/A N/A N/A $13.25 N/A N/A $13.25 $57.35 $57.35 N/A N/A N/A $13.25 $211.91 330104 88309 5674 306 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL VI O "$2,895.42 " $931.61 $931.61 $264.99 "$1,447.71 " $654.16 $591.36 $922.29 $264.99 "$1,770.06 " $264.99 $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " $317.99 $264.99 "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " $264.99 $931.61 "$1,117.93 " $370.99 "$2,316.34 " $264.99 $264.99 $317.99 "$1,304.25 " $264.99 $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " $264.99 "$2,171.57 " $543.23 $264.99 "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $67.70 $978.19 $931.61 $67.70 $264.99 $264.99 $698.71 $698.71 $698.71 $67.70 "$5,310.18 " 330104 88307 5673 306 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL V O "$1,676.69 " $388.85 $388.85 $174.41 $838.35 $436.77 $394.84 $384.96 $174.41 $738.81 $174.41 $388.85 "$1,257.52 " $427.73 "$1,056.31 " "$1,225.66 " $209.29 $174.41 "$1,006.01 " "$1,341.35 " "$1,322.08 " "$2,216.43 " $174.41 $388.85 $466.62 $244.17 "$1,341.35 " $174.41 $174.41 $209.29 $544.39 $174.41 $388.85 $388.85 $423.84 "$1,341.35 " "$1,425.19 " $174.41 "$1,257.52 " $357.54 $174.41 $838.35 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $67.70 $408.29 $388.85 $67.70 $174.41 $174.41 $291.64 $291.64 $291.64 $67.70 "$2,216.43 " 330104 88305 5671 305 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL IV O "$1,035.76 " $60.15 $60.15 $43.19 $517.88 $104.81 $94.75 $59.55 $43.19 $114.29 $43.19 $60.15 $776.82 $66.17 $652.53 $757.14 $51.83 $43.19 $621.46 $828.61 $204.53 $342.88 $43.19 $60.15 $72.19 $60.47 $828.61 $43.19 $43.19 $51.83 $84.22 $43.19 $60.15 $60.15 $65.57 $828.61 $880.40 $43.19 $776.82 $88.54 $43.19 $517.88 $161.82 $84.52 $84.52 $84.52 $84.52 $43.78 $63.16 $60.15 $43.78 $43.19 $43.19 $45.12 $45.12 $45.12 $43.19 $880.40 330104 88304 5671 305 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL III O $823.90 $60.15 $60.15 $25.33 $411.95 $64.67 $58.47 $59.55 $25.33 $114.29 $25.33 $60.15 $617.92 $66.17 $519.06 $602.27 $30.40 $25.33 $494.34 $659.12 $204.53 $342.88 $25.33 $60.15 $72.19 $35.46 $659.12 $25.33 $25.33 $30.40 $84.22 $25.33 $60.15 $60.15 $65.57 $659.12 $700.31 $25.33 $617.92 $51.93 $25.33 $411.95 $161.82 $84.52 $84.52 $84.52 $84.52 $43.78 $63.16 $60.15 $43.78 $25.33 $25.33 $45.12 $45.12 $45.12 $25.33 $700.31 330104 88302 5731 305 310 HC TISSUE EXAM BY PATHOLOGIST LEVEL II O $527.51 $29.95 $29.95 $19.31 $263.75 $50.38 $45.54 $29.65 $19.31 $56.90 $19.31 $29.95 $395.63 $32.94 $332.33 $385.61 $23.17 $19.31 $316.51 $422.01 $101.81 $170.69 $19.31 $29.95 $35.93 $27.03 $422.01 $19.31 $19.31 $23.17 $41.92 $19.31 $29.95 $29.95 $32.64 $422.01 $448.38 $19.31 $395.63 $39.59 $19.31 $263.75 $80.55 $42.07 $42.07 $42.07 $42.07 $20.48 $31.44 $29.95 $20.48 $19.31 $19.31 $22.46 $22.46 $22.46 $19.31 $448.38 330104 81401 386 310 HC MOPATH PROCEDURE LEVEL 2 O $177.62 $137.00 $137.00 N/A $88.81 N/A N/A N/A N/A $260.30 N/A $137.00 $133.22 $150.70 $111.90 $129.84 N/A N/A $106.57 $142.10 $465.80 $780.90 N/A $137.00 $115.45 N/A $142.10 N/A N/A N/A $191.80 N/A $137.00 $137.00 $149.33 $142.10 $150.98 N/A $133.22 N/A N/A $88.81 $115.45 $192.49 $192.49 $192.49 $192.49 $164.40 $143.85 $137.00 $164.40 N/A N/A $102.75 $102.75 $102.75 $88.81 $780.90 330104 88271 385 310 HC CYTOGENETICS DNA PROBE O $284.62 $21.42 $21.42 $21.42 $142.31 N/A N/A N/A $21.42 $40.70 $21.42 $21.42 $213.47 $23.56 $179.31 $208.06 $25.70 $21.42 $170.77 $227.70 $72.83 $122.09 $21.42 $21.42 $185.00 $29.99 $227.70 $21.42 $21.42 $25.70 $29.99 $21.42 $21.42 $21.42 $23.35 $227.70 $241.93 $28.92 $213.47 $43.91 $28.92 $142.31 $185.00 $30.10 $30.10 $30.10 $30.10 $36.17 $22.49 $21.42 $36.17 $21.42 $21.42 $16.07 $16.07 $16.07 $16.07 $241.93 330104 81400 385 310 HC MOPATH PROCEDURE LEVEL 1 O $328.49 $63.96 $63.96 N/A $164.25 N/A N/A N/A N/A $121.52 N/A $63.96 $246.37 $70.36 $206.95 $240.13 N/A N/A $197.09 $262.79 $217.46 $364.57 N/A $63.96 $213.52 N/A $262.79 N/A N/A N/A $89.54 N/A $63.96 $63.96 $69.72 $262.79 $279.22 N/A $246.37 N/A N/A $164.25 $213.52 $89.86 $89.86 $89.86 $89.86 $76.75 $67.16 $63.96 $76.75 N/A N/A $47.97 $47.97 $47.97 $47.97 $364.57 330104 81377 385 310 HC HLA II TYPE 1 AG EQUIV LR O $276.06 $94.74 $94.74 N/A $138.03 N/A N/A N/A N/A $180.01 N/A $94.74 $207.05 $104.21 $173.92 $201.80 N/A N/A $165.64 $220.85 $322.12 $540.02 N/A $94.74 $179.44 N/A $220.85 N/A N/A N/A $132.64 N/A $94.74 $94.74 $103.27 $220.85 $234.65 N/A $207.05 N/A N/A $138.03 $179.44 $133.11 $133.11 $133.11 $133.11 $150.30 $99.48 $94.74 $150.30 N/A N/A $71.05 $71.05 $71.05 $71.05 $540.02 330104 81276 386 310 HC KRAS GENE ADDL VARIANTS O $918.06 $193.25 $193.25 $118.31 $459.03 N/A N/A N/A $118.31 $367.17 $118.31 $193.25 $688.54 $212.58 $578.38 $671.10 $141.97 $118.31 $550.84 $734.45 $657.05 "$1,101.53 " $118.31 $193.25 $596.74 $165.63 $734.45 $118.31 $118.31 $141.97 $270.55 $118.31 $193.25 $193.25 $210.64 $734.45 $780.35 $159.72 $688.54 $242.54 $159.72 $459.03 $596.74 $271.52 $271.52 $271.52 $271.52 $236.63 $202.91 $193.25 $236.63 $118.31 $118.31 $144.94 $144.94 $144.94 $118.31 "$1,101.53 " 330104 81275 386 310 HC KRAS GENE O $786.45 $193.25 $193.25 $193.25 $393.23 N/A N/A N/A $193.25 $367.17 $193.25 $193.25 $589.84 $212.58 $495.46 $574.89 $231.90 $193.25 $471.87 $629.16 $657.05 "$1,101.53 " $193.25 $193.25 $511.19 $270.55 $629.16 $193.25 $193.25 $231.90 $270.55 $193.25 $193.25 $193.25 $210.64 $629.16 $668.48 $260.89 $589.84 $396.16 $260.89 $393.23 $511.19 $271.52 $271.52 $271.52 $271.52 $236.98 $202.91 $193.25 $236.98 $193.25 $193.25 $144.94 $144.94 $144.94 $144.94 "$1,101.53 " 330104 81273 385 310 HC KIT GENE ANALYS D816 VARIANT O $532.86 $124.87 $124.87 N/A $266.43 N/A N/A N/A N/A $237.25 N/A $124.87 $399.64 $137.36 $335.70 $389.52 N/A N/A $319.72 $426.29 $424.56 $711.76 N/A $124.87 $346.36 N/A $426.29 N/A N/A N/A $174.82 N/A $124.87 $124.87 $136.11 $426.29 $452.93 N/A $399.64 N/A N/A $266.43 $346.36 $175.44 $175.44 $175.44 $175.44 $149.84 $131.11 $124.87 $149.84 N/A N/A $93.65 $93.65 $93.65 $93.65 $711.76 330104 81270 385 310 HC JAK2 GENE O $916.99 $91.66 $91.66 N/A $458.50 N/A N/A N/A N/A $174.15 N/A $91.66 $687.74 $100.83 $577.70 $670.32 N/A N/A $550.19 $733.59 $311.64 $522.46 N/A $91.66 $596.04 N/A $733.59 N/A N/A N/A $128.32 N/A $91.66 $91.66 $99.91 $733.59 $779.44 N/A $687.74 N/A N/A $458.50 $596.04 $128.78 $128.78 $128.78 $128.78 $150.07 $96.24 $91.66 $150.07 N/A N/A $68.75 $68.75 $68.75 $68.75 $779.44 330104 81256 385 310 HC HFE GENE O "$1,043.25 " $65.36 $65.36 N/A $521.62 N/A N/A N/A N/A $124.18 N/A $65.36 $782.44 $71.90 $657.25 $762.62 N/A N/A $625.95 $834.60 $222.22 $372.55 N/A $65.36 $678.11 N/A $834.60 N/A N/A N/A $91.50 N/A $65.36 $65.36 $71.24 $834.60 $886.76 N/A $782.44 N/A N/A $521.62 $678.11 $91.83 $91.83 $91.83 $91.83 $107.00 $68.63 $65.36 $107.00 N/A N/A $49.02 $49.02 $49.02 $49.02 $886.76 330104 81251 385 310 HC GBA GENE O $155.15 $47.25 $47.25 N/A $77.58 N/A N/A N/A N/A $89.77 N/A $47.25 $116.36 $51.98 $97.74 $113.41 N/A N/A $93.09 $124.12 $160.65 $269.32 N/A $47.25 $100.85 N/A $124.12 N/A N/A N/A $66.15 N/A $47.25 $47.25 $51.50 $124.12 $131.88 N/A $116.36 N/A N/A $77.58 $100.85 $66.39 $66.39 $66.39 $66.39 $56.70 $49.61 $47.25 $56.70 N/A N/A $35.44 $35.44 $35.44 $35.44 $269.32 330104 81246 385 310 HC FLT3 GENE ANALYSIS O $303.88 $83.00 $83.00 $83.00 $151.94 N/A N/A N/A $83.00 $157.70 $83.00 $83.00 $227.91 $91.30 $191.44 $222.14 $99.60 $83.00 $182.33 $243.10 $282.20 $473.10 $83.00 $83.00 $197.52 $116.20 $243.10 $83.00 $83.00 $99.60 $116.20 $83.00 $83.00 $83.00 $90.47 $243.10 $258.30 $112.05 $227.91 $170.15 $112.05 $151.94 $197.52 $116.62 $116.62 $116.62 $116.62 $99.61 $87.15 $83.00 $99.61 $83.00 $83.00 $62.25 $62.25 $62.25 $62.25 $473.10 330104 81245 386 310 HC FLT3 GENE O $606.69 $165.51 $165.51 $165.51 $303.35 N/A N/A N/A $165.51 $314.47 $165.51 $165.51 $455.02 $182.06 $382.21 $443.49 $198.61 $165.51 $364.01 $485.35 $562.73 $943.41 $165.51 $165.51 $394.35 $231.71 $485.35 $165.51 $165.51 $198.61 $231.71 $165.51 $165.51 $165.51 $180.41 $485.35 $515.69 $223.44 $455.02 $339.30 $223.44 $303.35 $394.35 $232.54 $232.54 $232.54 $232.54 $199.10 $173.79 $165.51 $199.10 $165.51 $165.51 $124.13 $124.13 $124.13 $124.13 $943.41 330104 81244 385 310 HC FMR1 GENE CHARACTERIZATION O $169.06 $44.89 $44.89 N/A $84.53 N/A N/A N/A N/A $85.29 N/A $44.89 $126.80 $49.38 $106.51 $123.58 N/A N/A $101.44 $135.25 $152.63 $255.87 N/A $44.89 $109.89 N/A $135.25 N/A N/A N/A $62.85 N/A $44.89 $44.89 $48.93 $135.25 $143.70 N/A $126.80 N/A N/A $84.53 $109.89 $63.07 $63.07 $63.07 $63.07 $53.87 $47.13 $44.89 $53.87 N/A N/A $33.67 $33.67 $33.67 $33.67 $255.87 330104 81241 385 310 HC F5 GENE O $842.09 $73.37 $73.37 $73.37 $421.05 N/A N/A N/A $73.37 $139.40 $73.37 $73.37 $631.57 $80.71 $530.52 $615.57 $88.04 $73.37 $505.25 $673.67 $249.46 $418.21 $73.37 $73.37 $547.36 $102.72 $673.67 $73.37 $73.37 $88.04 $102.72 $73.37 $73.37 $73.37 $79.97 $673.67 $715.78 $99.05 $631.57 $150.41 $99.05 $421.05 $547.36 $103.08 $103.08 $103.08 $103.08 $100.04 $77.04 $73.37 $100.04 $73.37 $73.37 $55.03 $55.03 $55.03 $55.03 $715.78 330104 81240 385 310 HC F2 GENE O $503.97 $65.69 $65.69 $65.69 $251.99 N/A N/A N/A $65.69 $124.81 $65.69 $65.69 $377.98 $72.26 $317.50 $368.40 $78.83 $65.69 $302.38 $403.18 $223.35 $374.43 $65.69 $65.69 $327.58 $91.97 $403.18 $65.69 $65.69 $78.83 $91.97 $65.69 $65.69 $65.69 $71.60 $403.18 $428.37 $88.68 $377.98 $134.66 $88.68 $251.99 $327.58 $92.29 $92.29 $92.29 $92.29 $80.56 $68.97 $65.69 $80.56 $65.69 $65.69 $49.27 $49.27 $49.27 $49.27 $428.37 330104 81235 387 310 HC EGFR GENE COM VARIANTS O "$1,417.75 " $324.58 $324.58 N/A $708.88 N/A N/A N/A N/A $616.70 N/A $324.58 "$1,063.31 " $357.04 $893.18 "$1,036.38 " N/A N/A $850.65 "$1,134.20 " "$1,103.57 " "$1,850.11 " N/A $324.58 $921.54 N/A "$1,134.20 " N/A N/A N/A $454.41 N/A $324.58 $324.58 $353.79 "$1,134.20 " "$1,205.09 " N/A "$1,063.31 " N/A N/A $708.88 $921.54 $456.03 $456.03 $456.03 $456.03 $396.01 $340.81 $324.58 $396.01 N/A N/A $243.44 $243.44 $243.44 $243.44 "$1,850.11 " 330104 81229 2045 310 HC CYTOGEN M ARRAY COPY NO&SNP O "$1,606.07 " "$1,160.00 " "$1,160.00 " N/A $803.03 N/A N/A N/A N/A "$2,204.00 " N/A "$1,160.00 " "$1,204.55 " "$1,276.00 " "$1,011.82 " "$1,174.04 " N/A N/A $963.64 "$1,284.86 " "$3,944.00 " "$6,612.00 " N/A "$1,160.00 " "$1,043.95 " N/A "$1,284.86 " N/A N/A N/A "$1,624.00 " N/A "$1,160.00 " "$1,160.00 " "$1,264.40 " "$1,284.86 " "$1,365.16 " N/A "$1,204.55 " N/A N/A $803.03 "$1,043.95 " "$1,629.80 " "$1,629.80 " "$1,629.80 " "$1,629.80 " "$1,392.00 " "$1,218.00 " "$1,160.00 " "$1,392.00 " N/A N/A $870.00 $870.00 $870.00 $803.03 "$6,612.00 " 330104 81220 387 310 HC CFTR GENE COM VARIANTS O "$2,272.68 " $556.60 $556.60 $325.00 "$1,136.34 " N/A N/A N/A $325.00 "$1,057.54 " $325.00 $556.60 "$1,704.51 " $612.26 "$1,431.79 " "$1,661.33 " $390.00 $325.00 "$1,363.61 " "$1,818.14 " "$1,892.44 " "$3,172.62 " $325.00 $556.60 "$1,477.24 " $455.00 "$1,818.14 " $325.00 $325.00 $390.00 $779.24 $325.00 $556.60 $556.60 $606.69 "$1,818.14 " "$1,931.78 " $438.75 "$1,704.51 " $666.25 $438.75 "$1,136.34 " "$1,477.24 " $782.02 $782.02 $782.02 $782.02 $667.92 $584.43 $556.60 $667.92 $325.00 $325.00 $417.45 $417.45 $417.45 $325.00 "$3,172.62 " 330104 81121 386 310 HC IDH2 COMMON VARIANTS O "$1,092.47 " $295.79 $295.79 N/A $546.24 N/A N/A N/A N/A $562.00 N/A $295.79 $819.35 $325.37 $688.26 $798.60 N/A N/A $655.48 $873.98 "$1,005.69 " "$1,686.00 " N/A $295.79 $710.11 N/A $873.98 N/A N/A N/A $414.11 N/A $295.79 $295.79 $322.41 $873.98 $928.60 N/A $819.35 N/A N/A $546.24 $710.11 $415.58 $415.58 $415.58 $415.58 $354.95 $310.58 $295.79 $354.95 N/A N/A $221.84 $221.84 $221.84 $221.84 "$1,686.00 " 330104 81219 385 310 HC CALR GENE ANALYSIS COMMON VARIANTS IN EXON 9 O $642.00 $121.63 $121.63 N/A $321.00 N/A N/A N/A N/A $231.10 N/A $121.63 $481.50 $133.79 $404.46 $469.30 N/A N/A $385.20 $513.60 $413.54 $693.29 N/A $121.63 $417.30 N/A $513.60 N/A N/A N/A $170.28 N/A $121.63 $121.63 $132.58 $513.60 $545.70 N/A $481.50 N/A N/A $321.00 $417.30 $170.89 $170.89 $170.89 $170.89 $198.82 $127.71 $121.63 $198.82 N/A N/A $91.22 $91.22 $91.22 $91.22 $693.29 330104 81210 386 310 HC BRAF GENE O $674.10 $175.40 $175.40 $175.40 $337.05 N/A N/A N/A $175.40 $333.26 $175.40 $175.40 $505.58 $192.94 $424.68 $492.77 $210.48 $175.40 $404.46 $539.28 $596.36 $999.78 $175.40 $175.40 $438.17 $245.56 $539.28 $175.40 $175.40 $210.48 $245.56 $175.40 $175.40 $175.40 $191.19 $539.28 $572.99 $236.79 $505.58 $359.57 $236.79 $337.05 $438.17 $246.44 $246.44 $246.44 $246.44 $215.10 $184.17 $175.40 $215.10 $175.40 $175.40 $131.55 $131.55 $131.55 $131.55 $999.78 330104 81278 386 310 HC IGH@/BCL2 TRANSLOCATION ALYS O $169.06 $207.31 $207.31 $124.39 $84.53 N/A N/A N/A $124.39 $393.89 $124.39 $207.31 $126.80 $228.04 $106.51 $123.58 $149.27 $124.39 $101.44 $135.25 $704.85 "$1,181.67 " $124.39 $207.31 $109.89 $174.15 $135.25 $124.39 $124.39 $149.27 $290.23 $124.39 $207.31 $207.31 $225.97 $135.25 $143.70 $167.93 $126.80 $255.00 $167.93 $84.53 $109.89 $291.27 $291.27 $291.27 $291.27 N/A $217.68 $207.31 $112.76 $124.39 $124.39 $155.48 $155.48 $155.48 $84.53 "$1,181.67 " 330104 81383 385 310 HC HLA II TYPING 1 ALLELE HR O $739.37 $109.13 $109.13 N/A $369.69 N/A N/A N/A N/A $207.35 N/A $109.13 $554.53 $120.04 $465.80 $540.48 N/A N/A $443.62 $591.50 $371.04 $622.04 N/A $109.13 $480.59 N/A $591.50 N/A N/A N/A $152.78 N/A $109.13 $109.13 $118.95 $591.50 $628.46 N/A $554.53 N/A N/A $369.69 $480.59 $153.33 $153.33 $153.33 $153.33 $178.66 $114.59 $109.13 $178.66 N/A N/A $81.85 $81.85 $81.85 $81.85 $628.46 330104 81279 386 310 HC JAK2 GENE TRGT SEQUENCE ALYS O $169.06 $185.20 $185.20 $111.12 $84.53 N/A N/A N/A $111.12 $351.88 $111.12 $185.20 $126.80 $203.72 $106.51 $123.58 $133.34 $111.12 $101.44 $135.25 $629.68 "$1,055.64 " $111.12 $185.20 $109.89 $155.57 $135.25 $111.12 $111.12 $133.34 $259.28 $111.12 $185.20 $185.20 $201.87 $135.25 $143.70 $150.01 $126.80 $227.80 $150.01 $84.53 $109.89 $260.21 $260.21 $260.21 $260.21 N/A $194.46 $185.20 $112.76 $111.12 $111.12 $138.90 $138.90 $138.90 $84.53 "$1,055.64 " 330104 81301 386 310 HC MICROSATELLITE INSTABILITY O "$1,826.49 " $348.56 $348.56 $348.56 $913.25 N/A N/A N/A $348.56 $662.26 $348.56 $348.56 "$1,369.87 " $383.42 "$1,150.69 " "$1,335.16 " $418.27 $348.56 "$1,095.89 " "$1,461.19 " "$1,185.10 " "$1,986.79 " $348.56 $348.56 "$1,187.22 " $487.98 "$1,461.19 " $348.56 $348.56 $418.27 $487.98 $348.56 $348.56 $348.56 $379.93 "$1,461.19 " "$1,552.52 " $470.56 "$1,369.87 " $714.55 $470.56 $913.25 "$1,187.22 " $489.73 $489.73 $489.73 $489.73 $474.05 $365.99 $348.56 $474.05 $348.56 $348.56 $261.42 $261.42 $261.42 $261.42 "$1,986.79 " 330104 81376 385 310 HC HLA II TYPING 1 LOCUS LR O $485.78 $122.22 $122.22 N/A $242.89 N/A N/A N/A N/A $232.22 N/A $122.22 $364.33 $134.44 $306.04 $355.11 N/A N/A $291.47 $388.62 $415.55 $696.65 N/A $122.22 $315.76 N/A $388.62 N/A N/A N/A $171.11 N/A $122.22 $122.22 $133.22 $388.62 $412.91 N/A $364.33 N/A N/A $242.89 $315.76 $171.72 $171.72 $171.72 $171.72 $200.09 $128.33 $122.22 $200.09 N/A N/A $91.66 $91.66 $91.66 $91.66 $696.65 330104 81360 386 310 HC ZRSR2 GENE COMMON VARIANTS O $169.06 $193.25 $193.25 $115.95 $84.53 N/A N/A N/A $115.95 $367.17 $115.95 $193.25 $126.80 $212.58 $106.51 $123.58 $139.14 $115.95 $101.44 $135.25 $657.05 "$1,101.53 " $115.95 $193.25 $109.89 $162.33 $135.25 $115.95 $115.95 $139.14 $270.55 $115.95 $193.25 $193.25 $210.64 $135.25 $143.70 $156.53 $126.80 $237.70 $156.53 $84.53 $109.89 $271.52 $271.52 $271.52 $271.52 N/A $202.91 $193.25 $112.76 $115.95 $115.95 $144.94 $144.94 $144.94 $84.53 "$1,101.53 " 330104 81357 386 310 HC U2AF1 GENE COMMON VARIANTS O $169.06 $193.25 $193.25 $115.95 $84.53 N/A N/A N/A $115.95 $367.17 $115.95 $193.25 $126.80 $212.58 $106.51 $123.58 $139.14 $115.95 $101.44 $135.25 $657.05 "$1,101.53 " $115.95 $193.25 $109.89 $162.33 $135.25 $115.95 $115.95 $139.14 $270.55 $115.95 $193.25 $193.25 $210.64 $135.25 $143.70 $156.53 $126.80 $237.70 $156.53 $84.53 $109.89 $271.52 $271.52 $271.52 $271.52 N/A $202.91 $193.25 $112.76 $115.95 $115.95 $144.94 $144.94 $144.94 $84.53 "$1,101.53 " 330104 81353 386 310 HC TP53 GENE KNOWN FAMIL VRNT O $169.06 $308.00 $308.00 $184.80 $84.53 N/A N/A N/A $184.80 $585.20 $184.80 $308.00 $126.80 $338.80 $106.51 $123.58 $221.76 $184.80 $101.44 $135.25 "$1,047.20 " "$1,755.60 " $184.80 $308.00 $109.89 $258.72 $135.25 $184.80 $184.80 $221.76 $431.20 $184.80 $308.00 $308.00 $335.72 $135.25 $143.70 $249.48 $126.80 $378.84 $249.48 $84.53 $109.89 $432.74 $432.74 $432.74 $432.74 N/A $323.40 $308.00 $112.76 $184.80 $184.80 $231.00 $231.00 $231.00 $84.53 "$1,755.60 " 330104 81352 386 310 HC TP53 GENE TRGT SEQUENCE ALYS O $169.06 $329.51 $329.51 $197.71 $84.53 N/A N/A N/A $197.71 $626.07 $197.71 $329.51 $126.80 $362.46 $106.51 $123.58 $237.25 $197.71 $101.44 $135.25 "$1,120.33 " "$1,878.21 " $197.71 $329.51 $109.89 $276.79 $135.25 $197.71 $197.71 $237.25 $461.31 $197.71 $329.51 $329.51 $359.17 $135.25 $143.70 $266.91 $126.80 $405.31 $266.91 $84.53 $109.89 $462.96 $462.96 $462.96 $462.96 N/A $345.99 $329.51 $112.76 $197.71 $197.71 $247.13 $247.13 $247.13 $84.53 "$1,878.21 " 330104 81351 2044 310 HC TP53 GENE FULL GENE SEQUENCE O $169.06 $641.85 $641.85 $385.11 $84.53 N/A N/A N/A $385.11 "$1,219.51 " $385.11 $641.85 $126.80 $706.04 $106.51 $123.58 $462.13 $385.11 $101.44 $135.25 "$2,182.29 " "$3,658.55 " $385.11 $641.85 $109.89 $539.15 $135.25 $385.11 $385.11 $462.13 $898.59 $385.11 $641.85 $641.85 $699.62 $135.25 $143.70 $519.90 $126.80 $789.48 $519.90 $84.53 $109.89 $901.80 $901.80 $901.80 $901.80 N/A $673.94 $641.85 $112.76 $385.11 $385.11 $481.39 $481.39 $481.39 $84.53 "$3,658.55 " 330104 81350 386 310 HC UGT1A1 GENE O $916.99 $234.00 $234.00 N/A $458.50 N/A N/A N/A N/A $444.60 N/A $234.00 $687.74 $257.40 $577.70 $670.32 N/A N/A $550.19 $733.59 $795.60 "$1,333.80 " N/A $234.00 $596.04 N/A $733.59 N/A N/A N/A $327.60 N/A $234.00 $234.00 $255.06 $733.59 $779.44 N/A $687.74 N/A N/A $458.50 $596.04 $328.77 $328.77 $328.77 $328.77 $280.80 $245.70 $234.00 $280.80 N/A N/A $175.50 $175.50 $175.50 $175.50 "$1,333.80 " 330104 81348 386 310 HC SRSF2 GENE COMMON VARIANTS O $169.06 $175.40 $175.40 $105.24 $84.53 N/A N/A N/A $105.24 $333.26 $105.24 $175.40 $126.80 $192.94 $106.51 $123.58 $126.29 $105.24 $101.44 $135.25 $596.36 $999.78 $105.24 $175.40 $109.89 $147.34 $135.25 $105.24 $105.24 $126.29 $245.56 $105.24 $175.40 $175.40 $191.19 $135.25 $143.70 $142.07 $126.80 $215.74 $142.07 $84.53 $109.89 $246.44 $246.44 $246.44 $246.44 N/A $184.17 $175.40 $112.76 $105.24 $105.24 $131.55 $131.55 $131.55 $84.53 $999.78 330104 81347 386 310 HC SF3B1 GENE COMMON VARIANTS O $169.06 $193.25 $193.25 $115.95 $84.53 N/A N/A N/A $115.95 $367.17 $115.95 $193.25 $126.80 $212.58 $106.51 $123.58 $139.14 $115.95 $101.44 $135.25 $657.05 "$1,101.53 " $115.95 $193.25 $109.89 $162.33 $135.25 $115.95 $115.95 $139.14 $270.55 $115.95 $193.25 $193.25 $210.64 $135.25 $143.70 $156.53 $126.80 $237.70 $156.53 $84.53 $109.89 $271.52 $271.52 $271.52 $271.52 N/A $202.91 $193.25 $112.76 $115.95 $115.95 $144.94 $144.94 $144.94 $84.53 "$1,101.53 " 330104 81342 386 310 HC TRG GENE REARRANGEMENT ANAL O "$1,274.37 " $201.50 $201.50 N/A $637.18 N/A N/A N/A N/A $382.85 N/A $201.50 $955.78 $221.65 $802.85 $931.56 N/A N/A $764.62 "$1,019.50 " $685.10 "$1,148.55 " N/A $201.50 $828.34 N/A "$1,019.50 " N/A N/A N/A $282.10 N/A $201.50 $201.50 $219.64 "$1,019.50 " "$1,083.21 " N/A $955.78 N/A N/A $637.18 $828.34 $283.11 $283.11 $283.11 $283.11 $329.88 $211.58 $201.50 $329.88 N/A N/A $151.12 $151.12 $151.12 $151.12 "$1,148.55 " 330104 81340 386 310 HC TRB@ GENE REARRANGE AMPLIFY O "$1,317.17 " $208.92 $208.92 N/A $658.59 N/A N/A N/A N/A $396.95 N/A $208.92 $987.88 $229.81 $829.82 $962.85 N/A N/A $790.30 "$1,053.74 " $710.33 "$1,190.84 " N/A $208.92 $856.16 N/A "$1,053.74 " N/A N/A N/A $292.49 N/A $208.92 $208.92 $227.72 "$1,053.74 " "$1,119.59 " N/A $987.88 N/A N/A $658.59 $856.16 $293.53 $293.53 $293.53 $293.53 $342.02 $219.37 $208.92 $342.02 N/A N/A $156.69 $156.69 $156.69 $156.69 "$1,190.84 " 330104 81339 386 310 HC MPL GENE SEQ ALYS EXON 10 O $169.06 $185.20 $185.20 $111.12 $84.53 N/A N/A N/A $111.12 $351.88 $111.12 $185.20 $126.80 $203.72 $106.51 $123.58 $133.34 $111.12 $101.44 $135.25 $629.68 "$1,055.64 " $111.12 $185.20 $109.89 $155.57 $135.25 $111.12 $111.12 $133.34 $259.28 $111.12 $185.20 $185.20 $201.87 $135.25 $143.70 $150.01 $126.80 $227.80 $150.01 $84.53 $109.89 $260.21 $260.21 $260.21 $260.21 N/A $194.46 $185.20 $112.76 $111.12 $111.12 $138.90 $138.90 $138.90 $84.53 "$1,055.64 " 330104 81338 386 310 HC MPL GENE COMMON VARIANTS O $169.06 $150.33 $150.33 $90.20 $84.53 N/A N/A N/A $90.20 $285.63 $90.20 $150.33 $126.80 $165.36 $106.51 $123.58 $108.24 $90.20 $101.44 $135.25 $511.12 $856.88 $90.20 $150.33 $109.89 $126.28 $135.25 $90.20 $90.20 $108.24 $210.46 $90.20 $150.33 $150.33 $163.86 $135.25 $143.70 $121.77 $126.80 $184.91 $121.77 $84.53 $109.89 $211.21 $211.21 $211.21 $211.21 N/A $157.85 $150.33 $112.76 $90.20 $90.20 $112.75 $112.75 $112.75 $84.53 $856.88 330104 81334 386 310 HC RUNX1 GENE TARGETED SEQ O "$1,213.38 " $329.51 $329.51 N/A $606.69 N/A N/A N/A N/A $626.07 N/A $329.51 $910.04 $362.46 $764.43 $886.98 N/A N/A $728.03 $970.70 "$1,120.33 " "$1,878.21 " N/A $329.51 $788.70 N/A $970.70 N/A N/A N/A $461.31 N/A $329.51 $329.51 $359.17 $970.70 "$1,031.37 " N/A $910.04 N/A N/A $606.69 $788.70 $462.96 $462.96 $462.96 $462.96 $395.41 $345.99 $329.51 $395.41 N/A N/A $247.13 $247.13 $247.13 $247.13 "$1,878.21 " 330104 81329 386 310 HC SMN1 GENE DOS/DELETION ALYS O $539.28 $137.00 $137.00 N/A $269.64 N/A N/A N/A N/A $260.30 N/A $137.00 $404.46 $150.70 $339.75 $394.21 N/A N/A $323.57 $431.42 $465.80 $780.90 N/A $137.00 $350.53 N/A $431.42 N/A N/A N/A $191.80 N/A $137.00 $137.00 $149.33 $431.42 $458.39 N/A $404.46 N/A N/A $269.64 $350.53 $192.49 $192.49 $192.49 $192.49 $164.40 $143.85 $137.00 $164.40 N/A N/A $102.75 $102.75 $102.75 $102.75 $780.90 330104 81321 2044 310 HC PTEN GENE FULL SEQUENCE O "$2,184.94 " $600.00 $600.00 N/A "$1,092.47 " N/A N/A N/A N/A "$1,140.00 " N/A $600.00 "$1,638.70 " $660.00 "$1,376.51 " "$1,597.19 " N/A N/A "$1,310.96 " "$1,747.95 " "$2,040.00 " "$3,420.00 " N/A $600.00 "$1,420.21 " N/A "$1,747.95 " N/A N/A N/A $840.00 N/A $600.00 $600.00 $654.00 "$1,747.95 " "$1,857.20 " N/A "$1,638.70 " N/A N/A "$1,092.47 " "$1,420.21 " $843.00 $843.00 $843.00 $843.00 $720.84 $630.00 $600.00 $720.84 N/A N/A $450.00 $450.00 $450.00 $450.00 "$3,420.00 " 330104 81310 386 310 HC NPM1 GENE O $910.57 $246.52 $246.52 $246.52 $455.29 N/A N/A N/A $246.52 $468.39 $246.52 $246.52 $682.93 $271.17 $573.66 $665.63 $295.82 $246.52 $546.34 $728.46 $838.17 "$1,405.16 " $246.52 $246.52 $591.87 $345.13 $728.46 $246.52 $246.52 $295.82 $345.13 $246.52 $246.52 $246.52 $268.71 $728.46 $773.98 $332.80 $682.93 $505.37 $332.80 $455.29 $591.87 $346.36 $346.36 $346.36 $346.36 $296.57 $258.85 $246.52 $296.57 $246.52 $246.52 $184.89 $184.89 $184.89 $184.89 "$1,405.16 " 330104 81291 385 310 HC MTHFR GENE O "$1,043.25 " $65.34 $65.34 N/A $521.62 N/A N/A N/A N/A $124.15 N/A $65.34 $782.44 $71.87 $657.25 $762.62 N/A N/A $625.95 $834.60 $222.16 $372.44 N/A $65.34 $678.11 N/A $834.60 N/A N/A N/A $91.48 N/A $65.34 $65.34 $71.22 $834.60 $886.76 N/A $782.44 N/A N/A $521.62 $678.11 $91.80 $91.80 $91.80 $91.80 $71.46 $68.61 $65.34 $71.46 N/A N/A $49.01 $49.01 $49.01 $49.01 $886.76 330104 81120 386 310 HC IDH1 COMMON VARIANTS O $728.67 $193.25 $193.25 N/A $364.33 N/A N/A N/A N/A $367.17 N/A $193.25 $546.50 $212.58 $459.06 $532.66 N/A N/A $437.20 $582.94 $657.05 "$1,101.53 " N/A $193.25 $473.64 N/A $582.94 N/A N/A N/A $270.55 N/A $193.25 $193.25 $210.64 $582.94 $619.37 N/A $546.50 N/A N/A $364.33 $473.64 $271.52 $271.52 $271.52 $271.52 $231.90 $202.91 $193.25 $231.90 N/A N/A $144.94 $144.94 $144.94 $144.94 "$1,101.53 " 330104 80506 158 310 HC PATHOLOGY CLINICAL CONSLTJ PROLNG SVC EA ADDL 30 O $107.00 N/A N/A $25.96 $53.50 $61.77 $55.84 $48.92 $25.96 N/A $25.96 N/A $80.25 N/A $67.41 $78.22 $31.15 $25.96 $64.20 $85.60 N/A N/A $25.96 N/A $69.55 $36.34 $85.60 $25.96 $25.96 $31.15 N/A $25.96 N/A N/A N/A $85.60 $90.95 $35.05 $80.25 $53.22 $35.05 $53.50 $69.55 N/A N/A N/A N/A N/A N/A N/A $71.37 $25.96 $25.96 N/A N/A N/A $25.96 $90.95 330104 80505 5672 158 310 HC PATHOLOGY CLINICAL CONSULTATION HI MDM 41-60 MIN O $642.00 $188.66 $188.66 $57.93 $321.00 $129.90 $117.43 $186.77 $57.93 $358.45 $57.93 $188.66 $481.50 $207.53 $404.46 $469.30 $69.52 $57.93 $385.20 $513.60 $641.44 "$1,075.36 " $57.93 $188.66 $226.39 $81.10 $513.60 $57.93 $57.93 $69.52 $264.12 $57.93 $188.66 $188.66 $205.64 $513.60 $545.70 $57.93 $481.50 $118.76 $57.93 $321.00 $507.49 $265.07 $265.07 $265.07 $265.07 N/A $198.09 $188.66 $428.21 $57.93 $57.93 $141.49 $141.49 $141.49 $57.93 "$1,075.36 " 330104 88333 5674 158 310 HC INTRAOPERATIVE CYTO PATH CONSULT INITIAL SITE O "$2,895.42 " $931.61 $931.61 N/A "$1,447.71 " $135.16 $122.18 $922.29 N/A "$1,770.06 " N/A $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " N/A N/A "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " N/A $931.61 "$1,117.93 " N/A "$2,316.34 " N/A N/A N/A "$1,304.25 " N/A $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " N/A "$2,171.57 " N/A N/A "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $20.48 $978.19 $931.61 $20.48 N/A N/A $698.71 $698.71 $698.71 $20.48 "$5,310.18 " 330104 88381 305 310 HC MICRODISSECTION MANUAL O $359.52 N/A N/A $57.35 $179.76 $307.88 $278.32 $243.84 $57.35 N/A $57.35 N/A $269.64 N/A $226.50 $262.81 $68.82 $57.35 $215.71 $287.62 N/A N/A $57.35 N/A $233.69 $80.29 $287.62 $57.35 $57.35 $68.82 N/A $57.35 N/A N/A N/A $287.62 $305.59 $77.43 $269.64 $117.57 $77.43 $179.76 $233.69 N/A N/A N/A N/A $126.82 N/A N/A $126.82 $57.35 $57.35 N/A N/A N/A $57.35 $307.88 330104 88377 5672 306 310 HC M/PHMTRC ALYS ISHQUANT/SEMIQ O "$1,162.02 " $188.66 $188.66 $80.82 $581.01 $598.46 $541.00 $186.77 $80.82 $358.45 $80.82 $188.66 $871.51 $207.53 $732.07 $849.44 $96.99 $80.82 $697.21 $929.62 $641.44 "$1,075.36 " $80.82 $188.66 $226.39 $113.15 $929.62 $80.82 $80.82 $96.99 $264.12 $80.82 $188.66 $188.66 $205.64 $929.62 $987.72 $80.82 $871.51 $165.68 $80.82 $581.01 $507.49 $265.07 $265.07 $265.07 $265.07 $220.34 $198.09 $188.66 $220.34 $80.82 $80.82 $141.49 $141.49 $141.49 $80.82 "$1,075.36 " 330104 88374 5672 306 310 HC M/PHMTRC ALYS ISHQUANT/SEMIQ O $662.33 $188.66 $188.66 $80.82 $331.17 $458.89 $414.83 $186.77 $80.82 $358.45 $80.82 $188.66 $496.75 $207.53 $417.27 $484.16 $96.99 $80.82 $397.40 $529.86 $641.44 "$1,075.36 " $80.82 $188.66 $226.39 $113.15 $529.86 $80.82 $80.82 $96.99 $264.12 $80.82 $188.66 $188.66 $205.64 $529.86 $562.98 $80.82 $496.75 $165.68 $80.82 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $220.34 $198.09 $188.66 $220.34 $80.82 $80.82 $141.49 $141.49 $141.49 $80.82 "$1,075.36 " 330104 88373 306 310 HC M/PHMTRC ALYS ISH QUANT/SEMIQ CPTR PER SPEC EACH O $298.53 N/A N/A $80.82 $149.26 $100.90 $91.21 $79.91 $80.82 N/A $80.82 N/A $223.90 N/A $188.07 $218.23 $96.99 $80.82 $179.12 $238.82 N/A N/A $80.82 N/A $194.04 $113.15 $238.82 $80.82 $80.82 $96.99 N/A $80.82 N/A N/A N/A $238.82 $253.75 $109.11 $223.90 $165.68 $109.11 $149.26 $194.04 N/A N/A N/A N/A $46.82 N/A N/A $46.82 $80.82 $80.82 N/A N/A N/A $46.82 $253.75 330104 88369 306 310 HC M/PHMTRC ALYS ISH QUANT/SEMIQ MNL PER SPEC EACH O $424.79 N/A N/A $80.82 $212.40 $183.18 $165.59 $145.08 $80.82 N/A $80.82 N/A $318.59 N/A $267.62 $310.52 $96.99 $80.82 $254.87 $339.83 N/A N/A $80.82 N/A $276.11 $113.15 $339.83 $80.82 $80.82 $96.99 N/A $80.82 N/A N/A N/A $339.83 $361.07 $109.11 $318.59 $165.68 $109.11 $212.40 $276.11 N/A N/A N/A N/A $58.43 N/A N/A $58.43 $80.82 $80.82 N/A N/A N/A $58.43 $361.07 330104 88368 5673 306 310 HC INSITU HYBRIDIZATION MANUAL O "$1,308.61 " $388.85 $388.85 $80.82 $654.30 $213.25 $192.78 $384.96 $80.82 $738.81 $80.82 $388.85 $981.46 $427.73 $824.42 $956.59 $96.99 $80.82 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $80.82 $388.85 $466.62 $113.15 "$1,046.89 " $80.82 $80.82 $96.99 $544.39 $80.82 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $80.82 $981.46 $165.68 $80.82 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $67.70 $408.29 $388.85 $67.70 $80.82 $80.82 $291.64 $291.64 $291.64 $67.70 "$2,216.43 " 330104 88365 5672 306 310 HC INSITU HYBRIDIZATION (FISH) O $662.33 $188.66 $188.66 $80.82 $331.17 $271.78 $245.69 $186.77 $80.82 $358.45 $80.82 $188.66 $496.75 $207.53 $417.27 $484.16 $96.99 $80.82 $397.40 $529.86 $641.44 "$1,075.36 " $80.82 $188.66 $226.39 $113.15 $529.86 $80.82 $80.82 $96.99 $264.12 $80.82 $188.66 $188.66 $205.64 $529.86 $562.98 $80.82 $496.75 $165.68 $80.82 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $67.70 $198.09 $188.66 $67.70 $80.82 $80.82 $141.49 $141.49 $141.49 $67.70 "$1,075.36 " 330104 88364 306 310 HC INSITU HYBRIDIZATION (FISH) O $224.70 N/A N/A $80.82 $112.35 $205.25 $185.55 $162.56 $80.82 N/A $80.82 N/A $168.52 N/A $141.56 $164.26 $96.99 $80.82 $134.82 $179.76 N/A N/A $80.82 N/A $146.06 $113.15 $179.76 $80.82 $80.82 $96.99 N/A $80.82 N/A N/A N/A $179.76 $190.99 $109.11 $168.52 $165.68 $109.11 $112.35 $146.06 N/A N/A N/A N/A $84.20 N/A N/A $84.20 $80.82 $80.82 N/A N/A N/A $80.82 $205.25 330104 88363 5731 391 310 HC XM ARCHIVE TISSUE MOLEC ANAL O $108.07 $29.95 $29.95 N/A $54.03 $27.75 $25.08 $29.65 N/A $56.90 N/A $29.95 $81.05 $32.94 $68.08 $79.00 N/A N/A $64.84 $86.46 $101.81 $170.69 N/A $29.95 $35.93 N/A $86.46 N/A N/A N/A $41.92 N/A $29.95 $29.95 $32.64 $86.46 $91.86 N/A $81.05 N/A N/A $54.03 $80.55 $42.07 $42.07 $42.07 $42.07 $13.25 $31.44 $29.95 $13.25 N/A N/A $22.46 $22.46 $22.46 $13.25 $170.69 330104 88362 5674 306 310 HC NERVE TEASING PREPARATIONS O "$2,895.42 " $931.61 $931.61 $80.82 "$1,447.71 " $338.48 $305.98 $922.29 $80.82 "$1,770.06 " $80.82 $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " $96.99 $80.82 "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " $80.82 $931.61 "$1,117.93 " $113.15 "$2,316.34 " $80.82 $80.82 $96.99 "$1,304.25 " $80.82 $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " $80.82 "$2,171.57 " $165.68 $80.82 "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $67.70 $978.19 $931.61 $67.70 $80.82 $80.82 $698.71 $698.71 $698.71 $67.70 "$5,310.18 " 330104 88332 158 310 HC PATH CONSULT INTRAOP ADDL O $219.35 N/A N/A N/A $109.67 $80.71 $72.96 $63.92 N/A N/A N/A N/A $164.51 N/A $138.19 $160.34 N/A N/A $131.61 $175.48 N/A N/A N/A N/A $142.58 N/A $175.48 N/A N/A N/A N/A N/A N/A N/A N/A $175.48 $186.45 N/A $164.51 N/A N/A $109.67 $142.58 N/A N/A N/A N/A $20.48 N/A N/A $20.48 N/A N/A N/A N/A N/A $20.48 $186.45 330104 88348 5674 306 310 HC ELECTRON MICROSCOPY O "$2,895.42 " $931.61 $931.61 $80.82 "$1,447.71 " $718.54 $649.56 $922.29 $80.82 "$1,770.06 " $80.82 $931.61 "$2,171.57 " "$1,024.77 " "$1,824.11 " "$2,116.55 " $96.99 $80.82 "$1,737.25 " "$2,316.34 " "$3,167.47 " "$5,310.18 " $80.82 $931.61 "$1,117.93 " $113.15 "$2,316.34 " $80.82 $80.82 $96.99 "$1,304.25 " $80.82 $931.61 $931.61 "$1,015.46 " "$2,316.34 " "$2,461.11 " $80.82 "$2,171.57 " $165.68 $80.82 "$1,447.71 " "$2,506.03 " "$1,308.91 " "$1,308.91 " "$1,308.91 " "$1,308.91 " $180.94 $978.19 $931.61 $180.94 $80.82 $80.82 $698.71 $698.71 $698.71 $80.82 "$5,310.18 " 330104 88360 5672 306 310 HC TUMOR IMMUNOHISTOCHEM/MANUAL O $662.33 $188.66 $188.66 $25.37 $331.17 $176.02 $159.13 $186.77 $25.37 $358.45 $25.37 $188.66 $496.75 $207.53 $417.27 $484.16 $30.44 $25.37 $397.40 $529.86 $641.44 "$1,075.36 " $25.37 $188.66 $226.39 $35.52 $529.86 $25.37 $25.37 $30.44 $264.12 $25.37 $188.66 $188.66 $205.64 $529.86 $562.98 $25.37 $496.75 $52.01 $25.37 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $43.78 $198.09 $188.66 $43.78 $25.37 $25.37 $141.49 $141.49 $141.49 $25.37 "$1,075.36 " 330104 80503 5671 158 310 HC PATHOLOGY CLINICAL CONSULTATION SF MDM 5-20 MIN O $214.00 $60.15 $60.15 $15.99 $107.00 $31.46 $28.44 $59.55 $15.99 $114.29 $15.99 $60.15 $160.50 $66.17 $134.82 $156.43 $19.19 $15.99 $128.40 $171.20 $204.53 $342.88 $15.99 $60.15 $72.19 $22.39 $171.20 $15.99 $15.99 $19.19 $84.22 $15.99 $60.15 $60.15 $65.57 $171.20 $181.90 $15.99 $160.50 $32.78 $15.99 $107.00 $161.82 $84.52 $84.52 $84.52 $84.52 N/A $63.16 $60.15 $142.74 $15.99 $15.99 $45.12 $45.12 $45.12 $15.99 $342.88 330104 0037U 2045 310 HC FOUNDATIONONE CDX O "$12,740.49 " "$3,500.00 " "$3,500.00 " N/A "$6,370.24 " N/A N/A "$8,332.28 " N/A "$6,650.00 " N/A "$3,500.00 " "$9,555.37 " "$3,850.00 " "$8,026.51 " "$9,313.30 " N/A N/A "$7,644.29 " "$10,192.39 " "$11,900.00 " "$19,950.00 " N/A "$3,500.00 " N/A N/A "$10,192.39 " N/A N/A N/A "$4,900.00 " N/A "$3,500.00 " "$3,500.00 " "$3,815.00 " "$10,192.39 " "$10,829.42 " N/A "$9,555.37 " N/A N/A "$6,370.24 " "$8,281.32 " "$4,917.50 " "$4,917.50 " "$4,917.50 " "$4,917.50 " "$4,200.00 " "$3,675.00 " "$3,500.00 " "$4,200.00 " N/A N/A "$2,625.00 " "$2,625.00 " "$2,625.00 " "$2,625.00 " "$19,950.00 " 330104 88342 5672 306 310 HC IMMUNOHISTO ANTIBODY SLIDE O $662.33 $188.66 $188.66 $25.37 $331.17 $149.29 $134.96 $186.77 $25.37 $358.45 $25.37 $188.66 $496.75 $207.53 $417.27 $484.16 $30.44 $25.37 $397.40 $529.86 $641.44 "$1,075.36 " $25.37 $188.66 $226.39 $35.52 $529.86 $25.37 $25.37 $30.44 $264.12 $25.37 $188.66 $188.66 $205.64 $529.86 $562.98 $25.37 $496.75 $52.01 $25.37 $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $43.78 $198.09 $188.66 $43.78 $25.37 $25.37 $141.49 $141.49 $141.49 $25.37 "$1,075.36 " 330104 80504 5672 158 310 HC PATHOLOGY CLINICAL CONSULTATION MOD MDM 21-40MIN O $642.00 $188.66 $188.66 $31.97 $321.00 $67.72 $61.22 $186.77 $31.97 $358.45 $31.97 $188.66 $481.50 $207.53 $404.46 $469.30 $38.36 $31.97 $385.20 $513.60 $641.44 "$1,075.36 " $31.97 $188.66 $226.39 $44.76 $513.60 $31.97 $31.97 $38.36 $264.12 $31.97 $188.66 $188.66 $205.64 $513.60 $545.70 $31.97 $481.50 $65.54 $31.97 $321.00 $507.49 $265.07 $265.07 $265.07 $265.07 N/A $198.09 $188.66 $428.21 $31.97 $31.97 $141.49 $141.49 $141.49 $31.97 "$1,075.36 " 330104 81243 385 310 HC FMR1 GENE DETECTION O $544.63 $57.04 $57.04 N/A $272.31 N/A N/A N/A N/A $108.38 N/A $57.04 $408.47 $62.74 $343.12 $398.12 N/A N/A $326.78 $435.70 $193.94 $325.13 N/A $57.04 $354.01 N/A $435.70 N/A N/A N/A $79.86 N/A $57.04 $57.04 $62.17 $435.70 $462.94 N/A $408.47 N/A N/A $272.31 $354.01 $80.14 $80.14 $80.14 $80.14 $68.45 $59.89 $57.04 $68.45 N/A N/A $42.78 $42.78 $42.78 $42.78 $462.94 330104 88331 5672 158 310 HC PATH CONSULT INTRAOP 1 BLOC O $662.33 $188.66 $188.66 N/A $331.17 $149.09 $134.77 $186.77 N/A $358.45 N/A $188.66 $496.75 $207.53 $417.27 $484.16 N/A N/A $397.40 $529.86 $641.44 "$1,075.36 " N/A $188.66 $226.39 N/A $529.86 N/A N/A N/A $264.12 N/A $188.66 $188.66 $205.64 $529.86 $562.98 N/A $496.75 N/A N/A $331.17 $507.49 $265.07 $265.07 $265.07 $265.07 $43.78 $198.09 $188.66 $43.78 N/A N/A $141.49 $141.49 $141.49 $43.78 "$1,075.36 " 330104 88334 158 310 HC INTRAOPERATIVE CYTO PATH CONSULT ADD SITES O $151.94 N/A N/A N/A $75.97 $81.38 $73.56 $64.45 N/A N/A N/A N/A $113.95 N/A $95.72 $111.07 N/A N/A $91.16 $121.55 N/A N/A N/A N/A $98.76 N/A $121.55 N/A N/A N/A N/A N/A N/A N/A N/A $121.55 $129.15 N/A $113.95 N/A N/A $75.97 $98.76 N/A N/A N/A N/A $20.48 N/A N/A $20.48 N/A N/A N/A N/A N/A $20.48 $129.15 330104 88341 306 310 HC IMMUNOHISTO ANTIBODY SLIDE PER EA ADDL O $157.29 N/A N/A $25.37 $78.64 $128.70 $116.35 $101.93 $25.37 N/A $25.37 N/A $117.97 N/A $99.09 $114.98 $30.44 $25.37 $94.37 $125.83 N/A N/A $25.37 N/A $102.24 $35.52 $125.83 $25.37 $25.37 $30.44 N/A $25.37 N/A N/A N/A $125.83 $133.70 $34.25 $117.97 $52.01 $34.25 $78.64 $102.24 N/A N/A N/A N/A $54.56 N/A N/A $54.56 $25.37 $25.37 N/A N/A N/A $25.37 $133.70 330104 81257 385 310 HC HBA1/HBA2 GENE O "$1,127.78 " $102.26 $102.26 N/A $563.89 N/A N/A N/A N/A $194.29 N/A $102.26 $845.84 $112.49 $710.50 $824.41 N/A N/A $676.67 $902.22 $347.68 $582.88 N/A $102.26 $733.06 N/A $902.22 N/A N/A N/A $143.16 N/A $102.26 $102.26 $111.46 $902.22 $958.61 N/A $845.84 N/A N/A $563.89 $733.06 $143.68 $143.68 $143.68 $143.68 $122.71 $107.37 $102.26 $122.71 N/A N/A $76.70 $76.70 $76.70 $76.70 $958.61 330104 88164 392 311 HC CYTOPATH TBS C/V MANUAL O $53.50 $17.31 $17.31 $14.65 $26.75 N/A N/A N/A $14.65 $32.89 $14.65 $17.31 $40.12 $19.04 $33.70 $39.11 $17.58 $14.65 $32.10 $42.80 $58.85 $98.67 $14.65 $17.31 $34.77 $20.51 $42.80 $14.65 $14.65 $17.58 $24.23 $14.65 $17.31 $17.31 $18.87 $42.80 $45.48 $19.78 $40.12 $30.03 $19.78 $26.75 $34.77 $24.32 $24.32 $24.32 $24.32 $17.84 $18.18 $17.31 $17.84 $14.65 $14.65 $12.98 $12.98 $12.98 $12.98 $98.67 330104 88291 158 311 HC CYTO/MOLECULAR REPORT O $359.52 N/A N/A $20.00 $179.76 $46.78 $42.29 $37.05 $20.00 N/A $20.00 N/A $269.64 N/A $226.50 $262.81 $24.00 $20.00 $215.71 $287.62 N/A N/A $20.00 N/A $233.69 $28.00 $287.62 $20.00 $20.00 $24.00 N/A $20.00 N/A N/A N/A $287.62 $305.59 $27.00 $269.64 $41.00 $27.00 $179.76 $233.69 N/A N/A N/A N/A $35.06 N/A N/A $35.06 $20.00 $20.00 N/A N/A N/A $20.00 $305.59 330104 88280 385 311 HC CHROMOSOME KARYOTYPE STUDY O $398.04 $33.47 $33.47 $10.00 $199.02 N/A N/A N/A $10.00 $63.59 $10.00 $33.47 $298.53 $36.82 $250.77 $290.97 $12.00 $10.00 $238.82 $318.43 $113.80 $190.78 $10.00 $33.47 $258.73 $14.00 $318.43 $10.00 $10.00 $12.00 $46.86 $10.00 $33.47 $33.47 $36.48 $318.43 $338.33 $13.50 $298.53 $20.50 $13.50 $199.02 $258.73 $47.03 $47.03 $47.03 $47.03 $42.38 $35.14 $33.47 $42.38 $10.00 $10.00 $25.10 $25.10 $25.10 $10.00 $338.33 330104 88275 385 311 HC CYTOGENETICS 100-300 O $846.37 $51.19 $51.19 $51.19 $423.19 N/A N/A N/A $51.19 $97.26 $51.19 $51.19 $634.78 $56.31 $533.21 $618.70 $61.43 $51.19 $507.82 $677.10 $174.05 $291.78 $51.19 $51.19 $550.14 $71.67 $677.10 $51.19 $51.19 $61.43 $71.67 $51.19 $51.19 $51.19 $55.80 $677.10 $719.41 $69.11 $634.78 $104.94 $69.11 $423.19 $550.14 $71.92 $71.92 $71.92 $71.92 $67.81 $53.75 $51.19 $67.81 $51.19 $51.19 $38.39 $38.39 $38.39 $38.39 $719.41 330104 88235 308 311 HC TISSUE CULTURE PLACENTA O $553.19 $150.30 $150.30 $131.91 $276.60 N/A N/A N/A $131.91 $285.57 $131.91 $150.30 $414.89 $165.33 $348.51 $404.38 $158.29 $131.91 $331.91 $442.55 $511.02 $856.71 $131.91 $150.30 $359.57 $184.67 $442.55 $131.91 $131.91 $158.29 $210.42 $131.91 $150.30 $150.30 $163.83 $442.55 $470.21 $178.08 $414.89 $270.42 $178.08 $276.60 $359.57 $211.17 $211.17 $211.17 $211.17 $248.66 $157.82 $150.30 $248.66 $131.91 $131.91 $112.73 $112.73 $112.73 $112.73 $856.71 330104 88177 391 311 HC CYTP FNA EVAL EA ADDL O $99.51 N/A N/A N/A $49.76 $42.35 $38.29 $33.54 N/A N/A N/A N/A $74.63 N/A $62.69 $72.74 N/A N/A $59.71 $79.61 N/A N/A N/A N/A $64.68 N/A $79.61 N/A N/A N/A N/A N/A N/A N/A N/A $79.61 $84.58 N/A $74.63 N/A N/A $49.76 $64.68 N/A N/A N/A N/A $13.25 N/A N/A $13.25 N/A N/A N/A N/A N/A $13.25 $84.58 330104 88173 5671 158 311 HC CYTOPATH EVAL FNA REPORT O $306.02 $60.15 $60.15 $19.12 $153.01 $240.54 $217.45 $59.55 $19.12 $114.29 $19.12 $60.15 $229.51 $66.17 $192.79 $223.70 $22.94 $19.12 $183.61 $244.82 $204.53 $342.88 $19.12 $60.15 $72.19 $26.77 $244.82 $19.12 $19.12 $22.94 $84.22 $19.12 $60.15 $60.15 $65.57 $244.82 $260.12 $19.12 $229.51 $39.20 $19.12 $153.01 $161.82 $84.52 $84.52 $84.52 $84.52 $43.78 $63.16 $60.15 $43.78 $19.12 $19.12 $45.12 $45.12 $45.12 $19.12 $342.88 330104 88172 5672 308 311 HC CYTP DX EVAL FNA 1ST EA SITE O $671.96 $188.66 $188.66 $86.27 $335.98 $81.08 $73.29 $186.77 $86.27 $358.45 $86.27 $188.66 $503.97 $207.53 $423.33 $491.20 $103.53 $86.27 $403.18 $537.57 $641.44 "$1,075.36 " $86.27 $188.66 $226.39 $120.78 $537.57 $86.27 $86.27 $103.53 $264.12 $86.27 $188.66 $188.66 $205.64 $537.57 $571.17 $86.27 $503.97 $176.86 $86.27 $335.98 $507.49 $265.07 $265.07 $265.07 $265.07 $20.48 $198.09 $188.66 $20.48 $86.27 $86.27 $141.49 $141.49 $141.49 $20.48 "$1,075.36 " 330104 88108 5732 391 311 HC CYTOPATH CONCENTRATE TECH O $340.26 $40.74 $40.74 $19.12 $170.13 $99.16 $89.64 $40.34 $19.12 $77.41 $19.12 $40.74 $255.19 $44.82 $214.36 $248.73 $22.94 $19.12 $204.16 $272.21 $138.53 $232.24 $19.12 $40.74 $48.89 $26.77 $272.21 $19.12 $19.12 $22.94 $57.04 $19.12 $40.74 $40.74 $44.41 $272.21 $289.22 $19.12 $255.19 $39.20 $19.12 $170.13 $109.60 $57.24 $57.24 $57.24 $57.24 $20.48 $42.78 $40.74 $20.48 $19.12 $19.12 $30.56 $30.56 $30.56 $19.12 $289.22 330104 88104 5732 391 311 HC CYTOPATH FL NONGYN SMEARS O $260.01 $40.74 $40.74 $19.12 $130.00 $103.45 $93.52 $40.34 $19.12 $77.41 $19.12 $40.74 $195.01 $44.82 $163.81 $190.07 $22.94 $19.12 $156.01 $208.01 $138.53 $232.24 $19.12 $40.74 $48.89 $26.77 $208.01 $19.12 $19.12 $22.94 $57.04 $19.12 $40.74 $40.74 $44.41 $208.01 $221.01 $19.12 $195.01 $39.20 $19.12 $130.00 $109.60 $57.24 $57.24 $57.24 $57.24 $20.48 $42.78 $40.74 $20.48 $19.12 $19.12 $30.56 $30.56 $30.56 $19.12 $232.24 330104 88263 386 311 HC MICROBIOLOGY PROCEDURE O $606.69 $150.29 $150.29 $100.00 $303.35 N/A N/A N/A $100.00 $285.55 $100.00 $150.29 $455.02 $165.32 $382.21 $443.49 $120.00 $100.00 $364.01 $485.35 $510.99 $856.65 $100.00 $150.29 $394.35 $140.00 $485.35 $100.00 $100.00 $120.00 $210.41 $100.00 $150.29 $150.29 $163.82 $485.35 $515.69 $135.00 $455.02 $205.00 $135.00 $303.35 $394.35 $211.16 $211.16 $211.16 $211.16 $253.78 $157.80 $150.29 $253.78 $100.00 $100.00 $112.72 $112.72 $112.72 $100.00 $856.65 330104 88189 391 311 HC FLOWCYTOMETRY/READ 16 & > O $129.47 $95.02 $95.02 $30.00 $64.73 $118.77 $107.37 $94.07 $30.00 $180.53 $30.00 $95.02 $97.10 $104.52 $81.57 $94.64 $36.00 $30.00 $77.68 $103.58 $323.06 $541.60 $30.00 $95.02 $84.16 $42.00 $103.58 $30.00 $30.00 $36.00 $133.02 $30.00 $95.02 $95.02 $103.57 $103.58 $110.05 $40.50 $97.10 $61.50 $40.50 $64.73 $84.16 $133.50 $133.50 $133.50 $133.50 $43.78 $99.77 $95.02 $43.78 $30.00 $30.00 $71.26 $71.26 $71.26 $30.00 $541.60 330104 88188 391 311 HC FLOWCYTOMETRY/READ 9-15 O $107.00 $70.63 $70.63 $25.00 $53.50 $88.29 $79.81 $69.93 $25.00 $134.20 $25.00 $70.63 $80.25 $77.70 $67.41 $78.22 $30.00 $25.00 $64.20 $85.60 $240.15 $402.60 $25.00 $70.63 $69.55 $35.00 $85.60 $25.00 $25.00 $30.00 $98.89 $25.00 $70.63 $70.63 $76.99 $85.60 $90.95 $33.75 $80.25 $51.25 $33.75 $53.50 $69.55 $99.24 $99.24 $99.24 $99.24 $43.78 $74.16 $70.63 $43.78 $25.00 $25.00 $52.97 $52.97 $52.97 $25.00 $402.60 330104 88187 391 311 HC FLOWCYTOMETRY/READ 2-8 O $205.44 $40.29 $40.29 $20.00 $102.72 $50.36 $45.52 $39.88 $20.00 $76.54 $20.00 $40.29 $154.08 $44.32 $129.43 $150.18 $24.00 $20.00 $123.26 $164.35 $136.97 $229.63 $20.00 $40.29 $133.54 $28.00 $164.35 $20.00 $20.00 $24.00 $56.40 $20.00 $40.29 $40.29 $43.91 $164.35 $174.62 $27.00 $154.08 $41.00 $27.00 $102.72 $133.54 $56.60 $56.60 $56.60 $56.60 $13.25 $42.30 $40.29 $13.25 $20.00 $20.00 $30.21 $30.21 $30.21 $13.25 $229.63 330104 88185 391 311 HC FLOWCYTOMETRY/TC ADD-ON O $218.28 N/A N/A $15.45 $109.14 $36.45 $32.95 $28.87 $15.45 N/A $15.45 N/A $163.71 N/A $137.52 $159.56 $18.54 $15.45 $130.97 $174.62 N/A N/A $15.45 N/A $141.88 $21.63 $174.62 $15.45 $15.45 $18.54 N/A $15.45 N/A N/A N/A $174.62 $185.54 $20.86 $163.71 $31.67 $20.86 $109.14 $141.88 N/A N/A N/A N/A $20.48 N/A N/A $20.48 $15.45 $15.45 N/A N/A N/A $15.45 $185.54 330104 88184 5673 308 311 HC FLOWCYTOMETRY/ TC 1 MARKER O "$1,308.61 " $388.85 $388.85 $23.17 $654.30 $114.90 $103.87 $384.96 $23.17 $738.81 $23.17 $388.85 $981.46 $427.73 $824.42 $956.59 $27.80 $23.17 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $23.17 $388.85 $466.62 $32.44 "$1,046.89 " $23.17 $23.17 $27.80 $544.39 $23.17 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $23.17 $981.46 $47.50 $23.17 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $20.48 $408.29 $388.85 $20.48 $23.17 $23.17 $291.64 $291.64 $291.64 $20.48 "$2,216.43 " 330104 88142 392 311 HC SCREEN CYTOPATH C/V THIN LAYER O $318.86 $20.26 $20.26 $20.26 $159.43 N/A N/A N/A $20.26 $38.49 $20.26 $20.26 $239.15 $22.29 $200.88 $233.09 $24.31 $20.26 $191.32 $255.09 $68.88 $115.48 $20.26 $20.26 $207.26 $28.36 $255.09 $20.26 $20.26 $24.31 $28.36 $20.26 $20.26 $20.26 $22.08 $255.09 $271.03 $27.35 $239.15 $41.53 $27.35 $159.43 $207.26 $28.47 $28.47 $28.47 $28.47 $34.21 $21.27 $20.26 $34.21 $20.26 $20.26 $15.20 $15.20 $15.20 $15.20 $271.03 330104 88262 385 311 HC CHROMOSOME ANALYSIS 15-20 O "$1,959.17 " $125.49 $125.49 $100.00 $979.59 N/A N/A N/A $100.00 $238.43 $100.00 $125.49 "$1,469.38 " $138.04 "$1,234.28 " "$1,432.15 " $120.00 $100.00 "$1,175.50 " "$1,567.34 " $426.67 $715.29 $100.00 $125.49 "$1,273.46 " $140.00 "$1,567.34 " $100.00 $100.00 $120.00 $175.69 $100.00 $125.49 $125.49 $136.78 "$1,567.34 " "$1,665.29 " $135.00 "$1,469.38 " $205.00 $135.00 $979.59 "$1,273.46 " $176.31 $176.31 $176.31 $176.31 $210.48 $131.76 $125.49 $210.48 $100.00 $100.00 $94.12 $94.12 $94.12 $94.12 "$1,665.29 " 330104 88350 306 312 HC IMMUNOFLUOR ANTB ADDL STAIN O $160.50 N/A N/A $16.25 $80.25 $175.18 $158.36 $138.74 $16.25 N/A $16.25 N/A $120.38 N/A $101.11 $117.33 $19.50 $16.25 $96.30 $128.40 N/A N/A $16.25 N/A $104.33 $22.75 $128.40 $16.25 $16.25 $19.50 N/A $16.25 N/A N/A N/A $128.40 $136.42 $21.94 $120.38 $33.31 $21.94 $80.25 $104.33 N/A N/A N/A N/A $52.45 N/A N/A $52.45 $16.25 $16.25 N/A N/A N/A $16.25 $175.18 330104 88346 5673 306 312 HC IMMUNOFLUORESCENT STDY EA ANTIBDY; DRCT MTHD O "$1,308.61 " $388.85 $388.85 $19.25 $654.30 $228.60 $206.66 $384.96 $19.25 $738.81 $19.25 $388.85 $981.46 $427.73 $824.42 $956.59 $23.10 $19.25 $785.17 "$1,046.89 " "$1,322.08 " "$2,216.43 " $19.25 $388.85 $466.62 $26.95 "$1,046.89 " $19.25 $19.25 $23.10 $544.39 $19.25 $388.85 $388.85 $423.84 "$1,046.89 " "$1,112.32 " $19.25 $981.46 $39.46 $19.25 $654.30 "$1,046.00 " $546.33 $546.33 $546.33 $546.33 $43.78 $408.29 $388.85 $43.78 $19.25 $19.25 $291.64 $291.64 $291.64 $19.25 "$2,216.43 " 330104 73501 5521 471 320 HC X-RAY EXAM HIP UNI 1 VIEW O $476.15 $104.23 $104.23 $9.03 $238.07 $57.85 $52.59 $103.19 $9.03 $198.04 $9.03 $104.23 $357.11 $114.66 $299.97 $348.07 $10.84 $9.03 $285.69 $380.92 $354.39 $594.13 $9.03 $104.23 $125.08 $12.64 $380.92 $9.03 $9.03 $10.84 $145.93 $9.03 $104.23 $104.23 $113.61 $380.92 $404.73 $9.03 $357.11 $18.51 $9.03 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $9.03 $9.03 $88.60 $88.60 $104.23 $9.03 $594.13 330104 72190 5522 471 320 HC X-RAY EXAM OF PELVIS; COMPLETE MIN 3 VIEWS O $518.95 $128.23 $128.23 $20.00 $259.48 $73.76 $67.06 $126.95 $20.00 $243.63 $20.00 $128.23 $389.21 $141.05 $326.94 $379.35 $24.00 $20.00 $311.37 $415.16 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $415.16 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $415.16 $441.11 $20.00 $389.21 $41.00 $20.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $730.90 330104 72170 5522 471 320 HC X-RAY EXAM OF PELVIS 1 OR 2 VIEWS O "$1,006.87 " $128.23 $128.23 $12.50 $503.44 $49.11 $44.65 $126.95 $12.50 $243.63 $12.50 $128.23 $755.15 $141.05 $634.33 $736.02 $15.00 $12.50 $604.12 $805.50 $435.98 $730.90 $12.50 $128.23 $153.87 $17.50 $805.50 $12.50 $12.50 $15.00 $179.52 $12.50 $128.23 $128.23 $139.77 $805.50 $855.84 $12.50 $755.15 $25.62 $12.50 $503.44 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $12.50 $12.50 $108.99 $108.99 $128.23 $12.50 $855.84 330104 72120 5522 471 320 HC X-RAY BEND ONLY L-S SPINE O $589.57 $128.23 $128.23 $20.00 $294.79 $71.05 $64.59 $126.95 $20.00 $243.63 $20.00 $128.23 $442.18 $141.05 $371.43 $430.98 $24.00 $20.00 $353.74 $471.66 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $471.66 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $471.66 $501.13 $20.00 $442.18 $41.00 $20.00 $294.79 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $730.90 330104 72114 5522 471 320 HC X-RAY EXAM L-S SPINE BENDING O $480.43 $128.23 $128.23 $30.00 $240.22 $108.57 $98.70 $126.95 $30.00 $243.63 $30.00 $128.23 $360.32 $141.05 $302.67 $351.19 $36.00 $30.00 $288.26 $384.34 $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 $384.34 $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 $384.34 $408.37 $30.00 $360.32 $61.50 $30.00 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 $730.90 330104 72110 5522 471 320 HC X-RAY EXAM L-2 SPINE 4/>VWS O $934.11 $128.23 $128.23 $30.00 $467.06 $89.54 $81.40 $126.95 $30.00 $243.63 $30.00 $128.23 $700.58 $141.05 $588.49 $682.83 $36.00 $30.00 $560.47 $747.29 $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 $747.29 $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 $747.29 $793.99 $30.00 $700.58 $61.50 $30.00 $467.06 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 $793.99 330104 72100 5522 471 320 HC X-RAY EXAM L-S SPINE 2/3 VWS O $934.11 $128.23 $128.23 $15.00 $467.06 $69.88 $63.52 $126.95 $15.00 $243.63 $15.00 $128.23 $700.58 $141.05 $588.49 $682.83 $18.00 $15.00 $560.47 $747.29 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $747.29 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $747.29 $793.99 $15.00 $700.58 $30.75 $15.00 $467.06 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $793.99 330104 72084 5522 471 320 HC X-RAY EXAM ENTIRE SPI 6/> VWS O $480.43 $128.23 $128.23 $24.30 $240.22 $174.04 $158.22 $126.95 $24.30 $243.63 $24.30 $128.23 $360.32 $141.05 $302.67 $351.19 $29.16 $24.30 $288.26 $384.34 $435.98 $730.90 $24.30 $128.23 $153.87 $34.02 $384.34 $24.30 $24.30 $29.16 $179.52 $24.30 $128.23 $128.23 $139.77 $384.34 $408.37 $24.30 $360.32 $49.81 $24.30 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $307.15 $134.64 $128.23 $307.15 $24.30 $24.30 $108.99 $108.99 $128.23 $24.30 $730.90 330104 72083 5522 471 320 HC X-RAY EXAM ENTIRE SPI 4/5 VW O $480.43 $128.23 $128.23 $20.43 $240.22 $137.61 $125.10 $126.95 $20.43 $243.63 $20.43 $128.23 $360.32 $141.05 $302.67 $351.19 $24.52 $20.43 $288.26 $384.34 $435.98 $730.90 $20.43 $128.23 $153.87 $28.60 $384.34 $20.43 $20.43 $24.52 $179.52 $20.43 $128.23 $128.23 $139.77 $384.34 $408.37 $20.43 $360.32 $41.88 $20.43 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $307.15 $134.64 $128.23 $307.15 $20.43 $20.43 $108.99 $108.99 $128.23 $20.43 $730.90 330104 72082 5522 471 320 HC X-RAY ENTIRE SPINE 2/3 VWS O $518.95 $128.23 $128.23 $18.81 $259.48 $123.17 $111.98 $126.95 $18.81 $243.63 $18.81 $128.23 $389.21 $141.05 $326.94 $379.35 $22.57 $18.81 $311.37 $415.16 $435.98 $730.90 $18.81 $128.23 $153.87 $26.33 $415.16 $18.81 $18.81 $22.57 $179.52 $18.81 $128.23 $128.23 $139.77 $415.16 $441.11 $18.81 $389.21 $38.56 $18.81 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $161.10 $134.64 $128.23 $161.10 $18.81 $18.81 $108.99 $108.99 $128.23 $18.81 $730.90 330104 72081 5521 471 320 HC X-RAY ENTIRE SPINE 1 VW O $376.64 $104.23 $104.23 $11.72 $188.32 $74.27 $67.52 $103.19 $11.72 $198.04 $11.72 $104.23 $282.48 $114.66 $237.28 $275.32 $14.06 $11.72 $225.98 $301.31 $354.39 $594.13 $11.72 $104.23 $125.08 $16.41 $301.31 $11.72 $11.72 $14.06 $145.93 $11.72 $104.23 $104.23 $113.61 $301.31 $320.14 $11.72 $282.48 $24.03 $11.72 $188.32 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $11.72 $11.72 $88.60 $88.60 $104.23 $11.72 $594.13 330104 72072 5522 471 320 HC X-RAY EXAM THORAC SPINE 3VIEWS O $518.95 $128.23 $128.23 $30.00 $259.48 $68.63 $62.39 $126.95 $30.00 $243.63 $30.00 $128.23 $389.21 $141.05 $326.94 $379.35 $36.00 $30.00 $311.37 $415.16 $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 $415.16 $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 $415.16 $441.11 $30.00 $389.21 $61.50 $30.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 $730.90 330104 72070 5522 471 320 HC X-RAY EXAM THORAC SPINE 2VIEWS O $930.90 $128.23 $128.23 $15.00 $465.45 $57.69 $52.45 $126.95 $15.00 $243.63 $15.00 $128.23 $698.17 $141.05 $586.47 $680.49 $18.00 $15.00 $558.54 $744.72 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $744.72 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $744.72 $791.26 $15.00 $698.17 $30.75 $15.00 $465.45 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $791.26 330104 72052 5522 471 320 HC X-RAY EXAM NECK SPINE 6/>VWS O $996.17 $128.23 $128.23 $30.00 $498.08 $109.15 $99.23 $126.95 $30.00 $243.63 $30.00 $128.23 $747.13 $141.05 $627.59 $728.20 $36.00 $30.00 $597.70 $796.94 $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 $796.94 $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 $796.94 $846.74 $30.00 $747.13 $61.50 $30.00 $498.08 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 $846.74 330104 72050 5522 471 320 HC X-RAY EXAM NECK SPINE 4/5VWS O $826.04 $128.23 $128.23 $20.00 $413.02 $92.99 $84.54 $126.95 $20.00 $243.63 $20.00 $128.23 $619.53 $141.05 $520.41 $603.84 $24.00 $20.00 $495.62 $660.83 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $660.83 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $660.83 $702.13 $20.00 $619.53 $41.00 $20.00 $413.02 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $730.90 330104 72040 5521 471 320 HC X-RAY EXAM NECK SPINE 2-3 VW O $861.35 $104.23 $104.23 $15.00 $430.68 $69.29 $62.99 $103.19 $15.00 $198.04 $15.00 $104.23 $646.01 $114.66 $542.65 $629.65 $18.00 $15.00 $516.81 $689.08 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $689.08 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $689.08 $732.15 $15.00 $646.01 $30.75 $15.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $732.15 330104 72020 5521 471 320 HC X-RAY EXAM OF SPINE 1 VIEW O $772.54 $104.23 $104.23 $10.00 $386.27 $43.31 $39.38 $103.19 $10.00 $198.04 $10.00 $104.23 $579.40 $114.66 $486.70 $564.73 $12.00 $10.00 $463.52 $618.03 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $618.03 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $618.03 $656.66 $10.00 $579.40 $20.50 $10.00 $386.27 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $656.66 330104 72200 5522 471 320 HC X-RAY EXAM SI JOINTS; <3VIEWS O $480.43 $128.23 $128.23 $12.50 $240.22 $57.92 $52.66 $126.95 $12.50 $243.63 $12.50 $128.23 $360.32 $141.05 $302.67 $351.19 $15.00 $12.50 $288.26 $384.34 $435.98 $730.90 $12.50 $128.23 $153.87 $17.50 $384.34 $12.50 $12.50 $15.00 $179.52 $12.50 $128.23 $128.23 $139.77 $384.34 $408.37 $12.50 $360.32 $25.62 $12.50 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $12.50 $12.50 $108.99 $108.99 $128.23 $12.50 $730.90 330104 72202 5522 471 320 HC X-RAY EXAM SI JOINTS 3 OR MORE VIEWS O $728.67 $128.23 $128.23 $20.00 $364.33 $68.63 $62.39 $126.95 $20.00 $243.63 $20.00 $128.23 $546.50 $141.05 $459.06 $532.66 $24.00 $20.00 $437.20 $582.94 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $582.94 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $582.94 $619.37 $20.00 $546.50 $41.00 $20.00 $364.33 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $730.90 330104 72220 5521 471 320 HC X-RAY EXAM SACRUM TAILBONE O $600.27 $104.23 $104.23 $15.00 $300.13 $57.33 $52.12 $103.19 $15.00 $198.04 $15.00 $104.23 $450.20 $114.66 $378.17 $438.80 $18.00 $15.00 $360.16 $480.22 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $480.22 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $480.22 $510.23 $15.00 $450.20 $30.75 $15.00 $300.13 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 72270 5573 284 320 HC MYELOGPHY 2/> SPINE REGIONS O "$4,351.69 " $888.71 $888.71 N/A "$2,175.85 " $284.33 $258.48 $879.82 N/A "$1,688.54 " N/A $888.71 "$3,263.77 " $977.58 "$2,741.56 " "$3,181.09 " N/A N/A "$2,611.01 " "$3,481.35 " "$3,021.61 " "$5,065.63 " N/A $888.71 "$1,066.45 " N/A "$3,481.35 " N/A N/A N/A "$1,244.19 " N/A $888.71 $888.71 $968.69 "$3,481.35 " "$3,698.94 " N/A "$3,263.77 " N/A N/A "$2,175.85 " "$2,390.62 " "$1,399.71 " "$1,399.71 " "$1,399.71 " "$1,399.71 " $798.56 $933.14 $888.71 $798.56 N/A N/A $755.40 $755.40 $888.71 $258.48 "$5,065.63 " 330104 73140 5521 471 320 HC X-RAY EXAM OF FINGER(S); MIN 2 VIEWS O $708.34 $104.23 $104.23 $7.50 $354.17 $67.03 $60.94 $103.19 $7.50 $198.04 $7.50 $104.23 $531.25 $114.66 $446.25 $517.80 $9.00 $7.50 $425.00 $566.67 $354.39 $594.13 $7.50 $104.23 $125.08 $10.50 $566.67 $7.50 $7.50 $9.00 $145.93 $7.50 $104.23 $104.23 $113.61 $566.67 $602.09 $7.50 $531.25 $15.37 $7.50 $354.17 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $7.50 $7.50 $88.60 $88.60 $104.23 $7.50 $602.09 330104 73130 5521 471 320 HC X-RAY EXAM OF HAND; MIN 3 VIEWS O $861.35 $104.23 $104.23 $12.50 $430.68 $64.97 $59.06 $103.19 $12.50 $198.04 $12.50 $104.23 $646.01 $114.66 $542.65 $629.65 $15.00 $12.50 $516.81 $689.08 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $689.08 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $689.08 $732.15 $12.50 $646.01 $25.62 $12.50 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $732.15 330104 73120 5522 471 320 HC X-RAY EXAM OF HAND; 2 VIEWS O $518.95 $128.23 $128.23 $10.00 $259.48 $55.06 $50.05 $126.95 $10.00 $243.63 $10.00 $128.23 $389.21 $141.05 $326.94 $379.35 $12.00 $10.00 $311.37 $415.16 $435.98 $730.90 $10.00 $128.23 $153.87 $14.00 $415.16 $10.00 $10.00 $12.00 $179.52 $10.00 $128.23 $128.23 $139.77 $415.16 $441.11 $10.00 $389.21 $20.50 $10.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $10.00 $10.00 $108.99 $108.99 $128.23 $10.00 $730.90 330104 73100 5521 471 320 HC X-RAY EXAM OF WRIST; 2 VIEWS O $792.87 $104.23 $104.23 $10.00 $396.44 $59.76 $54.33 $103.19 $10.00 $198.04 $10.00 $104.23 $594.65 $114.66 $499.51 $579.59 $12.00 $10.00 $475.72 $634.30 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $634.30 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $634.30 $673.94 $10.00 $594.65 $20.50 $10.00 $396.44 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $673.94 330104 73092 5522 471 320 HC X-RAY EXAM OF ARM INFANT O $518.95 $128.23 $128.23 $10.00 $259.48 $55.65 $50.59 $126.95 $10.00 $243.63 $10.00 $128.23 $389.21 $141.05 $326.94 $379.35 $12.00 $10.00 $311.37 $415.16 $435.98 $730.90 $10.00 $128.23 $153.87 $14.00 $415.16 $10.00 $10.00 $12.00 $179.52 $10.00 $128.23 $128.23 $139.77 $415.16 $441.11 $10.00 $389.21 $20.50 $10.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $10.00 $10.00 $108.99 $108.99 $128.23 $10.00 $730.90 330104 73090 5521 471 320 HC X-RAY EXAM OF FOREARM; 2 VIEWS O $861.35 $104.23 $104.23 $10.00 $430.68 $51.54 $46.85 $103.19 $10.00 $198.04 $10.00 $104.23 $646.01 $114.66 $542.65 $629.65 $12.00 $10.00 $516.81 $689.08 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $689.08 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $689.08 $732.15 $10.00 $646.01 $20.50 $10.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $732.15 330104 73080 5521 471 320 HC X-RAY EXAM OF ELBOW;COMPLETE MIN 3 VIEWS O $465.45 $104.23 $104.23 $12.50 $232.72 $57.33 $52.12 $103.19 $12.50 $198.04 $12.50 $104.23 $349.09 $114.66 $293.23 $340.24 $15.00 $12.50 $279.27 $372.36 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $372.36 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $372.36 $395.63 $12.50 $349.09 $25.62 $12.50 $232.72 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $594.13 330104 73502 5521 471 320 HC X-RAY EXAM HIP UNI 2-3 VIEWS O $988.68 $104.23 $104.23 $12.47 $494.34 $82.21 $74.74 $103.19 $12.47 $198.04 $12.47 $104.23 $741.51 $114.66 $622.87 $722.73 $14.96 $12.47 $593.21 $790.94 $354.39 $594.13 $12.47 $104.23 $125.08 $17.46 $790.94 $12.47 $12.47 $14.96 $145.93 $12.47 $104.23 $104.23 $113.61 $790.94 $840.38 $12.47 $741.51 $25.56 $12.47 $494.34 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $12.47 $12.47 $88.60 $88.60 $104.23 $12.47 $840.38 330104 73070 5521 471 320 HC X-RAY EXAM OF ELBOW;2 VIEWS O $861.35 $104.23 $104.23 $10.00 $430.68 $51.54 $46.85 $103.19 $10.00 $198.04 $10.00 $104.23 $646.01 $114.66 $542.65 $629.65 $12.00 $10.00 $516.81 $689.08 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $689.08 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $689.08 $732.15 $10.00 $646.01 $20.50 $10.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $732.15 330104 70355 5521 471 320 HC PANORAMIC X-RAY OF JAWS O $861.35 $104.23 $104.23 $13.00 $430.68 $31.26 $28.42 $103.19 $13.00 $198.04 $13.00 $104.23 $646.01 $114.66 $542.65 $629.65 $15.60 $13.00 $516.81 $689.08 $354.39 $594.13 $13.00 $104.23 $125.08 $18.20 $689.08 $13.00 $13.00 $15.60 $145.93 $13.00 $104.23 $104.23 $113.61 $689.08 $732.15 $13.00 $646.01 $26.65 $13.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $48.77 $109.45 $104.23 $48.77 $13.00 $13.00 $88.60 $88.60 $104.23 $13.00 $732.15 330104 73050 5521 471 320 HC X-RAY EXAM OF SHOULDERS O $792.87 $104.23 $104.23 $17.50 $396.44 $50.21 $45.65 $103.19 $17.50 $198.04 $17.50 $104.23 $594.65 $114.66 $499.51 $579.59 $21.00 $17.50 $475.72 $634.30 $354.39 $594.13 $17.50 $104.23 $125.08 $24.50 $634.30 $17.50 $17.50 $21.00 $145.93 $17.50 $104.23 $104.23 $113.61 $634.30 $673.94 $17.50 $594.65 $35.88 $17.50 $396.44 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $17.50 $17.50 $88.60 $88.60 $104.23 $17.50 $673.94 330104 73030 5521 471 320 HC X-RAY EXAM OF SHOULDER; COMPLETE MIN 2 VIEWS O $861.35 $104.23 $104.23 $15.00 $430.68 $60.78 $55.26 $103.19 $15.00 $198.04 $15.00 $104.23 $646.01 $114.66 $542.65 $629.65 $18.00 $15.00 $516.81 $689.08 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $689.08 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $689.08 $732.15 $15.00 $646.01 $30.75 $15.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $732.15 330104 73020 5521 471 320 HC X-RAY EXAM OF SHOULDER; 1 VIEW O $666.61 $104.23 $104.23 $10.00 $333.31 $38.10 $34.64 $103.19 $10.00 $198.04 $10.00 $104.23 $499.96 $114.66 $419.96 $487.29 $12.00 $10.00 $399.97 $533.29 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $533.29 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $533.29 $566.62 $10.00 $499.96 $20.50 $10.00 $333.31 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73010 5522 471 320 HC X-RAY EXAM OF SHOULDER BLADE O $600.27 $128.23 $128.23 $15.00 $300.13 $41.48 $37.71 $126.95 $15.00 $243.63 $15.00 $128.23 $450.20 $141.05 $378.17 $438.80 $18.00 $15.00 $360.16 $480.22 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $480.22 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $480.22 $510.23 $15.00 $450.20 $30.75 $15.00 $300.13 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $730.90 330104 73000 5521 471 320 HC X-RAY EXAM OF COLLAR BONE O $844.23 $104.23 $104.23 $10.00 $422.12 $56.82 $51.66 $103.19 $10.00 $198.04 $10.00 $104.23 $633.17 $114.66 $531.86 $617.13 $12.00 $10.00 $506.54 $675.38 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $675.38 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $675.38 $717.60 $10.00 $633.17 $20.50 $10.00 $422.12 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $717.60 330104 72275 474 320 HC EPIDUROGRAPHY O "$2,726.36 " N/A N/A $358.61 "$1,363.18 " N/A N/A "$1,783.04 " $358.61 N/A $358.61 N/A "$2,044.77 " N/A "$1,717.61 " "$1,992.97 " $430.34 $358.61 "$1,635.82 " "$2,181.09 " N/A N/A $358.61 N/A N/A $502.06 "$2,181.09 " $358.61 $358.61 $430.34 N/A $358.61 N/A N/A N/A "$2,181.09 " "$2,317.41 " $484.13 "$2,044.77 " $735.16 $484.13 "$1,363.18 " "$1,772.13 " N/A N/A N/A N/A N/A N/A N/A "$1,818.48 " $358.61 $358.61 N/A N/A N/A $358.61 "$2,317.41 " 330104 73060 5521 471 320 HC X-RAY EXAM OF HUMERUS O $600.27 $104.23 $104.23 $10.00 $300.13 $56.82 $51.66 $103.19 $10.00 $198.04 $10.00 $104.23 $450.20 $114.66 $378.17 $438.80 $12.00 $10.00 $360.16 $480.22 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $480.22 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $480.22 $510.23 $10.00 $450.20 $20.50 $10.00 $300.13 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73110 5521 471 320 HC X-RAY EXAM OF WRIST; COMPLETE MIN 3 VIEWS O $861.35 $104.23 $104.23 $12.50 $430.68 $72.02 $65.47 $103.19 $12.50 $198.04 $12.50 $104.23 $646.01 $114.66 $542.65 $629.65 $15.00 $12.50 $516.81 $689.08 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $689.08 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $689.08 $732.15 $12.50 $646.01 $25.62 $12.50 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $732.15 330104 77091 5521 291 320 HC TBS TECHNICAL CALCULATION ONLY O $321.00 $104.23 $104.23 N/A $160.50 $49.87 $45.33 $103.19 N/A $198.04 N/A $104.23 $240.75 $114.66 $202.23 $234.65 N/A N/A $192.60 $256.80 $354.39 $594.13 N/A $104.23 $125.08 N/A $256.80 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $256.80 $272.85 N/A $240.75 N/A N/A $160.50 $280.39 $164.17 $164.17 $164.17 $164.17 N/A $109.45 $104.23 $214.11 N/A N/A $88.60 $88.60 $104.23 $45.33 $594.13 330104 71130 5521 471 320 HC X-RAY STRENOCLAVIC JT 3/>VWS O $800.36 $104.23 $104.23 $20.00 $400.18 $72.23 $65.66 $103.19 $20.00 $198.04 $20.00 $104.23 $600.27 $114.66 $504.23 $585.06 $24.00 $20.00 $480.22 $640.29 $354.39 $594.13 $20.00 $104.23 $125.08 $28.00 $640.29 $20.00 $20.00 $24.00 $145.93 $20.00 $104.23 $104.23 $113.61 $640.29 $680.31 $20.00 $600.27 $41.00 $20.00 $400.18 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $20.00 $20.00 $88.60 $88.60 $104.23 $20.00 $680.31 330104 75989 474 320 HC ABSCESS DRAINAGE UNDER X-RAY O "$1,809.37 " N/A N/A $40.00 $904.68 $194.29 $176.63 $134.51 $40.00 N/A $40.00 N/A "$1,357.03 " N/A "$1,139.90 " "$1,322.65 " $48.00 $40.00 "$1,085.62 " "$1,447.50 " N/A N/A $40.00 N/A "$1,176.09 " $56.00 "$1,447.50 " $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A "$1,447.50 " "$1,537.96 " $54.00 "$1,357.03 " $82.00 $54.00 $904.68 "$1,176.09 " N/A N/A N/A N/A N/A N/A N/A "$1,206.85 " $40.00 $40.00 N/A N/A N/A $40.00 "$1,537.96 " 330104 75984 474 320 HC XR BILIARY TUBE CHNG O "$1,521.54 " N/A N/A $30.00 $760.77 $165.53 $150.48 $114.60 $30.00 N/A $30.00 N/A "$1,141.15 " N/A $958.57 "$1,112.25 " $36.00 $30.00 $912.92 "$1,217.23 " N/A N/A $30.00 N/A $989.00 $42.00 "$1,217.23 " $30.00 $30.00 $36.00 N/A $30.00 N/A N/A N/A "$1,217.23 " "$1,293.31 " $40.50 "$1,141.15 " $61.50 $40.50 $760.77 $989.00 N/A N/A N/A N/A N/A N/A N/A "$1,014.87 " $30.00 $30.00 N/A N/A N/A $30.00 "$1,293.31 " 330104 75898 5183 277 320 HC FOLLOW-UP ANGIOGRAPHY O "$7,515.68 " "$3,573.99 " "$3,573.99 " $322.76 "$3,757.84 " N/A N/A "$3,538.25 " $322.76 "$6,790.58 " $322.76 "$3,573.99 " "$5,636.76 " "$3,931.39 " "$4,734.88 " "$5,493.96 " $387.31 $322.76 "$4,509.41 " "$6,012.54 " "$12,151.56 " "$20,371.74 " $322.76 "$3,573.99 " "$4,288.79 " $451.86 "$6,012.54 " $322.76 $322.76 $387.31 "$5,003.59 " $322.76 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$6,012.54 " "$6,388.33 " $322.76 "$5,636.76 " $661.65 $322.76 "$3,757.84 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " $121.38 "$3,752.69 " "$3,573.99 " $121.38 $322.76 $322.76 "$3,037.89 " "$3,037.89 " "$3,573.99 " $121.38 "$20,371.74 " 330104 75893 5184 280 320 HC VENOUS SAMPLING BY CATHETER O "$21,176.37 " "$6,166.38 " "$6,166.38 " $936.59 "$10,588.18 " $181.76 $165.23 "$6,104.71 " $936.59 "$11,716.11 " $936.59 "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,341.11 " "$15,479.93 " "$1,123.91 " $936.59 "$12,705.82 " "$16,941.10 " "$20,965.68 " "$35,148.34 " $936.59 "$6,166.38 " "$7,399.65 " "$1,311.22 " "$16,941.10 " $936.59 $936.59 "$1,123.91 " "$8,632.93 " $936.59 "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " $936.59 "$15,882.28 " "$1,920.01 " $936.59 "$10,588.18 " "$16,587.55 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$3,242.54 " "$6,474.69 " "$6,166.38 " "$3,242.54 " $936.59 $936.59 "$5,241.42 " "$5,241.42 " "$6,166.38 " $165.23 "$35,148.34 " 330104 75860 5183 279 320 HC VEIN X-RAY NECK O "$12,768.31 " "$3,573.99 " "$3,573.99 " $135.00 "$6,384.15 " $219.76 $199.78 "$3,538.25 " $135.00 "$6,790.58 " $135.00 "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,044.04 " "$9,333.63 " $162.00 $135.00 "$7,660.99 " "$10,214.65 " "$12,151.56 " "$20,371.74 " $135.00 "$3,573.99 " "$4,288.79 " $189.00 "$10,214.65 " $135.00 $135.00 $162.00 "$5,003.59 " $135.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " $135.00 "$9,576.23 " $276.75 $135.00 "$6,384.15 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$1,149.92 " "$3,752.69 " "$3,573.99 " "$1,149.92 " $135.00 $135.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $135.00 "$20,371.74 " 330104 75842 5184 280 320 HC VEIN X-RAY ADRENAL GLANDS O "$21,176.37 " "$6,166.38 " "$6,166.38 " $135.00 "$10,588.18 " $274.19 $249.27 "$6,104.71 " $135.00 "$11,716.11 " $135.00 "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,341.11 " "$15,479.93 " $162.00 $135.00 "$12,705.82 " "$16,941.10 " "$20,965.68 " "$35,148.34 " $135.00 "$6,166.38 " "$7,399.65 " $189.00 "$16,941.10 " $135.00 $135.00 $162.00 "$8,632.93 " $135.00 "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " $135.00 "$15,882.28 " $276.75 $135.00 "$10,588.18 " "$16,587.55 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$3,242.54 " "$6,474.69 " "$6,166.38 " "$3,242.54 " $135.00 $135.00 "$5,241.42 " "$5,241.42 " "$6,166.38 " $135.00 "$35,148.34 " 330104 75833 5183 279 320 HC VEIN X-RAY KIDNEYS O "$13,083.96 " "$3,573.99 " "$3,573.99 " $110.00 "$6,541.98 " $257.77 $234.34 "$3,538.25 " $110.00 "$6,790.58 " $110.00 "$3,573.99 " "$9,812.97 " "$3,931.39 " "$8,242.89 " "$9,564.37 " $132.00 $110.00 "$7,850.38 " "$10,467.17 " "$12,151.56 " "$20,371.74 " $110.00 "$3,573.99 " "$4,288.79 " $154.00 "$10,467.17 " $110.00 $110.00 $132.00 "$5,003.59 " $110.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,467.17 " "$11,121.37 " $110.00 "$9,812.97 " $225.50 $110.00 "$6,541.98 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $110.00 $110.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $110.00 "$20,371.74 " 330104 75831 5183 279 320 HC VEIN X-RAY KIDNEY O "$15,510.72 " "$3,573.99 " "$3,573.99 " $80.00 "$7,755.36 " $209.77 $190.70 "$3,538.25 " $80.00 "$6,790.58 " $80.00 "$3,573.99 " "$11,633.04 " "$3,931.39 " "$9,771.75 " "$11,338.34 " $96.00 $80.00 "$9,306.43 " "$12,408.58 " "$12,151.56 " "$20,371.74 " $80.00 "$3,573.99 " "$4,288.79 " $112.00 "$12,408.58 " $80.00 $80.00 $96.00 "$5,003.59 " $80.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$12,408.58 " "$13,184.11 " $80.00 "$11,633.04 " $164.00 $80.00 "$7,755.36 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $80.00 $80.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $80.00 "$20,371.74 " 330104 75827 5182 277 320 HC VEIN X-RAY CHEST O "$4,515.40 " "$1,785.03 " "$1,785.03 " $40.00 "$2,257.70 " $209.60 $190.55 "$1,767.18 " $40.00 "$3,391.56 " $40.00 "$1,785.03 " "$3,386.55 " "$1,963.54 " "$2,844.70 " "$3,300.76 " $48.00 $40.00 "$2,709.24 " "$3,612.32 " "$6,069.11 " "$10,174.69 " $40.00 "$1,785.03 " "$2,142.04 " $56.00 "$3,612.32 " $40.00 $40.00 $48.00 "$2,499.05 " $40.00 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$3,612.32 " "$3,838.09 " $40.00 "$3,386.55 " $82.00 $40.00 "$2,257.70 " "$4,801.74 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$1,149.92 " "$1,874.28 " "$1,785.03 " "$1,149.92 " $40.00 $40.00 "$1,517.28 " "$1,517.28 " "$1,785.03 " $40.00 "$10,174.69 " 330104 75822 5182 277 320 HC VEIN X-RAY ARMS/LEGS O "$7,515.68 " "$1,785.03 " "$1,785.03 " $64.00 "$3,757.84 " $229.46 $208.60 "$1,767.18 " $64.00 "$3,391.56 " $64.00 "$1,785.03 " "$5,636.76 " "$1,963.54 " "$4,734.88 " "$5,493.96 " $76.80 $64.00 "$4,509.41 " "$6,012.54 " "$6,069.11 " "$10,174.69 " $64.00 "$1,785.03 " "$2,142.04 " $89.60 "$6,012.54 " $64.00 $64.00 $76.80 "$2,499.05 " $64.00 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$6,012.54 " "$6,388.33 " $64.00 "$5,636.76 " $131.20 $64.00 "$3,757.84 " "$4,801.74 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$1,149.92 " "$1,874.28 " "$1,785.03 " "$1,149.92 " $64.00 $64.00 "$1,517.28 " "$1,517.28 " "$1,785.03 " $64.00 "$10,174.69 " 330104 75820 5182 277 320 HC VEIN X-RAY ARM/LEG O "$4,289.63 " "$1,785.03 " "$1,785.03 " $40.00 "$2,144.82 " $188.89 $171.72 "$1,767.18 " $40.00 "$3,391.56 " $40.00 "$1,785.03 " "$3,217.22 " "$1,963.54 " "$2,702.47 " "$3,135.72 " $48.00 $40.00 "$2,573.78 " "$3,431.70 " "$6,069.11 " "$10,174.69 " $40.00 "$1,785.03 " "$2,142.04 " $56.00 "$3,431.70 " $40.00 $40.00 $48.00 "$2,499.05 " $40.00 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$3,431.70 " "$3,646.19 " $40.00 "$3,217.22 " $82.00 $40.00 "$2,144.82 " "$4,801.74 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$2,811.43 " "$1,149.92 " "$1,874.28 " "$1,785.03 " "$1,149.92 " $40.00 $40.00 "$1,517.28 " "$1,517.28 " "$1,785.03 " $40.00 "$10,174.69 " 330104 75809 5522 389 320 HC NONVASCULAR SHUNT X-RAY O "$1,430.59 " $128.23 $128.23 $258.22 $715.29 $144.17 $131.06 $126.95 $258.22 $243.63 $258.22 $128.23 "$1,072.94 " $141.05 $901.27 "$1,045.76 " $309.86 $258.22 $858.35 "$1,144.47 " $435.98 $730.90 $258.22 $128.23 $153.87 $361.51 "$1,144.47 " $258.22 $258.22 $309.86 $179.52 $258.22 $128.23 $128.23 $139.77 "$1,144.47 " "$1,216.00 " $258.22 "$1,072.94 " $529.35 $258.22 $715.29 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $258.22 $258.22 $108.99 $108.99 $128.23 $108.99 "$1,216.00 " 330104 75736 5184 280 320 HC ARTERY X-RAYS PELVIS O "$21,176.37 " "$6,166.38 " "$6,166.38 " $80.00 "$10,588.18 " $250.18 $227.44 "$6,104.71 " $80.00 "$11,716.11 " $80.00 "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,341.11 " "$15,479.93 " $96.00 $80.00 "$12,705.82 " "$16,941.10 " "$20,965.68 " "$35,148.34 " $80.00 "$6,166.38 " "$7,399.65 " $112.00 "$16,941.10 " $80.00 $80.00 $96.00 "$8,632.93 " $80.00 "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " $80.00 "$15,882.28 " $164.00 $80.00 "$10,588.18 " "$16,587.55 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$3,242.54 " "$6,474.69 " "$6,166.38 " "$3,242.54 " $80.00 $80.00 "$5,241.42 " "$5,241.42 " "$6,166.38 " $80.00 "$35,148.34 " 330104 74740 5523 389 320 HC HYSTEROSALPINGOGRAM O "$1,535.45 " $280.16 $280.16 $25.00 $767.73 $167.87 $152.61 $277.36 $25.00 $532.31 $25.00 $280.16 "$1,151.59 " $308.18 $967.33 "$1,122.41 " $30.00 $25.00 $921.27 "$1,228.36 " $952.56 "$1,596.93 " $25.00 $280.16 $336.20 $35.00 "$1,228.36 " $25.00 $25.00 $30.00 $392.23 $25.00 $280.16 $280.16 $305.38 "$1,228.36 " "$1,305.13 " $25.00 "$1,151.59 " $51.25 $25.00 $767.73 $753.64 $441.26 $441.26 $441.26 $441.26 $367.94 $294.17 $280.16 $367.94 $25.00 $25.00 $238.14 $238.14 $280.16 $25.00 "$1,596.93 " 330104 74455 5523 389 320 HC X-RAY URETHRA/BLADDER; VOIDING O "$1,823.28 " $280.16 $280.16 $35.00 $911.64 $183.57 $166.88 $277.36 $35.00 $532.31 $35.00 $280.16 "$1,367.46 " $308.18 "$1,148.67 " "$1,332.82 " $42.00 $35.00 "$1,093.97 " "$1,458.62 " $952.56 "$1,596.93 " $35.00 $280.16 $336.20 $49.00 "$1,458.62 " $35.00 $35.00 $42.00 $392.23 $35.00 $280.16 $280.16 $305.38 "$1,458.62 " "$1,549.79 " $35.00 "$1,367.46 " $71.75 $35.00 $911.64 $753.64 $441.26 $441.26 $441.26 $441.26 $281.79 $294.17 $280.16 $281.79 $35.00 $35.00 $238.14 $238.14 $280.16 $35.00 "$1,596.93 " 330104 76000 5523 389 320 HC FLUOROSCOPE EXAMINATION O "$1,572.90 " $280.16 $280.16 $10.00 $786.45 $76.74 $69.76 $277.36 $10.00 $532.31 $10.00 $280.16 "$1,179.68 " $308.18 $990.93 "$1,149.79 " $12.00 $10.00 $943.74 "$1,258.32 " $952.56 "$1,596.93 " $10.00 $280.16 $336.20 $14.00 "$1,258.32 " $10.00 $10.00 $12.00 $392.23 $10.00 $280.16 $280.16 $305.38 "$1,258.32 " "$1,336.97 " $10.00 "$1,179.68 " $20.50 $10.00 $786.45 $753.64 $441.26 $441.26 $441.26 $441.26 $133.60 $294.17 $280.16 $133.60 $10.00 $10.00 $238.14 $238.14 $280.16 $10.00 "$1,596.93 " 330104 74450 5523 389 320 HC X-RAY URETHRA/BLADDER; RETROGRADE O "$1,256.18 " $280.16 $280.16 $20.00 $628.09 N/A N/A $277.36 $20.00 $532.31 $20.00 $280.16 $942.13 $308.18 $791.39 $918.27 $24.00 $20.00 $753.71 "$1,004.94 " $952.56 "$1,596.93 " $20.00 $280.16 $336.20 $28.00 "$1,004.94 " $20.00 $20.00 $24.00 $392.23 $20.00 $280.16 $280.16 $305.38 "$1,004.94 " "$1,067.75 " $20.00 $942.13 $41.00 $20.00 $628.09 $753.64 $441.26 $441.26 $441.26 $441.26 $281.79 $294.17 $280.16 $281.79 $20.00 $20.00 $238.14 $238.14 $280.16 $20.00 "$1,596.93 " 330104 76010 5521 471 320 HC X-RAY NOSE TO RECTUM O $761.84 $104.23 $104.23 $10.00 $380.92 $52.56 $47.78 $103.19 $10.00 $198.04 $10.00 $104.23 $571.38 $114.66 $479.96 $556.91 $12.00 $10.00 $457.10 $609.47 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $609.47 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $609.47 $647.56 $10.00 $571.38 $20.50 $10.00 $380.92 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $647.56 330104 76098 5524 389 320 HC X-RAY EXAM BREAST SPECIMEN O "$2,365.77 " $603.63 $603.63 $258.22 "$1,182.88 " $73.25 $66.59 $597.59 $258.22 "$1,146.89 " $258.22 $603.63 "$1,774.33 " $663.99 "$1,490.44 " "$1,729.38 " $309.86 $258.22 "$1,419.46 " "$1,892.62 " "$2,052.33 " "$3,440.66 " $258.22 $603.63 $724.35 $361.51 "$1,892.62 " $258.22 $258.22 $309.86 $845.08 $258.22 $603.63 $603.63 $657.95 "$1,892.62 " "$2,010.90 " $258.22 "$1,774.33 " $529.35 $258.22 "$1,182.88 " "$1,623.75 " $950.71 $950.71 $950.71 $950.71 $651.38 $633.81 $603.63 $651.38 $258.22 $258.22 $513.08 $513.08 $603.63 $66.59 "$3,440.66 " 330104 77090 5521 291 320 HC TBS TECHL PREP&TRANSMIS DATA ALYS PFRMD ELSEWHR O $321.00 $104.23 $104.23 N/A $160.50 $5.23 $4.75 $103.19 N/A $198.04 N/A $104.23 $240.75 $114.66 $202.23 $234.65 N/A N/A $192.60 $256.80 $354.39 $594.13 N/A $104.23 $125.08 N/A $256.80 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $256.80 $272.85 N/A $240.75 N/A N/A $160.50 $280.39 $164.17 $164.17 $164.17 $164.17 N/A $109.45 $104.23 $214.11 N/A N/A $88.60 $88.60 $104.23 $4.75 $594.13 330104 77081 5521 291 320 HC DXA BONE DENSITY/PERIPHERAL O "$2,324.04 " $104.23 $104.23 $52.00 "$1,162.02 " $54.76 $49.78 $103.19 $52.00 $198.04 $52.00 $104.23 "$1,743.03 " $114.66 "$1,464.15 " "$1,698.87 " $62.40 $52.00 "$1,394.42 " "$1,859.23 " $354.39 $594.13 $52.00 $104.23 $125.08 $72.80 "$1,859.23 " $52.00 $52.00 $62.40 $145.93 $52.00 $104.23 $104.23 $113.61 "$1,859.23 " "$1,975.43 " $52.00 "$1,743.03 " $106.60 $52.00 "$1,162.02 " $280.39 $164.17 $164.17 $164.17 $164.17 $51.38 $109.45 $104.23 $51.38 $52.00 $52.00 $88.60 $88.60 $104.23 $49.78 "$1,975.43 " 330104 77080 5522 291 320 HC DXA BONE DENSITY AXIAL O "$1,735.54 " $128.23 $128.23 $100.00 $867.77 $66.50 $60.46 $126.95 $100.00 $243.63 $100.00 $128.23 "$1,301.65 " $141.05 "$1,093.39 " "$1,268.68 " $120.00 $100.00 "$1,041.32 " "$1,388.43 " $435.98 $730.90 $100.00 $128.23 $153.87 $140.00 "$1,388.43 " $100.00 $100.00 $120.00 $179.52 $100.00 $128.23 $128.23 $139.77 "$1,388.43 " "$1,475.21 " $100.00 "$1,301.65 " $205.00 $100.00 $867.77 $344.93 $201.96 $201.96 $201.96 $201.96 $112.83 $134.64 $128.23 $112.83 $100.00 $100.00 $108.99 $108.99 $128.23 $60.46 "$1,475.21 " 330104 77077 5522 471 320 HC JOINT SURVEY SINGLE VIEW O $485.78 $128.23 $128.23 $50.00 $242.89 $81.91 $74.46 $126.95 $50.00 $243.63 $50.00 $128.23 $364.33 $141.05 $306.04 $355.11 $60.00 $50.00 $291.47 $388.62 $435.98 $730.90 $50.00 $128.23 $153.87 $70.00 $388.62 $50.00 $50.00 $60.00 $179.52 $50.00 $128.23 $128.23 $139.77 $388.62 $412.91 $50.00 $364.33 $102.50 $50.00 $242.89 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $50.00 $50.00 $108.99 $108.99 $128.23 $50.00 $730.90 330104 77076 5522 471 320 HC X-RAYS BONE SURVEY INFANT O $942.67 $128.23 $128.23 $35.00 $471.33 $187.60 $170.54 $126.95 $35.00 $243.63 $35.00 $128.23 $707.00 $141.05 $593.88 $689.09 $42.00 $35.00 $565.60 $754.14 $435.98 $730.90 $35.00 $128.23 $153.87 $49.00 $754.14 $35.00 $35.00 $42.00 $179.52 $35.00 $128.23 $128.23 $139.77 $754.14 $801.27 $35.00 $707.00 $71.75 $35.00 $471.33 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $35.00 $35.00 $108.99 $108.99 $128.23 $35.00 $801.27 330104 77075 5522 389 320 HC X-RAYS BONE SURVEY COMPLETE O "$1,827.56 " $128.23 $128.23 $50.00 $913.78 $175.22 $159.29 $126.95 $50.00 $243.63 $50.00 $128.23 "$1,370.67 " $141.05 "$1,151.36 " "$1,335.95 " $60.00 $50.00 "$1,096.54 " "$1,462.05 " $435.98 $730.90 $50.00 $128.23 $153.87 $70.00 "$1,462.05 " $50.00 $50.00 $60.00 $179.52 $50.00 $128.23 $128.23 $139.77 "$1,462.05 " "$1,553.43 " $50.00 "$1,370.67 " $102.50 $50.00 $913.78 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $50.00 $50.00 $108.99 $108.99 $128.23 $50.00 "$1,553.43 " 330104 77074 5522 471 320 HC X-RAYS BONE SURVEY LIMITED O "$1,464.83 " $128.23 $128.23 $35.00 $732.41 $112.79 $102.54 $126.95 $35.00 $243.63 $35.00 $128.23 "$1,098.62 " $141.05 $922.84 "$1,070.79 " $42.00 $35.00 $878.90 "$1,171.86 " $435.98 $730.90 $35.00 $128.23 $153.87 $49.00 "$1,171.86 " $35.00 $35.00 $42.00 $179.52 $35.00 $128.23 $128.23 $139.77 "$1,171.86 " "$1,245.11 " $35.00 "$1,098.62 " $71.75 $35.00 $732.41 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $35.00 $35.00 $108.99 $108.99 $128.23 $35.00 "$1,245.11 " 330104 77073 5522 471 320 HC X-RAYS BONE LENGTH STUDIES O $480.43 $128.23 $128.23 $25.00 $240.22 $78.91 $71.74 $126.95 $25.00 $243.63 $25.00 $128.23 $360.32 $141.05 $302.67 $351.19 $30.00 $25.00 $288.26 $384.34 $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $384.34 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $384.34 $408.37 $25.00 $360.32 $51.25 $25.00 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 $730.90 330104 77072 5522 471 320 HC X-RAYS FOR BONE AGE O $518.95 $128.23 $128.23 $15.00 $259.48 $45.44 $41.31 $126.95 $15.00 $243.63 $15.00 $128.23 $389.21 $141.05 $326.94 $379.35 $18.00 $15.00 $311.37 $415.16 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $415.16 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $415.16 $441.11 $15.00 $389.21 $30.75 $15.00 $259.48 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $730.90 330104 77003 474 320 HC FLUOROGUIDE FOR SPINE INJECT O "$1,692.74 " N/A N/A $25.00 $846.37 $184.88 $168.08 $128.00 $25.00 N/A $25.00 N/A "$1,269.56 " N/A "$1,066.43 " "$1,237.39 " $30.00 $25.00 "$1,015.64 " "$1,354.19 " N/A N/A $25.00 N/A "$1,100.28 " $35.00 "$1,354.19 " $25.00 $25.00 $30.00 N/A $25.00 N/A N/A N/A "$1,354.19 " "$1,438.83 " $33.75 "$1,269.56 " $51.25 $33.75 $846.37 "$1,100.28 " N/A N/A N/A N/A N/A N/A N/A "$1,129.06 " $25.00 $25.00 N/A N/A N/A $25.00 "$1,438.83 " 330104 77002 474 320 HC NEEDLE LOCALIZATION BY XRAY O "$2,010.53 " N/A N/A $25.00 "$1,005.26 " $204.13 $185.58 $141.32 $25.00 N/A $25.00 N/A "$1,507.90 " N/A "$1,266.63 " "$1,469.70 " $30.00 $25.00 "$1,206.32 " "$1,608.42 " N/A N/A $25.00 N/A "$1,306.84 " $35.00 "$1,608.42 " $25.00 $25.00 $30.00 N/A $25.00 N/A N/A N/A "$1,608.42 " "$1,708.95 " $33.75 "$1,507.90 " $51.25 $33.75 "$1,005.26 " "$1,306.84 " N/A N/A N/A N/A N/A N/A N/A "$1,341.02 " $25.00 $25.00 N/A N/A N/A $25.00 "$1,708.95 " 330104 77001 474 320 HC FLUOROGUIDE FOR VEIN DEVICE O "$1,460.55 " N/A N/A $21.00 $730.27 $177.15 $161.05 $122.64 $21.00 N/A $21.00 N/A "$1,095.41 " N/A $920.15 "$1,067.66 " $25.20 $21.00 $876.33 "$1,168.44 " N/A N/A $21.00 N/A $949.36 $29.40 "$1,168.44 " $21.00 $21.00 $25.20 N/A $21.00 N/A N/A N/A "$1,168.44 " "$1,241.47 " $28.35 "$1,095.41 " $43.05 $28.35 $730.27 $949.36 N/A N/A N/A N/A N/A N/A N/A $974.19 $21.00 $21.00 N/A N/A N/A $21.00 "$1,241.47 " 330104 76497 5521 299 320 HC CT PROCEDURE O $964.07 $104.23 $104.23 N/A $482.04 N/A N/A $103.19 N/A $198.04 N/A $104.23 $723.05 $114.66 $607.36 $704.74 N/A N/A $578.44 $771.26 $354.39 $594.13 N/A $104.23 $125.08 N/A $771.26 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $771.26 $819.46 N/A $723.05 N/A N/A $482.04 $280.39 $164.17 $164.17 $164.17 $164.17 $181.58 $109.45 $104.23 $181.58 N/A N/A $88.60 $88.60 $104.23 $88.60 $819.46 330104 76496 5521 471 320 HC FLUOROSCOPIC PROCEDURE O $342.40 $104.23 $104.23 N/A $171.20 N/A N/A $103.19 N/A $198.04 N/A $104.23 $256.80 $114.66 $215.71 $250.29 N/A N/A $205.44 $273.92 $354.39 $594.13 N/A $104.23 $125.08 N/A $273.92 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $273.92 $291.04 N/A $256.80 N/A N/A $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $133.60 $109.45 $104.23 $133.60 N/A N/A $88.60 $88.60 $104.23 $88.60 $594.13 330104 76376 2002 320 HC 3D RENDER W/INTRP POSTPROCES (NOT INDEP WKSTATION) O $94.16 N/A N/A $100.00 $47.08 $41.84 $38.03 $28.96 $100.00 N/A $100.00 N/A $70.62 N/A $59.32 $68.83 $120.00 $100.00 $56.50 $75.33 N/A N/A $100.00 N/A $61.20 $140.00 $75.33 $100.00 $100.00 $120.00 N/A $100.00 N/A N/A N/A $75.33 $80.04 $135.00 $70.62 $205.00 $135.00 $47.08 $61.20 N/A N/A N/A N/A N/A N/A N/A $62.80 $100.00 $100.00 N/A N/A N/A $28.96 $205.00 330104 76080 5524 389 320 HC X-RAY EXAM OF FISTULA O "$2,220.25 " $603.63 $603.63 $15.00 "$1,110.12 " $104.29 $94.81 $597.59 $15.00 "$1,146.89 " $15.00 $603.63 "$1,665.19 " $663.99 "$1,398.76 " "$1,623.00 " $18.00 $15.00 "$1,332.15 " "$1,776.20 " "$2,052.33 " "$3,440.66 " $15.00 $603.63 $724.35 $21.00 "$1,776.20 " $15.00 $15.00 $18.00 $845.08 $15.00 $603.63 $603.63 $657.95 "$1,776.20 " "$1,887.21 " $15.00 "$1,665.19 " $30.75 $15.00 "$1,110.12 " "$1,623.75 " $950.71 $950.71 $950.71 $950.71 $367.94 $633.81 $603.63 $367.94 $15.00 $15.00 $513.08 $513.08 $603.63 $15.00 "$3,440.66 " 330104 76377 2002 320 HC 3D CT RENDER W/INTRP POSTPROCES (INDEP WKSTATION) O "$1,070.00 " N/A N/A $100.00 $535.00 $130.00 $118.18 $90.00 $100.00 N/A $100.00 N/A $802.50 N/A $674.10 $782.17 $120.00 $100.00 $642.00 $856.00 N/A N/A $100.00 N/A $695.50 $140.00 $856.00 $100.00 $100.00 $120.00 N/A $100.00 N/A N/A N/A $856.00 $909.50 $135.00 $802.50 $205.00 $135.00 $535.00 $695.50 N/A N/A N/A N/A N/A N/A N/A $713.69 $100.00 $100.00 N/A N/A N/A $90.00 $909.50 330104 74430 5572 389 320 HC CONTRAST X-RAY BLADDER O "$1,760.15 " $442.02 $442.02 $20.00 $880.08 $72.00 $65.45 $437.60 $20.00 $839.84 $20.00 $442.02 "$1,320.11 " $486.22 "$1,108.89 " "$1,286.67 " $24.00 $20.00 "$1,056.09 " "$1,408.12 " "$1,502.87 " "$2,519.52 " $20.00 $442.02 $530.42 $28.00 "$1,408.12 " $20.00 $20.00 $24.00 $618.83 $20.00 $442.02 $442.02 $481.80 "$1,408.12 " "$1,496.13 " $20.00 "$1,320.11 " $41.00 $20.00 $880.08 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $281.79 $464.12 $442.02 $281.79 $20.00 $20.00 $375.72 $375.72 $442.02 $20.00 "$2,519.52 " 330104 74420 5572 389 320 HC UROGRAPHY/PYELOGRAPHY RETROGRADE W/OR WITHOUT KUB O "$1,760.15 " $442.02 $442.02 $25.00 $880.08 $133.33 $121.21 $437.60 $25.00 $839.84 $25.00 $442.02 "$1,320.11 " $486.22 "$1,108.89 " "$1,286.67 " $30.00 $25.00 "$1,056.09 " "$1,408.12 " "$1,502.87 " "$2,519.52 " $25.00 $442.02 $530.42 $35.00 "$1,408.12 " $25.00 $25.00 $30.00 $618.83 $25.00 $442.02 $442.02 $481.80 "$1,408.12 " "$1,496.13 " $25.00 "$1,320.11 " $51.25 $25.00 $880.08 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $281.79 $464.12 $442.02 $281.79 $25.00 $25.00 $375.72 $375.72 $442.02 $25.00 "$2,519.52 " 330104 73650 5521 471 320 HC X-RAY EXAM OF HEEL; MIN 2 VIEWS O $600.27 $104.23 $104.23 $10.00 $300.13 $50.36 $45.78 $103.19 $10.00 $198.04 $10.00 $104.23 $450.20 $114.66 $378.17 $438.80 $12.00 $10.00 $360.16 $480.22 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $480.22 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $480.22 $510.23 $10.00 $450.20 $20.50 $10.00 $300.13 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73630 5521 471 320 HC X-RAY EXAM OF FOOT; COMPLETE MIN 3 VIEWS O $861.35 $104.23 $104.23 $12.50 $430.68 $60.27 $54.79 $103.19 $12.50 $198.04 $12.50 $104.23 $646.01 $114.66 $542.65 $629.65 $15.00 $12.50 $516.81 $689.08 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $689.08 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $689.08 $732.15 $12.50 $646.01 $25.62 $12.50 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $732.15 330104 73620 5521 471 320 HC X-RAY EXAM OF FOOT; 2 VIEWS O $476.15 $104.23 $104.23 $10.00 $238.07 $49.77 $45.25 $103.19 $10.00 $198.04 $10.00 $104.23 $357.11 $114.66 $299.97 $348.07 $12.00 $10.00 $285.69 $380.92 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $380.92 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $380.92 $404.73 $10.00 $357.11 $20.50 $10.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73610 5521 471 320 HC ANKLE(S) (COMPLETE) XR EACH O $861.35 $104.23 $104.23 $12.50 $430.68 $64.97 $59.06 $103.19 $12.50 $198.04 $12.50 $104.23 $646.01 $114.66 $542.65 $629.65 $15.00 $12.50 $516.81 $689.08 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $689.08 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $689.08 $732.15 $12.50 $646.01 $25.62 $12.50 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $732.15 330104 73600 5521 471 320 HC RAD EXAM ANK;AP&LAT VIEWS O $476.15 $104.23 $104.23 $10.00 $238.07 $57.41 $52.19 $103.19 $10.00 $198.04 $10.00 $104.23 $357.11 $114.66 $299.97 $348.07 $12.00 $10.00 $285.69 $380.92 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $380.92 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $380.92 $404.73 $10.00 $357.11 $20.50 $10.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73592 5521 471 320 HC X-RAY EXAM OF LEG INFANT; MIN 2 VIEWS O $476.15 $104.23 $104.23 $15.00 $238.07 $55.65 $50.59 $103.19 $15.00 $198.04 $15.00 $104.23 $357.11 $114.66 $299.97 $348.07 $18.00 $15.00 $285.69 $380.92 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $380.92 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $380.92 $404.73 $15.00 $357.11 $30.75 $15.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 73590 5521 471 320 HC X-RAY EXAM OF LOWER LEG; 2 VIEWS O $708.34 $104.23 $104.23 $10.00 $354.17 $55.65 $50.59 $103.19 $10.00 $198.04 $10.00 $104.23 $531.25 $114.66 $446.25 $517.80 $12.00 $10.00 $425.00 $566.67 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $566.67 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $566.67 $602.09 $10.00 $531.25 $20.50 $10.00 $354.17 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $602.09 330104 73565 5521 471 320 HC X-RAY EXAM OF KNEES; BOTH KNEES STANDING AP O $721.18 $104.23 $104.23 $10.00 $360.59 $70.33 $63.94 $103.19 $10.00 $198.04 $10.00 $104.23 $540.89 $114.66 $454.34 $527.18 $12.00 $10.00 $432.71 $576.94 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $576.94 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $576.94 $613.00 $10.00 $540.89 $20.50 $10.00 $360.59 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $613.00 330104 73564 5522 471 320 HC X-RAY EXAM KNEE 4 OR MORE O $930.90 $128.23 $128.23 $20.00 $465.45 $81.62 $74.20 $126.95 $20.00 $243.63 $20.00 $128.23 $698.17 $141.05 $586.47 $680.49 $24.00 $20.00 $558.54 $744.72 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $744.72 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $744.72 $791.26 $20.00 $698.17 $41.00 $20.00 $465.45 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $791.26 330104 73562 5521 471 320 HC X-RAY EXAM OF KNEE 3 VIEWS O $476.15 $104.23 $104.23 $15.00 $238.07 $71.35 $64.87 $103.19 $15.00 $198.04 $15.00 $104.23 $357.11 $114.66 $299.97 $348.07 $18.00 $15.00 $285.69 $380.92 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $380.92 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $380.92 $404.73 $15.00 $357.11 $30.75 $15.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 73560 5521 471 320 HC X-RAY EXAM OF KNEE 1 OR 2 VIEWS O $476.15 $104.23 $104.23 $10.00 $238.07 $60.35 $54.86 $103.19 $10.00 $198.04 $10.00 $104.23 $357.11 $114.66 $299.97 $348.07 $12.00 $10.00 $285.69 $380.92 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $380.92 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $380.92 $404.73 $10.00 $357.11 $20.50 $10.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $594.13 330104 73552 5521 471 320 HC X-RAY EXAM OF FEMUR 2/> VWS O $799.29 $104.23 $104.23 $9.78 $399.64 $62.54 $56.86 $103.19 $9.78 $198.04 $9.78 $104.23 $599.47 $114.66 $503.55 $584.28 $11.74 $9.78 $479.57 $639.43 $354.39 $594.13 $9.78 $104.23 $125.08 $13.69 $639.43 $9.78 $9.78 $11.74 $145.93 $9.78 $104.23 $104.23 $113.61 $639.43 $679.40 $9.78 $599.47 $20.05 $9.78 $399.64 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $9.78 $9.78 $88.60 $88.60 $104.23 $9.78 $679.40 330104 73551 5521 471 320 HC X-RAY EXAM OF FEMUR 1VIEW O $828.18 $104.23 $104.23 $8.39 $414.09 $51.54 $46.85 $103.19 $8.39 $198.04 $8.39 $104.23 $621.14 $114.66 $521.75 $605.40 $10.07 $8.39 $496.91 $662.54 $354.39 $594.13 $8.39 $104.23 $125.08 $11.75 $662.54 $8.39 $8.39 $10.07 $145.93 $8.39 $104.23 $104.23 $113.61 $662.54 $703.95 $8.39 $621.14 $17.20 $8.39 $414.09 $280.39 $164.17 $164.17 $164.17 $164.17 $97.28 $109.45 $104.23 $97.28 $8.39 $8.39 $88.60 $88.60 $104.23 $8.39 $703.95 330104 73522 5522 471 320 HC X-RAY EXAM HIPS BI 3-4 VIEWS O "$1,158.81 " $128.23 $128.23 $14.73 $579.40 $93.43 $84.93 $126.95 $14.73 $243.63 $14.73 $128.23 $869.11 $141.05 $730.05 $847.09 $17.68 $14.73 $695.29 $927.05 $435.98 $730.90 $14.73 $128.23 $153.87 $20.62 $927.05 $14.73 $14.73 $17.68 $179.52 $14.73 $128.23 $128.23 $139.77 $927.05 $984.99 $14.73 $869.11 $30.20 $14.73 $579.40 $344.93 $201.96 $201.96 $201.96 $201.96 $161.10 $134.64 $128.23 $161.10 $14.73 $14.73 $108.99 $108.99 $128.23 $14.73 $984.99 330104 73521 5522 471 320 HC X-RAY EXAM HIPS BIL 2 VIEWS O "$2,784.14 " $128.23 $128.23 $12.04 "$1,392.07 " $72.23 $65.66 $126.95 $12.04 $243.63 $12.04 $128.23 "$2,088.11 " $141.05 "$1,754.01 " "$2,035.21 " $14.45 $12.04 "$1,670.48 " "$2,227.31 " $435.98 $730.90 $12.04 $128.23 $153.87 $16.86 "$2,227.31 " $12.04 $12.04 $14.45 $179.52 $12.04 $128.23 $128.23 $139.77 "$2,227.31 " "$2,366.52 " $12.04 "$2,088.11 " $24.68 $12.04 "$1,392.07 " $344.93 $201.96 $201.96 $201.96 $201.96 $161.10 $134.64 $128.23 $161.10 $12.04 $12.04 $108.99 $108.99 $128.23 $12.04 "$2,366.52 " 330104 73660 5521 471 320 HC X-RAY EXAM OF TOE(S); MIN 2 VIEWS O $557.47 $104.23 $104.23 $7.50 $278.74 $51.76 $47.06 $103.19 $7.50 $198.04 $7.50 $104.23 $418.10 $114.66 $351.21 $407.51 $9.00 $7.50 $334.48 $445.98 $354.39 $594.13 $7.50 $104.23 $125.08 $10.50 $445.98 $7.50 $7.50 $9.00 $145.93 $7.50 $104.23 $104.23 $113.61 $445.98 $473.85 $7.50 $418.10 $15.37 $7.50 $278.74 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $7.50 $7.50 $88.60 $88.60 $104.23 $7.50 $594.13 330104 74425 5572 389 320 HC UROGRAPHY ANTEGRADE (NEPHROSTOGRAM/LOOPOGRAM) O "$1,760.15 " $442.02 $442.02 $20.00 $880.08 $239.71 $217.92 $437.60 $20.00 $839.84 $20.00 $442.02 "$1,320.11 " $486.22 "$1,108.89 " "$1,286.67 " $24.00 $20.00 "$1,056.09 " "$1,408.12 " "$1,502.87 " "$2,519.52 " $20.00 $442.02 $530.42 $28.00 "$1,408.12 " $20.00 $20.00 $24.00 $618.83 $20.00 $442.02 $442.02 $481.80 "$1,408.12 " "$1,496.13 " $20.00 "$1,320.11 " $41.00 $20.00 $880.08 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $281.79 $464.12 $442.02 $281.79 $20.00 $20.00 $375.72 $375.72 $442.02 $20.00 "$2,519.52 " 330104 74019 5522 471 320 HC X-RAY EXAM ABDOMEN 2 VIEWS O "$1,151.32 " $128.23 $128.23 $15.00 $575.66 $64.52 $58.65 $126.95 $15.00 $243.63 $15.00 $128.23 $863.49 $141.05 $725.33 $841.61 $18.00 $15.00 $690.79 $921.06 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $921.06 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $921.06 $978.62 $15.00 $863.49 $30.75 $15.00 $575.66 $344.93 $201.96 $201.96 $201.96 $201.96 $189.98 $134.64 $128.23 $189.98 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $978.62 330104 74220 5571 471 320 HC CONTRAST X-RAY ESOPHAGUS O $916.99 $216.36 $216.36 $20.00 $458.50 $173.73 $157.93 $214.20 $20.00 $411.09 $20.00 $216.36 $687.74 $238.00 $577.70 $670.32 $24.00 $20.00 $550.19 $733.59 $735.63 "$1,233.26 " $20.00 $216.36 $259.63 $28.00 $733.59 $20.00 $20.00 $24.00 $302.91 $20.00 $216.36 $216.36 $235.83 $733.59 $779.44 $20.00 $687.74 $41.00 $20.00 $458.50 $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $20.00 $20.00 $183.91 $183.91 $216.36 $20.00 "$1,233.26 " 330104 74360 474 320 HC X-RAY GUIDE GI DILATION O "$2,324.04 " N/A N/A $40.00 "$1,162.02 " N/A N/A N/A $40.00 N/A $40.00 N/A "$1,743.03 " N/A "$1,464.15 " "$1,698.87 " $48.00 $40.00 "$1,394.42 " "$1,859.23 " N/A N/A $40.00 N/A "$1,510.63 " $56.00 "$1,859.23 " $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A "$1,859.23 " "$1,975.43 " $54.00 "$1,743.03 " $82.00 $54.00 "$1,162.02 " "$1,510.63 " N/A N/A N/A N/A N/A N/A N/A "$1,550.13 " $40.00 $40.00 N/A N/A N/A $40.00 "$1,975.43 " 330104 74330 474 320 HC X-RAY BILE/PANC ENDOSCOPY O "$3,616.60 " N/A N/A $36.00 "$1,808.30 " N/A N/A N/A $36.00 N/A $36.00 N/A "$2,712.45 " N/A "$2,278.46 " "$2,643.73 " $43.20 $36.00 "$2,169.96 " "$2,893.28 " N/A N/A $36.00 N/A "$2,350.79 " $50.40 "$2,893.28 " $36.00 $36.00 $43.20 N/A $36.00 N/A N/A N/A "$2,893.28 " "$3,074.11 " $48.60 "$2,712.45 " $73.80 $48.60 "$1,808.30 " "$2,350.79 " N/A N/A N/A N/A N/A N/A N/A "$2,412.27 " $36.00 $36.00 N/A N/A N/A $36.00 "$3,074.11 " 330104 74329 474 320 HC X-RAY FOR PANCREAS ENDOSCOPY O "$3,405.81 " N/A N/A $30.00 "$1,702.90 " N/A N/A N/A $30.00 N/A $30.00 N/A "$2,554.36 " N/A "$2,145.66 " "$2,489.65 " $36.00 $30.00 "$2,043.49 " "$2,724.65 " N/A N/A $30.00 N/A "$2,213.78 " $42.00 "$2,724.65 " $30.00 $30.00 $36.00 N/A $30.00 N/A N/A N/A "$2,724.65 " "$2,894.94 " $40.50 "$2,554.36 " $61.50 $40.50 "$1,702.90 " "$2,213.78 " N/A N/A N/A N/A N/A N/A N/A "$2,271.68 " $30.00 $30.00 N/A N/A N/A $30.00 "$2,894.94 " 330104 74328 474 320 HC X-RAY BILE DUCT ENDOSCOPY O "$3,421.86 " N/A N/A $30.00 "$1,710.93 " N/A N/A N/A $30.00 N/A $30.00 N/A "$2,566.39 " N/A "$2,155.77 " "$2,501.38 " $36.00 $30.00 "$2,053.12 " "$2,737.49 " N/A N/A $30.00 N/A "$2,224.21 " $42.00 "$2,737.49 " $30.00 $30.00 $36.00 N/A $30.00 N/A N/A N/A "$2,737.49 " "$2,908.58 " $40.50 "$2,566.39 " $61.50 $40.50 "$1,710.93 " "$2,224.21 " N/A N/A N/A N/A N/A N/A N/A "$2,282.38 " $30.00 $30.00 N/A N/A N/A $30.00 "$2,908.58 " 330104 74300 474 320 HC CHOLANGIOGRAP &/OR PANCREATO INTERP S&I O "$1,189.84 " N/A N/A $358.61 $594.92 N/A N/A N/A $358.61 N/A $358.61 N/A $892.38 N/A $749.60 $869.77 $430.34 $358.61 $713.90 $951.87 N/A N/A $358.61 N/A $773.40 $502.06 $951.87 $358.61 $358.61 $430.34 N/A $358.61 N/A N/A N/A $951.87 "$1,011.36 " $484.13 $892.38 $735.16 $484.13 $594.92 $773.40 N/A N/A N/A N/A N/A N/A N/A $793.62 $358.61 $358.61 N/A N/A N/A $358.61 "$1,011.36 " 330104 74280 5571 389 320 HC CONTRAST X-RAY EXAM COLON;W/BARIUM W/ W/O GLUCAGON O "$1,774.06 " $216.36 $216.36 $40.00 $887.03 $390.52 $355.02 $214.20 $40.00 $411.09 $40.00 $216.36 "$1,330.55 " $238.00 "$1,117.66 " "$1,296.84 " $48.00 $40.00 "$1,064.44 " "$1,419.25 " $735.63 "$1,233.26 " $40.00 $216.36 $259.63 $56.00 "$1,419.25 " $40.00 $40.00 $48.00 $302.91 $40.00 $216.36 $216.36 $235.83 "$1,419.25 " "$1,507.95 " $40.00 "$1,330.55 " $82.00 $40.00 $887.03 $582.01 $340.77 $340.77 $340.77 $340.77 $227.17 $227.18 $216.36 $227.17 $40.00 $40.00 $183.91 $183.91 $216.36 $40.00 "$1,507.95 " 330104 74270 5571 389 320 HC CONTRAST X-RAY EXAM OF COLON; ENEMA W/ W/O KUB O "$1,373.88 " $216.36 $216.36 $25.00 $686.94 $269.07 $244.61 $214.20 $25.00 $411.09 $25.00 $216.36 "$1,030.41 " $238.00 $865.54 "$1,004.31 " $30.00 $25.00 $824.33 "$1,099.10 " $735.63 "$1,233.26 " $25.00 $216.36 $259.63 $35.00 "$1,099.10 " $25.00 $25.00 $30.00 $302.91 $25.00 $216.36 $216.36 $235.83 "$1,099.10 " "$1,167.80 " $25.00 "$1,030.41 " $51.25 $25.00 $686.94 $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $25.00 $25.00 $183.91 $183.91 $216.36 $25.00 "$1,233.26 " 330104 74250 5571 389 320 HC X-RAY EXAM OF SMALL BOWEL O "$1,582.53 " $216.36 $216.36 $30.00 $791.26 $215.01 $195.47 $214.20 $30.00 $411.09 $30.00 $216.36 "$1,186.90 " $238.00 $996.99 "$1,156.83 " $36.00 $30.00 $949.52 "$1,266.02 " $735.63 "$1,233.26 " $30.00 $216.36 $259.63 $42.00 "$1,266.02 " $30.00 $30.00 $36.00 $302.91 $30.00 $216.36 $216.36 $235.83 "$1,266.02 " "$1,345.15 " $30.00 "$1,186.90 " $61.50 $30.00 $791.26 $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $30.00 $30.00 $183.91 $183.91 $216.36 $30.00 "$1,345.15 " 330104 74248 389 320 HC X-RAY SM INT F-THRU STD O $910.57 N/A N/A $17.09 $455.29 $144.78 $131.62 $100.23 $17.09 N/A $17.09 N/A $682.93 N/A $573.66 $665.63 $20.51 $17.09 $546.34 $728.46 N/A N/A $17.09 N/A $591.87 $23.93 $728.46 $17.09 $17.09 $20.51 N/A $17.09 N/A N/A N/A $728.46 $773.98 $23.07 $682.93 $35.03 $23.07 $455.29 $591.87 N/A N/A N/A N/A N/A N/A N/A $607.35 $17.09 $17.09 N/A N/A N/A $17.09 $773.98 330104 74246 5571 389 320 HC CONTRST X-RAY UPPR GI TRACT W/O KUB O "$2,060.82 " $216.36 $216.36 $50.00 "$1,030.41 " $244.87 $222.61 $214.20 $50.00 $411.09 $50.00 $216.36 "$1,545.62 " $238.00 "$1,298.32 " "$1,506.46 " $60.00 $50.00 "$1,236.49 " "$1,648.66 " $735.63 "$1,233.26 " $50.00 $216.36 $259.63 $70.00 "$1,648.66 " $50.00 $50.00 $60.00 $302.91 $50.00 $216.36 $216.36 $235.83 "$1,648.66 " "$1,751.70 " $50.00 "$1,545.62 " $102.50 $50.00 "$1,030.41 " $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $50.00 $50.00 $183.91 $183.91 $216.36 $50.00 "$1,751.70 " 330104 74245 389 320 HC X-RAY UPPER GI&SMALL INTEST O "$2,038.35 " N/A N/A $258.22 "$1,019.17 " N/A N/A "$1,333.08 " $258.22 N/A $258.22 N/A "$1,528.76 " N/A "$1,284.16 " "$1,490.03 " $309.86 $258.22 "$1,223.01 " "$1,630.68 " N/A N/A $258.22 N/A N/A $361.51 "$1,630.68 " $258.22 $258.22 $309.86 N/A $258.22 N/A N/A N/A "$1,630.68 " "$1,732.60 " $348.60 "$1,528.76 " $529.35 $348.60 "$1,019.17 " "$1,324.93 " N/A N/A N/A N/A N/A N/A N/A "$1,359.58 " $258.22 $258.22 N/A N/A N/A $258.22 "$1,732.60 " 330104 74241 389 320 HC X-RAYUPPER GI DELAY W/KUB O "$2,038.35 " N/A N/A $258.22 "$1,019.17 " N/A N/A "$1,333.08 " $258.22 N/A $258.22 N/A "$1,528.76 " N/A "$1,284.16 " "$1,490.03 " $309.86 $258.22 "$1,223.01 " "$1,630.68 " N/A N/A $258.22 N/A N/A $361.51 "$1,630.68 " $258.22 $258.22 $309.86 N/A $258.22 N/A N/A N/A "$1,630.68 " "$1,732.60 " $348.60 "$1,528.76 " $529.35 $348.60 "$1,019.17 " "$1,324.93 " N/A N/A N/A N/A N/A N/A N/A "$1,359.58 " $258.22 $258.22 N/A N/A N/A $258.22 "$1,732.60 " 330104 74240 5571 389 320 HC X-RAY UPPER GI DELAY W/O KUB O "$2,038.35 " $216.36 $216.36 $30.00 "$1,019.17 " $216.26 $196.60 $214.20 $30.00 $411.09 $30.00 $216.36 "$1,528.76 " $238.00 "$1,284.16 " "$1,490.03 " $36.00 $30.00 "$1,223.01 " "$1,630.68 " $735.63 "$1,233.26 " $30.00 $216.36 $259.63 $42.00 "$1,630.68 " $30.00 $30.00 $36.00 $302.91 $30.00 $216.36 $216.36 $235.83 "$1,630.68 " "$1,732.60 " $30.00 "$1,528.76 " $61.50 $30.00 "$1,019.17 " $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $30.00 $30.00 $183.91 $183.91 $216.36 $30.00 "$1,732.60 " 330104 74230 5571 389 320 HC CINE/VID X-RAY THROAT/ESOPH O "$1,481.95 " $216.36 $216.36 $20.00 $740.98 $223.00 $202.73 $214.20 $20.00 $411.09 $20.00 $216.36 "$1,111.46 " $238.00 $933.63 "$1,083.31 " $24.00 $20.00 $889.17 "$1,185.56 " $735.63 "$1,233.26 " $20.00 $216.36 $259.63 $28.00 "$1,185.56 " $20.00 $20.00 $24.00 $302.91 $20.00 $216.36 $216.36 $235.83 "$1,185.56 " "$1,259.66 " $20.00 "$1,111.46 " $41.00 $20.00 $740.98 $582.01 $340.77 $340.77 $340.77 $340.77 $138.75 $227.18 $216.36 $138.75 $20.00 $20.00 $183.91 $183.91 $216.36 $20.00 "$1,259.66 " 330104 74221 5571 389 320 HC X-RAY XM ESOPHAGUS 2CNTRST O $778.96 $216.36 $216.36 $24.94 $389.48 $194.70 $177.00 $214.20 $24.94 $411.09 $24.94 $216.36 $584.22 $238.00 $490.74 $569.42 $29.93 $24.94 $467.38 $623.17 $735.63 "$1,233.26 " $24.94 $216.36 $259.63 $34.92 $623.17 $24.94 $24.94 $29.93 $302.91 $24.94 $216.36 $216.36 $235.83 $623.17 $662.12 $24.94 $584.22 $51.13 $24.94 $389.48 $582.01 $340.77 $340.77 $340.77 $340.77 $291.52 $227.18 $216.36 $291.52 $24.94 $24.94 $183.91 $183.91 $216.36 $24.94 "$1,233.26 " 330104 74022 5522 471 320 HC X-RAY EXAM SERIES ABDOMEN O "$1,271.16 " $128.23 $128.23 $26.00 $635.58 $87.27 $79.34 $126.95 $26.00 $243.63 $26.00 $128.23 $953.37 $141.05 $800.83 $929.22 $31.20 $26.00 $762.70 "$1,016.93 " $435.98 $730.90 $26.00 $128.23 $153.87 $36.40 "$1,016.93 " $26.00 $26.00 $31.20 $179.52 $26.00 $128.23 $128.23 $139.77 "$1,016.93 " "$1,080.49 " $26.00 $953.37 $53.30 $26.00 $635.58 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $26.00 $26.00 $108.99 $108.99 $128.23 $26.00 "$1,080.49 " 330104 71120 5521 471 320 HC X-RAY EXAM BREASTBONE 2/>VWS O $861.35 $104.23 $104.23 $15.00 $430.68 $58.87 $53.52 $103.19 $15.00 $198.04 $15.00 $104.23 $646.01 $114.66 $542.65 $629.65 $18.00 $15.00 $516.81 $689.08 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $689.08 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $689.08 $732.15 $15.00 $646.01 $30.75 $15.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $732.15 330104 74018 5521 471 320 HC X-RAY EXAM ABDOMEN 1 VIEW O $861.35 $104.23 $104.23 $10.00 $430.68 $52.56 $47.78 $103.19 $10.00 $198.04 $10.00 $104.23 $646.01 $114.66 $542.65 $629.65 $12.00 $10.00 $516.81 $689.08 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $689.08 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $689.08 $732.15 $10.00 $646.01 $20.50 $10.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $99.38 $109.45 $104.23 $99.38 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $732.15 330104 71110 5522 471 320 HC X-RAY EXAM RIBS BIL 3 VIEWS O "$1,127.78 " $128.23 $128.23 $25.00 $563.89 $76.40 $69.45 $126.95 $25.00 $243.63 $25.00 $128.23 $845.84 $141.05 $710.50 $824.41 $30.00 $25.00 $676.67 $902.22 $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $902.22 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $902.22 $958.61 $25.00 $845.84 $51.25 $25.00 $563.89 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 $958.61 330104 61055 5441 214 320 HC RAD INJECTION INTO BRAIN CANAL O "$5,246.21 " $326.20 $326.20 $468.48 "$2,623.11 " $208.85 $189.86 $322.94 $468.48 $619.77 $468.48 $326.20 "$3,934.66 " $358.82 "$3,305.11 " "$3,834.98 " $562.18 $468.48 "$3,147.73 " "$4,196.97 " "$1,109.07 " "$1,859.32 " $468.48 $326.20 $391.44 $655.88 "$4,196.97 " $468.48 $468.48 $562.18 $456.68 $468.48 $326.20 $326.20 $355.56 "$4,196.97 " "$4,459.28 " $468.48 "$3,883.00 " $960.39 $468.48 "$2,623.11 " $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 "$3,499.22 " $468.48 $468.48 $277.27 $277.27 $326.20 $189.86 "$4,459.28 " 330104 49406 5072 150 320 HC IMAGE CATH FLUID PERI/RETRO O "$12,955.56 " "$1,799.07 " "$1,799.07 " $609.85 "$6,477.78 " $323.52 $294.11 "$1,781.08 " $609.85 "$3,418.23 " $609.85 "$1,799.07 " "$9,716.67 " "$1,978.98 " "$8,162.00 " "$9,470.51 " $731.82 $609.85 "$7,773.34 " "$10,364.45 " "$6,116.84 " "$10,254.70 " $609.85 "$1,799.07 " "$2,158.88 " $853.79 "$10,364.45 " $609.85 $609.85 $731.82 "$2,518.70 " $609.85 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$10,364.45 " "$11,012.23 " $609.85 "$9,716.67 " "$1,250.19 " $609.85 "$6,477.78 " "$4,839.50 " "$2,833.54 " "$2,833.54 " "$2,833.54 " "$2,833.54 " N/A "$1,889.02 " "$1,799.07 " "$8,641.36 " $609.85 $609.85 "$1,529.21 " "$1,529.21 " "$1,799.07 " $294.11 "$11,012.23 " 330104 47533 5341 151 320 HC PLMT BILIARY DRAINAGE CATH O "$8,560.00 " "$4,249.40 " "$4,249.40 " "$1,463.63 " "$4,280.00 " $440.75 $400.68 "$4,206.90 " "$1,463.63 " "$8,073.85 " "$1,463.63 " "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,392.80 " "$6,257.36 " "$1,756.35 " "$1,463.63 " "$5,136.00 " "$6,848.00 " "$14,447.94 " "$24,221.55 " "$1,463.63 " "$4,249.40 " "$5,099.27 " "$2,049.08 " "$6,848.00 " "$1,463.63 " "$1,463.63 " "$1,756.35 " "$5,949.15 " "$1,463.63 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " "$1,463.63 " "$6,420.00 " "$3,000.43 " "$1,463.63 " "$4,280.00 " "$11,430.87 " "$6,692.80 " "$6,692.80 " "$6,692.80 " "$6,692.80 " N/A "$4,461.86 " "$4,249.40 " "$5,709.52 " "$1,463.63 " "$1,463.63 " "$3,611.99 " "$3,611.99 " "$4,249.40 " $400.68 "$24,221.55 " 330104 47531 5341 279 320 HC INJECTION FOR CHOLANGIOGRAM O "$14,326.23 " "$4,249.40 " "$4,249.40 " $358.62 "$7,163.11 " $116.94 $106.31 "$4,206.90 " $358.62 "$8,073.85 " $358.62 "$4,249.40 " "$10,744.67 " "$4,674.33 " "$9,025.52 " "$10,472.47 " $430.34 $358.62 "$8,595.74 " "$11,460.98 " "$14,447.94 " "$24,221.55 " $358.62 "$4,249.40 " "$5,099.27 " $502.06 "$11,460.98 " $358.62 $358.62 $430.34 "$5,949.15 " $358.62 "$4,249.40 " "$4,249.40 " "$4,631.84 " "$11,460.98 " "$12,177.30 " $358.62 "$10,744.67 " $735.16 $358.62 "$7,163.11 " "$11,430.87 " "$6,692.80 " "$6,692.80 " "$6,692.80 " "$6,692.80 " N/A "$4,461.86 " "$4,249.40 " "$9,555.60 " $358.62 $358.62 "$3,611.99 " "$3,611.99 " "$4,249.40 " $106.31 "$24,221.55 " 330104 47490 5341 151 320 HC PERCUTANEOUS CHOLECYSTOSTOMY O "$14,326.23 " "$4,249.40 " "$4,249.40 " "$1,463.63 " "$7,163.11 " $565.76 $514.33 "$4,206.90 " "$1,463.63 " "$8,073.85 " "$1,463.63 " "$4,249.40 " "$10,744.67 " "$4,674.33 " "$9,025.52 " "$10,472.47 " "$1,756.35 " "$1,463.63 " "$8,595.74 " "$11,460.98 " "$14,447.94 " "$24,221.55 " "$1,463.63 " "$4,249.40 " "$5,099.27 " "$2,049.08 " "$11,460.98 " "$1,463.63 " "$1,463.63 " "$1,756.35 " "$5,949.15 " "$1,463.63 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$11,460.98 " "$12,177.30 " "$1,463.63 " "$3,883.00 " "$3,000.43 " "$1,463.63 " "$7,163.11 " "$11,430.87 " "$6,692.80 " "$6,692.80 " "$6,692.80 " "$6,692.80 " N/A "$4,461.86 " "$4,249.40 " "$9,555.60 " "$1,463.63 " "$1,463.63 " "$3,611.99 " "$3,611.99 " "$4,249.40 " $514.33 "$24,221.55 " 330104 36598 5693 278 320 HC CATHETER CHECK O "$1,443.43 " $247.83 $247.83 $468.99 $721.72 $59.79 $54.35 $245.35 $468.99 $470.88 $468.99 $247.83 "$1,082.57 " $272.61 $909.36 "$1,055.15 " $562.78 $468.99 $866.06 "$1,154.74 " $842.62 "$1,412.63 " $468.99 $247.83 $297.40 $656.58 "$1,154.74 " $468.99 $468.99 $562.78 $346.96 $468.99 $247.83 $247.83 $270.14 "$1,154.74 " "$1,226.92 " $468.99 "$1,082.57 " $961.42 $468.99 $721.72 $666.66 $390.33 $390.33 $390.33 $390.33 N/A $260.22 $247.83 $962.77 $468.99 $468.99 $210.66 $210.66 $247.83 $54.35 "$1,412.63 " 330104 36556 5183 75 320 HC RAD INS NON-TUNNEL CV CATH 5 YRS/> O "$7,469.67 " "$3,573.99 " "$3,573.99 " $235.81 "$3,734.84 " $144.10 $131.00 "$3,538.25 " $235.81 "$6,790.58 " $235.81 "$3,573.99 " "$5,602.25 " "$3,931.39 " "$4,705.89 " "$5,460.33 " $282.97 $235.81 "$4,481.80 " "$5,975.74 " "$12,151.56 " "$20,371.74 " $235.81 "$3,573.99 " "$4,288.79 " $330.13 "$5,975.74 " $235.81 $235.81 $282.97 "$5,003.59 " $235.81 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$5,975.74 " "$6,349.22 " $235.81 "$3,883.00 " $483.41 $235.81 "$3,734.84 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " N/A "$3,752.69 " "$3,573.99 " "$4,982.27 " $235.81 $235.81 "$3,037.89 " "$3,037.89 " "$3,573.99 " $131.00 "$20,371.74 " 330104 27093 278 320 HC HIP ARTHROGRAPHY INJ WO ANESTH O "$1,814.72 " N/A N/A $468.99 $907.36 $118.42 $107.65 $81.98 $468.99 N/A $468.99 N/A "$1,361.04 " N/A "$1,143.27 " "$1,326.56 " $562.78 $468.99 "$1,088.83 " "$1,451.78 " N/A N/A $468.99 N/A "$1,179.57 " $656.58 "$1,451.78 " $468.99 $468.99 $562.78 N/A $468.99 N/A N/A N/A "$1,451.78 " "$1,542.51 " $633.13 "$1,361.04 " $961.42 $633.13 $907.36 "$1,179.57 " N/A N/A N/A N/A N/A N/A N/A "$1,210.42 " $468.99 $468.99 N/A N/A N/A $81.98 "$1,542.51 " 330104 20610 5441 49 320 HC DRAIN/INJECT MAJOR JOINT/BURSA FL O "$1,206.96 " $326.20 $326.20 $296.51 $603.48 "$1,296.00 " "$1,180.00 " $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 $760.38 $882.29 $355.81 $296.51 $724.18 $965.57 "$1,109.07 " "$1,859.32 " $296.51 $326.20 $391.44 $415.11 $965.57 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $965.57 "$1,025.92 " $296.51 $905.22 $607.85 $296.51 $603.48 $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 $805.04 $296.51 $296.51 $277.27 $277.27 $326.20 $277.27 "$1,859.32 " 330104 20605 5441 49 320 HC DRAIN/INJECT INTERMED. JOINT/BURSA FL O "$1,206.96 " $326.20 $326.20 $296.51 $603.48 $64.77 $58.88 $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 $760.38 $882.29 $355.81 $296.51 $724.18 $965.57 "$1,109.07 " "$1,859.32 " $296.51 $326.20 $391.44 $415.11 $965.57 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $965.57 "$1,025.92 " $296.51 $905.22 $607.85 $296.51 $603.48 $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 $805.04 $296.51 $296.51 $277.27 $277.27 $326.20 $58.88 "$1,859.32 " 330104 20600 5441 49 320 HC DRAIN/INJECT SMALL JOINT/BURSA FL O "$1,277.58 " $326.20 $326.20 $296.51 $638.79 $60.92 $55.39 $322.94 $296.51 $619.77 $296.51 $326.20 $958.18 $358.82 $804.88 $933.91 $355.81 $296.51 $766.55 "$1,022.06 " "$1,109.07 " "$1,859.32 " $296.51 $326.20 $391.44 $415.11 "$1,022.06 " $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 "$1,022.06 " "$1,085.94 " $296.51 $958.18 $607.85 $296.51 $638.79 $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 $852.15 $296.51 $296.51 $277.27 $277.27 $326.20 $55.39 "$1,859.32 " 330104 20501 278 320 HC SINUS TRACT INJ DX O $529.65 N/A N/A $468.99 $264.82 $61.40 $55.82 $42.51 $468.99 N/A $468.99 N/A $397.24 N/A $333.68 $387.17 $562.78 $468.99 $317.79 $423.72 N/A N/A $468.99 N/A $344.27 $656.58 $423.72 $468.99 $468.99 $562.78 N/A $468.99 N/A N/A N/A $423.72 $450.20 $633.13 $397.24 $961.42 $633.13 $264.82 $344.27 N/A N/A N/A N/A N/A N/A N/A $353.28 $468.99 $468.99 N/A N/A N/A $42.51 $961.42 330104 0701T 177 320 HC MOLECULAR FLUOR IMAGING SUSPICIOUS NEVUS EA ADDL O $331.70 N/A N/A $43.08 $165.85 N/A N/A N/A $43.08 N/A $43.08 N/A $248.77 N/A $208.97 $242.47 $51.70 $43.08 $199.02 $265.36 N/A N/A $43.08 N/A $215.60 $60.31 $265.36 $43.08 $43.08 $51.70 N/A $43.08 N/A N/A N/A $265.36 $281.94 $58.16 $248.77 $88.31 $58.16 $165.85 $215.60 N/A N/A N/A N/A N/A N/A N/A $221.24 $43.08 $43.08 N/A N/A N/A $43.08 $281.94 330104 0700T 177 320 HC MOLECULAR FLUOR IMAGING SUSPICIOUS NEVUS 1ST LES O $663.40 N/A N/A $43.08 $331.70 N/A N/A N/A $43.08 N/A $43.08 N/A $497.55 N/A $417.94 $484.95 $51.70 $43.08 $398.04 $530.72 N/A N/A $43.08 N/A $431.21 $60.31 $530.72 $43.08 $43.08 $51.70 N/A $43.08 N/A N/A N/A $530.72 $563.89 $58.16 $497.55 $88.31 $58.16 $331.70 $431.21 N/A N/A N/A N/A N/A N/A N/A $442.49 $43.08 $43.08 N/A N/A N/A $43.08 $563.89 330104 0694T 2002 320 HC REAL-TIME 3D VOLUMETRIC IMG&RCNSTJ BRST/AX LYMPH NODE TISS - I&R O "$2,140.00 " N/A N/A N/A "$1,070.00 " N/A N/A N/A N/A N/A N/A N/A "$1,605.00 " N/A "$1,348.20 " "$1,564.34 " N/A N/A "$1,284.00 " "$1,712.00 " N/A N/A N/A N/A "$1,391.00 " N/A "$1,712.00 " N/A N/A N/A N/A N/A N/A N/A N/A "$1,712.00 " "$1,819.00 " N/A "$1,605.00 " N/A N/A "$1,070.00 " "$1,391.00 " N/A N/A N/A N/A N/A N/A N/A "$1,427.38 " N/A N/A N/A N/A N/A "$1,070.00 " "$1,819.00 " 330104 0693T 1505 213 320 HC COMPRE FUL BDY CPTR MRKRLS 3D KNMTC&KIN MTN ALYS W/I&R O $905.22 $420.51 $420.51 $138.60 $452.61 N/A N/A $416.30 $138.60 $798.97 $138.60 $420.51 $678.91 $462.56 $570.29 $661.72 $166.32 $138.60 $543.13 $724.18 "$1,429.73 " "$2,396.90 " $138.60 $420.51 $504.61 $194.04 $724.18 $138.60 $138.60 $166.32 $588.71 $138.60 $420.51 $420.51 $458.35 $724.18 $769.44 $138.60 $678.91 $284.13 $138.60 $452.61 "$1,131.17 " $662.30 $662.30 $662.30 $662.30 N/A $441.53 $420.51 $603.78 $138.60 $138.60 $357.43 $357.43 $420.51 $138.60 "$2,396.90 " 330104 71111 5522 471 320 HC X-RAY EXAM RIBS/CHEST4/> VWS O $826.04 $128.23 $128.23 $27.50 $413.02 $91.97 $83.61 $126.95 $27.50 $243.63 $27.50 $128.23 $619.53 $141.05 $520.41 $603.84 $33.00 $27.50 $495.62 $660.83 $435.98 $730.90 $27.50 $128.23 $153.87 $38.50 $660.83 $27.50 $27.50 $33.00 $179.52 $27.50 $128.23 $128.23 $139.77 $660.83 $702.13 $27.50 $619.53 $56.37 $27.50 $413.02 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $27.50 $27.50 $108.99 $108.99 $128.23 $27.50 $730.90 330104 62321 5442 53 320 HC RAD NJX INTERLAMINAR CRV/THRC O "$3,033.45 " $773.04 $773.04 $560.61 "$1,516.72 " $180.35 $163.95 $765.31 $560.61 "$1,468.78 " $560.61 $773.04 "$2,275.09 " $850.34 "$1,911.07 " "$2,217.45 " $672.74 $560.61 "$1,820.07 " "$2,426.76 " "$2,628.34 " "$4,406.33 " $560.61 $773.04 $927.65 $784.86 "$2,426.76 " $560.61 $560.61 $672.74 "$1,082.26 " $560.61 $773.04 $773.04 $842.61 "$2,426.76 " "$2,578.43 " $560.61 "$2,275.09 " "$1,149.26 " $560.61 "$1,516.72 " "$2,079.48 " "$1,217.54 " "$1,217.54 " "$1,217.54 " "$1,217.54 " N/A $811.69 $773.04 "$2,023.31 " $560.61 $560.61 $657.08 $657.08 $773.04 $163.95 "$4,406.33 " 330104 62323 5442 53 320 HC RAD NJX INTERLAMINAR LMBR/SAC O "$2,667.51 " $773.04 $773.04 $560.61 "$1,333.76 " $167.44 $152.22 $765.31 $560.61 "$1,468.78 " $560.61 $773.04 "$2,000.63 " $850.34 "$1,680.53 " "$1,949.95 " $672.74 $560.61 "$1,600.51 " "$2,134.01 " "$2,628.34 " "$4,406.33 " $560.61 $773.04 $927.65 $784.86 "$2,134.01 " $560.61 $560.61 $672.74 "$1,082.26 " $560.61 $773.04 $773.04 $842.61 "$2,134.01 " "$2,267.38 " $560.61 "$2,000.63 " "$1,149.26 " $560.61 "$1,333.76 " "$2,079.48 " "$1,217.54 " "$1,217.54 " "$1,217.54 " "$1,217.54 " N/A $811.69 $773.04 "$1,779.23 " $560.61 $560.61 $657.08 $657.08 $773.04 $152.22 "$4,406.33 " 330104 47536 5341 151 320 HC EXCHANGE BILIARY DRG CATH O "$14,326.23 " "$4,249.40 " "$4,249.40 " "$1,463.63 " "$7,163.11 " $219.01 $199.10 "$4,206.90 " "$1,463.63 " "$8,073.85 " "$1,463.63 " "$4,249.40 " "$10,744.67 " "$4,674.33 " "$9,025.52 " "$10,472.47 " "$1,756.35 " "$1,463.63 " "$8,595.74 " "$11,460.98 " "$14,447.94 " "$24,221.55 " "$1,463.63 " "$4,249.40 " "$5,099.27 " "$2,049.08 " "$11,460.98 " "$1,463.63 " "$1,463.63 " "$1,756.35 " "$5,949.15 " "$1,463.63 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$11,460.98 " "$12,177.30 " "$1,463.63 " "$10,744.67 " "$3,000.43 " "$1,463.63 " "$7,163.11 " "$11,430.87 " "$6,692.80 " "$6,692.80 " "$6,692.80 " "$6,692.80 " N/A "$4,461.86 " "$4,249.40 " "$9,555.60 " "$1,463.63 " "$1,463.63 " "$3,611.99 " "$3,611.99 " "$4,249.40 " $199.10 "$24,221.55 " 330104 70100 5521 471 320 HC X-RAY EXAM OF JAW <4VIEWS O $476.15 $104.23 $104.23 $15.00 $238.07 $67.83 $61.66 $103.19 $15.00 $198.04 $15.00 $104.23 $357.11 $114.66 $299.97 $348.07 $18.00 $15.00 $285.69 $380.92 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $380.92 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $380.92 $404.73 $15.00 $357.11 $30.75 $15.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 71101 5522 471 320 HC X-RAY EXAM UNILAT RIBS/CHEST; MIN 3 VIEWS O "$1,271.16 " $128.23 $128.23 $17.50 $635.58 $73.61 $66.92 $126.95 $17.50 $243.63 $17.50 $128.23 $953.37 $141.05 $800.83 $929.22 $21.00 $17.50 $762.70 "$1,016.93 " $435.98 $730.90 $17.50 $128.23 $153.87 $24.50 "$1,016.93 " $17.50 $17.50 $21.00 $179.52 $17.50 $128.23 $128.23 $139.77 "$1,016.93 " "$1,080.49 " $17.50 $953.37 $35.88 $17.50 $635.58 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $17.50 $17.50 $108.99 $108.99 $128.23 $17.50 "$1,080.49 " 330104 71100 5521 471 320 HC X-RAY EXAM RIBS UNI 2 VIEWS O $342.40 $104.23 $104.23 $15.00 $171.20 $64.59 $58.72 $103.19 $15.00 $198.04 $15.00 $104.23 $256.80 $114.66 $215.71 $250.29 $18.00 $15.00 $205.44 $273.92 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $273.92 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $273.92 $291.04 $15.00 $256.80 $30.75 $15.00 $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 70390 5523 389 320 HC X-RAY EXAM OF SALIVARY DUCT O "$1,945.26 " $280.16 $280.16 $20.00 $972.63 $207.22 $188.38 $277.36 $20.00 $532.31 $20.00 $280.16 "$1,458.94 " $308.18 "$1,225.51 " "$1,421.99 " $24.00 $20.00 "$1,167.16 " "$1,556.21 " $952.56 "$1,596.93 " $20.00 $280.16 $336.20 $28.00 "$1,556.21 " $20.00 $20.00 $24.00 $392.23 $20.00 $280.16 $280.16 $305.38 "$1,556.21 " "$1,653.47 " $20.00 "$1,458.94 " $41.00 $20.00 $972.63 $753.64 $441.26 $441.26 $441.26 $441.26 $367.94 $294.17 $280.16 $367.94 $20.00 $20.00 $238.14 $238.14 $280.16 $20.00 "$1,653.47 " 330104 70371 5523 389 320 HC SPEECH EVALUATION COMPLEX O "$3,046.29 " $280.16 $280.16 $35.00 "$1,523.14 " $187.18 $170.17 $277.36 $35.00 $532.31 $35.00 $280.16 "$2,284.72 " $308.18 "$1,919.16 " "$2,226.84 " $42.00 $35.00 "$1,827.77 " "$2,437.03 " $952.56 "$1,596.93 " $35.00 $280.16 $336.20 $49.00 "$2,437.03 " $35.00 $35.00 $42.00 $392.23 $35.00 $280.16 $280.16 $305.38 "$2,437.03 " "$2,589.35 " $35.00 "$2,284.72 " $71.75 $35.00 "$1,523.14 " $753.64 $441.26 $441.26 $441.26 $441.26 $133.60 $294.17 $280.16 $133.60 $35.00 $35.00 $238.14 $238.14 $280.16 $35.00 "$2,589.35 " 330104 70360 5521 471 320 HC X-RAY EXAM OF NECK; SOFT TISSUE O $861.35 $104.23 $104.23 $10.00 $430.68 $55.50 $50.45 $103.19 $10.00 $198.04 $10.00 $104.23 $646.01 $114.66 $542.65 $629.65 $12.00 $10.00 $516.81 $689.08 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $689.08 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $689.08 $732.15 $10.00 $646.01 $20.50 $10.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $732.15 330104 70030 5521 471 320 HC X-RAY EYE FOR FOREIGN BODY O $476.15 $104.23 $104.23 $40.00 $238.07 $57.26 $52.05 $103.19 $40.00 $198.04 $40.00 $104.23 $357.11 $114.66 $299.97 $348.07 $48.00 $40.00 $285.69 $380.92 $354.39 $594.13 $40.00 $104.23 $125.08 $56.00 $380.92 $40.00 $40.00 $48.00 $145.93 $40.00 $104.23 $104.23 $113.61 $380.92 $404.73 $40.00 $357.11 $82.00 $40.00 $238.07 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $40.00 $40.00 $88.60 $88.60 $104.23 $40.00 $594.13 330104 70260 5522 471 320 HC X-RAY EXAM OF SKULL; COMPLETE MIN 4 VIEWS O "$1,271.16 " $128.23 $128.23 $25.00 $635.58 $77.65 $70.59 $126.95 $25.00 $243.63 $25.00 $128.23 $953.37 $141.05 $800.83 $929.22 $30.00 $25.00 $762.70 "$1,016.93 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 "$1,016.93 " $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 "$1,016.93 " "$1,080.49 " $25.00 $953.37 $51.25 $25.00 $635.58 $344.93 $201.96 $201.96 $201.96 $201.96 $121.38 $134.64 $128.23 $121.38 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$1,080.49 " 330104 70250 5522 471 320 HC X-RAY EXAM OF SKULL; < 4 VIEWS O $606.69 $128.23 $128.23 $15.00 $303.35 $63.13 $57.39 $126.95 $15.00 $243.63 $15.00 $128.23 $455.02 $141.05 $382.21 $443.49 $18.00 $15.00 $364.01 $485.35 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $485.35 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $485.35 $515.69 $15.00 $455.02 $30.75 $15.00 $303.35 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $730.90 330104 70240 5521 471 320 HC X-RAY EXAM PITUITARY SADDLE (SELLA TURCICA) O $342.40 $104.23 $104.23 $12.50 $171.20 $57.77 $52.52 $103.19 $12.50 $198.04 $12.50 $104.23 $256.80 $114.66 $215.71 $250.29 $15.00 $12.50 $205.44 $273.92 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $273.92 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $273.92 $291.04 $12.50 $256.80 $25.62 $12.50 $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $594.13 330104 70330 5521 471 320 HC X-RAY EXAM OF JAW JOINTS; BILATERAL O $921.27 $104.23 $104.23 $20.00 $460.63 $92.63 $84.21 $103.19 $20.00 $198.04 $20.00 $104.23 $690.95 $114.66 $580.40 $673.45 $24.00 $20.00 $552.76 $737.02 $354.39 $594.13 $20.00 $104.23 $125.08 $28.00 $737.02 $20.00 $20.00 $24.00 $145.93 $20.00 $104.23 $104.23 $113.61 $737.02 $783.08 $20.00 $690.95 $41.00 $20.00 $460.63 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $20.00 $20.00 $88.60 $88.60 $104.23 $20.00 $783.08 330104 70210 5521 471 320 HC X-RAY EXAM OF SINUSES; <3 VIEWS O $342.40 $104.23 $104.23 $12.50 $171.20 $56.75 $51.59 $103.19 $12.50 $198.04 $12.50 $104.23 $256.80 $114.66 $215.71 $250.29 $15.00 $12.50 $205.44 $273.92 $354.39 $594.13 $12.50 $104.23 $125.08 $17.50 $273.92 $12.50 $12.50 $15.00 $145.93 $12.50 $104.23 $104.23 $113.61 $273.92 $291.04 $12.50 $256.80 $25.62 $12.50 $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $12.50 $12.50 $88.60 $88.60 $104.23 $12.50 $594.13 330104 70200 5522 471 320 HC X-RAY EXAM OF EYE SOCKETS;COMPLETE MIN 4 VIEWS O "$1,346.06 " $128.23 $128.23 $25.00 $673.03 $83.52 $75.93 $126.95 $25.00 $243.63 $25.00 $128.23 "$1,009.54 " $141.05 $848.02 $983.97 $30.00 $25.00 $807.64 "$1,076.85 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 "$1,076.85 " $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 "$1,076.85 " "$1,144.15 " $25.00 "$1,009.54 " $51.25 $25.00 $673.03 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$1,144.15 " 330104 70160 5521 471 320 HC X-RAY EXAM OF NASAL BONES; COMPLETE MIN 3 VIEWS O $861.35 $104.23 $104.23 $15.00 $430.68 $67.32 $61.20 $103.19 $15.00 $198.04 $15.00 $104.23 $646.01 $114.66 $542.65 $629.65 $18.00 $15.00 $516.81 $689.08 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $689.08 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $689.08 $732.15 $15.00 $646.01 $30.75 $15.00 $430.68 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $732.15 330104 70150 5522 471 320 HC X-RAY EXAM OF FACIAL BONES; COMPLETE MIN 3 VIEWS O "$1,271.16 " $128.23 $128.23 $25.00 $635.58 $81.91 $74.46 $126.95 $25.00 $243.63 $25.00 $128.23 $953.37 $141.05 $800.83 $929.22 $30.00 $25.00 $762.70 "$1,016.93 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 "$1,016.93 " $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 "$1,016.93 " "$1,080.49 " $25.00 $953.37 $51.25 $25.00 $635.58 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$1,080.49 " 330104 70140 5521 471 320 HC X-RAY EXAM OF FACIAL BONES; <3VIEWS O $468.66 $104.23 $104.23 $15.00 $234.33 $56.59 $51.45 $103.19 $15.00 $198.04 $15.00 $104.23 $351.50 $114.66 $295.26 $342.59 $18.00 $15.00 $281.20 $374.93 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $374.93 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $374.93 $398.36 $15.00 $351.50 $30.75 $15.00 $234.33 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $594.13 330104 70220 5521 471 320 HC X-RAY EXAM OF SINUSES;COMPLETE MIN 3 VIEWS O "$1,271.16 " $104.23 $104.23 $20.00 $635.58 $65.77 $59.79 $103.19 $20.00 $198.04 $20.00 $104.23 $953.37 $114.66 $800.83 $929.22 $24.00 $20.00 $762.70 "$1,016.93 " $354.39 $594.13 $20.00 $104.23 $125.08 $28.00 "$1,016.93 " $20.00 $20.00 $24.00 $145.93 $20.00 $104.23 $104.23 $113.61 "$1,016.93 " "$1,080.49 " $20.00 $953.37 $41.00 $20.00 $635.58 $280.39 $164.17 $164.17 $164.17 $164.17 $72.06 $109.45 $104.23 $72.06 $20.00 $20.00 $88.60 $88.60 $104.23 $20.00 "$1,080.49 " 330104 70130 5522 471 320 HC X-RAY EXAM OF MASTOIDS; MIN 3 VIEWS /SIDE O "$1,189.84 " $128.23 $128.23 $25.00 $594.92 $109.44 $99.49 $126.95 $25.00 $243.63 $25.00 $128.23 $892.38 $141.05 $749.60 $869.77 $30.00 $25.00 $713.90 $951.87 $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $951.87 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $951.87 "$1,011.36 " $25.00 $892.38 $51.25 $25.00 $594.92 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$1,011.36 " 330104 70120 5522 471 320 HC X-RAY EXAM OF MASTOIDS; <3VIEWS/SIDE O $480.43 $128.23 $128.23 $15.00 $240.22 $67.83 $61.66 $126.95 $15.00 $243.63 $15.00 $128.23 $360.32 $141.05 $302.67 $351.19 $18.00 $15.00 $288.26 $384.34 $435.98 $730.90 $15.00 $128.23 $153.87 $21.00 $384.34 $15.00 $15.00 $18.00 $179.52 $15.00 $128.23 $128.23 $139.77 $384.34 $408.37 $15.00 $360.32 $30.75 $15.00 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $15.00 $15.00 $108.99 $108.99 $128.23 $15.00 $730.90 330104 70110 5522 471 320 HC X-RAY EXAM OF JAW 4/> VIEWS O $996.17 $128.23 $128.23 $25.00 $498.08 $75.52 $68.66 $126.95 $25.00 $243.63 $25.00 $128.23 $747.13 $141.05 $627.59 $728.20 $30.00 $25.00 $597.70 $796.94 $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $796.94 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $796.94 $846.74 $25.00 $747.13 $51.25 $25.00 $498.08 $344.93 $201.96 $201.96 $201.96 $201.96 $72.06 $134.64 $128.23 $72.06 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 $846.74 330104 73040 5572 389 322 HC CONTRAST X-RAY OF SHOULDER O "$1,857.52 " $442.02 $442.02 $25.00 $928.76 $231.15 $210.14 $437.60 $25.00 $839.84 $25.00 $442.02 "$1,393.14 " $486.22 "$1,170.24 " "$1,357.85 " $30.00 $25.00 "$1,114.51 " "$1,486.02 " "$1,502.87 " "$2,519.52 " $25.00 $442.02 $530.42 $35.00 "$1,486.02 " $25.00 $25.00 $30.00 $618.83 $25.00 $442.02 $442.02 $481.80 "$1,486.02 " "$1,578.89 " $25.00 "$1,393.14 " $51.25 $25.00 $928.76 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $440.06 $464.12 $442.02 $440.06 $25.00 $25.00 $375.72 $375.72 $442.02 $25.00 "$2,519.52 " 330104 73525 5572 389 322 HC CONTRAST X-RAY OF HIP O "$1,857.52 " $442.02 $442.02 $25.00 $928.76 $229.39 $208.53 $437.60 $25.00 $839.84 $25.00 $442.02 "$1,393.14 " $486.22 "$1,170.24 " "$1,357.85 " $30.00 $25.00 "$1,114.51 " "$1,486.02 " "$1,502.87 " "$2,519.52 " $25.00 $442.02 $530.42 $35.00 "$1,486.02 " $25.00 $25.00 $30.00 $618.83 $25.00 $442.02 $442.02 $481.80 "$1,486.02 " "$1,578.89 " $25.00 "$1,393.14 " $51.25 $25.00 $928.76 "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $440.06 $464.12 $442.02 $440.06 $25.00 $25.00 $375.72 $375.72 $442.02 $25.00 "$2,519.52 " 330104 75741 5183 279 323 HC ARTERY X-RAYS LUNG UNILATERAL SELECTIVE O "$15,510.72 " "$3,573.99 " "$3,573.99 " $90.00 "$7,755.36 " $226.69 $206.09 "$3,538.25 " $90.00 "$6,790.58 " $90.00 "$3,573.99 " "$11,633.04 " "$3,931.39 " "$9,771.75 " "$11,338.34 " $108.00 $90.00 "$9,306.43 " "$12,408.58 " "$12,151.56 " "$20,371.74 " $90.00 "$3,573.99 " "$4,288.79 " $126.00 "$12,408.58 " $90.00 $90.00 $108.00 "$5,003.59 " $90.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$12,408.58 " "$13,184.11 " $90.00 "$11,633.04 " $184.50 $90.00 "$7,755.36 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $90.00 $90.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $90.00 "$20,371.74 " 330104 75733 5183 279 323 HC ARTERY X-RAYS ADRENALS O "$16,245.81 " "$3,573.99 " "$3,573.99 " $110.00 "$8,122.90 " $291.53 $265.02 "$3,538.25 " $110.00 "$6,790.58 " $110.00 "$3,573.99 " "$12,184.36 " "$3,931.39 " "$10,234.86 " "$11,875.69 " $132.00 $110.00 "$9,747.49 " "$12,996.65 " "$12,151.56 " "$20,371.74 " $110.00 "$3,573.99 " "$4,288.79 " $154.00 "$12,996.65 " $110.00 $110.00 $132.00 "$5,003.59 " $110.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$12,996.65 " "$13,808.94 " $110.00 "$12,184.36 " $225.50 $110.00 "$8,122.90 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $110.00 $110.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $110.00 "$20,371.74 " 330104 75731 5183 279 323 HC ARTERY X-RAYS ADRENAL GLAND O "$14,513.48 " "$3,573.99 " "$3,573.99 " $80.00 "$7,256.74 " $266.27 $242.06 "$3,538.25 " $80.00 "$6,790.58 " $80.00 "$3,573.99 " "$10,885.11 " "$3,931.39 " "$9,143.49 " "$10,609.35 " $96.00 $80.00 "$8,708.09 " "$11,610.78 " "$12,151.56 " "$20,371.74 " $80.00 "$3,573.99 " "$4,288.79 " $112.00 "$11,610.78 " $80.00 $80.00 $96.00 "$5,003.59 " $80.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$11,610.78 " "$12,336.46 " $80.00 "$10,885.11 " $164.00 $80.00 "$7,256.74 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $80.00 $80.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $80.00 "$20,371.74 " 330104 75716 5183 279 323 HC ARTERY X-RAYS ARMS/LEGS O "$16,734.80 " "$3,573.99 " "$3,573.99 " $56.00 "$8,367.40 " $282.22 $256.56 "$3,538.25 " $56.00 "$6,790.58 " $56.00 "$3,573.99 " "$12,551.10 " "$3,931.39 " "$10,542.92 " "$12,233.14 " $67.20 $56.00 "$10,040.88 " "$13,387.84 " "$12,151.56 " "$20,371.74 " $56.00 "$3,573.99 " "$4,288.79 " $78.40 "$13,387.84 " $56.00 $56.00 $67.20 "$5,003.59 " $56.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$13,387.84 " "$14,224.58 " $56.00 "$12,551.10 " $114.80 $56.00 "$8,367.40 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $56.00 $56.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $56.00 "$20,371.74 " 330104 75630 5183 279 323 HC X-RAY AORTA LEG ARTERIES O "$16,734.80 " "$3,573.99 " "$3,573.99 " $75.00 "$8,367.40 " $271.48 $246.80 "$3,538.25 " $75.00 "$6,790.58 " $75.00 "$3,573.99 " "$12,551.10 " "$3,931.39 " "$10,542.92 " "$12,233.14 " $90.00 $75.00 "$10,040.88 " "$13,387.84 " "$12,151.56 " "$20,371.74 " $75.00 "$3,573.99 " "$4,288.79 " $105.00 "$13,387.84 " $75.00 $75.00 $90.00 "$5,003.59 " $75.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$13,387.84 " "$14,224.58 " $75.00 "$12,551.10 " $153.75 $75.00 "$8,367.40 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $75.00 $75.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $75.00 "$20,371.74 " 330104 75625 5183 279 323 HC CONTRAST EXAM ABDOMINL AORTA O "$12,768.31 " "$3,573.99 " "$3,573.99 " $50.00 "$6,384.15 " $221.73 $201.58 "$3,538.25 " $50.00 "$6,790.58 " $50.00 "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,044.04 " "$9,333.63 " $60.00 $50.00 "$7,660.99 " "$10,214.65 " "$12,151.56 " "$20,371.74 " $50.00 "$3,573.99 " "$4,288.79 " $70.00 "$10,214.65 " $50.00 $50.00 $60.00 "$5,003.59 " $50.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " $50.00 "$9,576.23 " $102.50 $50.00 "$6,384.15 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $50.00 $50.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $50.00 "$20,371.74 " 330104 75605 5184 280 323 HC CONTRAST EXAM THORACIC AORTA BY SERIALOGRAPHY O "$21,176.37 " "$6,166.38 " "$6,166.38 " $50.00 "$10,588.18 " $210.30 $191.18 "$6,104.71 " $50.00 "$11,716.11 " $50.00 "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,341.11 " "$15,479.93 " $60.00 $50.00 "$12,705.82 " "$16,941.10 " "$20,965.68 " "$35,148.34 " $50.00 "$6,166.38 " "$7,399.65 " $70.00 "$16,941.10 " $50.00 $50.00 $60.00 "$8,632.93 " $50.00 "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " $50.00 "$15,882.28 " $102.50 $50.00 "$10,588.18 " "$16,587.55 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$9,712.04 " "$3,242.54 " "$6,474.69 " "$6,166.38 " "$3,242.54 " $50.00 $50.00 "$5,241.42 " "$5,241.42 " "$6,166.38 " $50.00 "$35,148.34 " 330104 75743 5183 279 323 HC ARTERY X-RAYS LUNGS BILATERAL SELECTIVE O "$14,513.48 " "$3,573.99 " "$3,573.99 " $120.00 "$7,256.74 " $255.65 $232.41 "$3,538.25 " $120.00 "$6,790.58 " $120.00 "$3,573.99 " "$10,885.11 " "$3,931.39 " "$9,143.49 " "$10,609.35 " $144.00 $120.00 "$8,708.09 " "$11,610.78 " "$12,151.56 " "$20,371.74 " $120.00 "$3,573.99 " "$4,288.79 " $168.00 "$11,610.78 " $120.00 $120.00 $144.00 "$5,003.59 " $120.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$11,610.78 " "$12,336.46 " $120.00 "$10,885.11 " $246.00 $120.00 "$7,256.74 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $120.00 $120.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $120.00 "$20,371.74 " 330104 75710 5183 279 323 HC ARTERY X-RAYS ARM/LEG O "$13,768.76 " "$3,573.99 " "$3,573.99 " $35.00 "$6,884.38 " $263.80 $239.82 "$3,538.25 " $35.00 "$6,790.58 " $35.00 "$3,573.99 " "$10,326.57 " "$3,931.39 " "$8,674.32 " "$10,064.96 " $42.00 $35.00 "$8,261.26 " "$11,015.01 " "$12,151.56 " "$20,371.74 " $35.00 "$3,573.99 " "$4,288.79 " $49.00 "$11,015.01 " $35.00 $35.00 $42.00 "$5,003.59 " $35.00 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$11,015.01 " "$11,703.45 " $35.00 "$10,326.57 " $71.75 $35.00 "$6,884.38 " "$9,614.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$5,629.03 " "$3,242.54 " "$3,752.69 " "$3,573.99 " "$3,242.54 " $35.00 $35.00 "$3,037.89 " "$3,037.89 " "$3,573.99 " $35.00 "$20,371.74 " 330104 71045 5521 471 324 HC X-RAY EXAM CHEST 1 VIEW O $961.93 $104.23 $104.23 $10.00 $480.96 $45.51 $41.37 $103.19 $10.00 $198.04 $10.00 $104.23 $721.45 $114.66 $606.02 $703.17 $12.00 $10.00 $577.16 $769.54 $354.39 $594.13 $10.00 $104.23 $125.08 $14.00 $769.54 $10.00 $10.00 $12.00 $145.93 $10.00 $104.23 $104.23 $113.61 $769.54 $817.64 $10.00 $721.45 $20.50 $10.00 $480.96 $280.39 $164.17 $164.17 $164.17 $164.17 $99.38 $109.45 $104.23 $99.38 $10.00 $10.00 $88.60 $88.60 $104.23 $10.00 $817.64 330104 71046 5521 471 324 HC X-RAY EXAM CHEST 2 VIEWS O $998.31 $104.23 $104.23 $15.00 $499.15 $58.72 $53.38 $103.19 $15.00 $198.04 $15.00 $104.23 $748.73 $114.66 $628.94 $729.76 $18.00 $15.00 $598.99 $798.65 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $798.65 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $798.65 $848.56 $15.00 $748.73 $30.75 $15.00 $499.15 $280.39 $164.17 $164.17 $164.17 $164.17 $99.38 $109.45 $104.23 $99.38 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $848.56 330104 71047 5521 471 324 HC X-RAY EXAM CHEST 3 VIEWS O "$1,165.23 " $104.23 $104.23 $15.00 $582.62 $73.61 $66.92 $103.19 $15.00 $198.04 $15.00 $104.23 $873.92 $114.66 $734.09 $851.78 $18.00 $15.00 $699.14 $932.18 $354.39 $594.13 $15.00 $104.23 $125.08 $21.00 $932.18 $15.00 $15.00 $18.00 $145.93 $15.00 $104.23 $104.23 $113.61 $932.18 $990.45 $15.00 $873.92 $30.75 $15.00 $582.62 $280.39 $164.17 $164.17 $164.17 $164.17 $99.38 $109.45 $104.23 $99.38 $15.00 $15.00 $88.60 $88.60 $104.23 $15.00 $990.45 330104 71048 5522 471 324 HC X-RAY EXAM CHEST 4+ VIEWS O "$1,031.48 " $128.23 $128.23 $20.00 $515.74 $80.36 $73.05 $126.95 $20.00 $243.63 $20.00 $128.23 $773.61 $141.05 $649.83 $754.01 $24.00 $20.00 $618.89 $825.18 $435.98 $730.90 $20.00 $128.23 $153.87 $28.00 $825.18 $20.00 $20.00 $24.00 $179.52 $20.00 $128.23 $128.23 $139.77 $825.18 $876.76 $20.00 $773.61 $41.00 $20.00 $515.74 $344.93 $201.96 $201.96 $201.96 $201.96 $189.98 $134.64 $128.23 $189.98 $20.00 $20.00 $108.99 $108.99 $128.23 $20.00 $876.76 330104 96411 5692 109 331 HC CHEMO IV PUSH ADDL DRUG O $707.27 $80.95 $80.95 $38.26 $353.63 $97.52 $88.65 $80.14 $38.26 $153.80 $38.26 $80.95 $530.45 $89.04 "$1,609.63 " $536.82 $45.91 $38.26 $424.36 "$3,881.00 " $275.22 "$2,934.00 " $38.26 $80.95 $97.14 $53.56 "$2,883.13 " $38.26 $38.26 $45.91 $113.33 $38.26 $80.95 $80.95 $88.23 $565.82 $601.18 $38.26 $530.45 $78.43 $38.26 $353.63 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $38.26 $38.26 $270.00 $270.00 $80.95 $38.26 "$3,881.00 " 330104 96401 5692 109 331 HC CHEMO ANTI-NEOPL SQ/IM O $707.27 $80.95 $80.95 $38.26 $353.63 $127.98 $116.35 $80.14 $38.26 $153.80 $38.26 $80.95 $530.45 $89.04 "$1,609.63 " $536.82 $45.91 $38.26 $424.36 "$3,881.00 " $275.22 "$2,934.00 " $38.26 $80.95 $97.14 $53.56 "$2,883.13 " $38.26 $38.26 $45.91 $113.33 $38.26 $80.95 $80.95 $88.23 $565.82 $601.18 $38.26 $530.45 $78.43 $38.26 $353.63 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $38.26 $38.26 $270.00 $270.00 $80.95 $38.26 "$3,881.00 " 330104 96402 5692 109 331 HC CHEMO HORMON ANTINEOPL SQ/IM O $707.27 $80.95 $80.95 $38.26 $353.63 $58.94 $53.59 $80.14 $38.26 $153.80 $38.26 $80.95 $530.45 $89.04 "$1,609.63 " $536.82 $45.91 $38.26 $424.36 "$3,881.00 " $275.22 "$2,934.00 " $38.26 $80.95 $97.14 $53.56 "$2,883.13 " $38.26 $38.26 $45.91 $113.33 $38.26 $80.95 $80.95 $88.23 $565.82 $601.18 $38.26 $530.45 $78.43 $38.26 $353.63 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $38.26 $38.26 $270.00 $270.00 $80.95 $38.26 "$3,881.00 " 330104 96409 5693 109 331 HC CHEMO IV PUSH SNGL DRUG O "$1,136.34 " $247.83 $247.83 $15.00 $568.17 $178.15 $161.96 $245.35 $15.00 $470.88 $15.00 $247.83 $852.25 $272.61 "$1,609.63 " $862.48 $18.00 $15.00 $681.80 "$3,881.00 " $842.62 "$2,934.00 " $15.00 $247.83 $297.40 $21.00 "$2,883.13 " $15.00 $15.00 $18.00 $346.96 $15.00 $247.83 $247.83 $270.14 $909.07 $965.89 $15.00 $852.25 $30.75 $15.00 $568.17 "$1,515.00 " $390.33 $390.33 $390.33 $390.33 "$2,066.00 " $260.22 $247.83 "$2,424.00 " $15.00 $15.00 $270.00 $270.00 $247.83 $15.00 "$3,881.00 " 330104 96450 5694 110 331 HC CHEMOTHERAPY INTO CNS O "$1,535.45 " $399.06 $399.06 $723.83 $767.73 $129.18 $117.44 $395.07 $723.83 $758.21 $723.83 $399.06 "$1,151.59 " $438.96 "$1,609.63 " "$1,165.41 " $868.59 $723.83 $921.27 "$3,881.00 " "$1,356.80 " "$2,934.00 " $723.83 $399.06 $478.87 "$1,013.36 " "$2,883.13 " $723.83 $723.83 $868.59 $558.68 $723.83 $399.06 $399.06 $434.97 "$1,228.36 " "$1,305.13 " $723.83 "$1,151.59 " "$1,483.84 " $723.83 $767.73 "$1,515.00 " $628.52 $628.52 $628.52 $628.52 "$2,066.00 " $419.01 $399.06 "$2,424.00 " $723.83 $723.83 $270.00 $270.00 $399.06 $117.44 "$3,881.00 " 330104 77336 5611 476 333 HC RADIATION PHYSICS CONSULT O "$1,346.06 " $160.02 $160.02 $41.80 $673.03 $155.77 $141.61 $158.42 $41.80 $304.04 $41.80 $160.02 "$1,009.54 " $176.02 $848.02 $983.97 $50.16 $41.80 $807.64 "$1,076.85 " $544.07 $912.12 $41.80 $160.02 $192.03 $58.52 "$1,076.85 " $41.80 $41.80 $50.16 $224.03 $41.80 $160.02 $160.02 $174.42 "$1,076.85 " "$1,144.15 " $41.80 "$1,009.54 " $85.69 $41.80 $673.03 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 $897.82 $41.80 $41.80 $136.02 $136.02 $160.02 $41.80 "$1,144.15 " 330104 77338 5612 477 333 HC DESIGN MLC DEVICE FOR IMRT O "$2,038.35 " $430.37 $430.37 $446.44 "$1,019.17 " $795.39 $723.08 $426.07 $446.44 $817.70 $446.44 $430.37 "$1,528.76 " $473.41 "$1,284.16 " "$1,490.03 " $535.73 $446.44 "$1,223.01 " "$1,630.68 " "$1,463.26 " "$2,453.11 " $446.44 $430.37 $516.44 $625.01 "$1,630.68 " $446.44 $446.44 $535.73 $602.52 $446.44 $430.37 $430.37 $469.10 "$1,630.68 " "$1,732.60 " $446.44 "$1,528.76 " $915.20 $446.44 "$1,019.17 " "$1,157.70 " $677.83 $677.83 $677.83 $677.83 N/A $451.89 $430.37 "$1,359.58 " $446.44 $446.44 $365.82 $365.82 $430.37 $365.82 "$2,453.11 " 330104 77373 5626 348 333 HC SBRT DELIVERY O "$8,149.12 " "$2,120.48 " "$2,120.48 " $63.70 "$4,074.56 " "$1,778.27 " "$1,616.61 " "$2,099.28 " $63.70 "$4,028.91 " $63.70 "$2,120.48 " "$6,111.84 " "$2,332.53 " "$5,133.95 " "$5,957.01 " $76.44 $63.70 "$4,889.47 " "$6,519.30 " "$7,209.63 " "$12,086.74 " $63.70 "$2,120.48 " "$2,544.58 " $89.18 "$6,519.30 " $63.70 $63.70 $76.44 "$2,968.67 " $63.70 "$2,120.48 " "$2,120.48 " "$2,311.32 " "$6,519.30 " "$6,926.75 " $63.70 "$6,111.84 " $130.59 $63.70 "$4,074.56 " "$5,704.09 " "$3,339.76 " "$3,339.76 " "$3,339.76 " "$3,339.76 " N/A "$2,226.50 " "$2,120.48 " "$5,435.46 " $63.70 $63.70 "$1,802.41 " "$1,802.41 " "$2,120.48 " $63.70 "$12,086.74 " 330104 77370 5611 476 333 HC SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION O "$1,562.20 " $160.02 $160.02 $472.72 $781.10 $251.17 $228.33 $158.42 $472.72 $304.04 $472.72 $160.02 "$1,171.65 " $176.02 $984.19 "$1,141.97 " $567.26 $472.72 $937.32 "$1,249.76 " $544.07 $912.12 $472.72 $160.02 $192.03 $661.80 "$1,249.76 " $472.72 $472.72 $567.26 $224.03 $472.72 $160.02 $160.02 $174.42 "$1,249.76 " "$1,327.87 " $472.72 "$1,171.65 " $969.07 $472.72 $781.10 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 "$1,041.99 " $472.72 $472.72 $136.02 $136.02 $160.02 $136.02 "$1,327.87 " 330104 77470 5623 347 333 HC SPECIAL RADIATION TREATMENT O "$3,847.72 " $686.82 $686.82 $77.40 "$1,923.86 " $234.76 $213.42 $679.95 $77.40 "$1,304.95 " $77.40 $686.82 "$2,885.79 " $755.50 "$2,424.06 " "$2,812.68 " $92.88 $77.40 "$2,308.63 " "$3,078.18 " "$2,335.17 " "$3,914.85 " $77.40 $686.82 $824.18 $108.36 "$3,078.18 " $77.40 $77.40 $92.88 $961.54 $77.40 $686.82 $686.82 $748.63 "$3,078.18 " "$3,270.56 " $77.40 "$2,885.79 " $158.67 $77.40 "$1,923.86 " "$1,847.53 " "$1,081.73 " "$1,081.73 " "$1,081.73 " "$1,081.73 " N/A $721.16 $686.82 "$2,566.43 " $77.40 $77.40 $583.79 $583.79 $686.82 $77.40 "$3,914.85 " 330104 77334 5612 477 333 HC RADIATION TREATMENT AID(S); COMPLEX O "$1,558.99 " $430.37 $430.37 $79.20 $779.50 $213.03 $193.66 $426.07 $79.20 $817.70 $79.20 $430.37 "$1,169.24 " $473.41 $982.16 "$1,139.62 " $95.04 $79.20 $935.39 "$1,247.19 " "$1,463.26 " "$2,453.11 " $79.20 $430.37 $516.44 $110.88 "$1,247.19 " $79.20 $79.20 $95.04 $602.52 $79.20 $430.37 $430.37 $469.10 "$1,247.19 " "$1,325.14 " $79.20 "$1,169.24 " $162.36 $79.20 $779.50 "$1,157.70 " $677.83 $677.83 $677.83 $677.83 N/A $451.89 $430.37 "$1,039.85 " $79.20 $79.20 $365.82 $365.82 $430.37 $79.20 "$2,453.11 " 330104 77387 476 333 HC NTSTY MODUL RAD TX DLVR SMPL O $815.34 N/A N/A $89.99 $407.67 N/A N/A N/A $89.99 N/A $89.99 N/A $611.50 N/A $513.66 $596.01 $107.99 $89.99 $489.20 $652.27 N/A N/A $89.99 N/A $529.97 $125.99 $652.27 $89.99 $89.99 $107.99 N/A $89.99 N/A N/A N/A $652.27 $693.04 $121.49 $611.50 $184.48 $121.49 $407.67 $529.97 N/A N/A N/A N/A N/A N/A N/A $543.83 $89.99 $89.99 N/A N/A N/A $89.99 $693.04 330104 77333 5611 476 333 HC RADIATION TREATMENT AID(S); INTERMEDIATE O "$1,308.61 " $160.02 $160.02 $58.40 $654.30 $238.96 $217.24 $158.42 $58.40 $304.04 $58.40 $160.02 $981.46 $176.02 $824.42 $956.59 $70.08 $58.40 $785.17 "$1,046.89 " $544.07 $912.12 $58.40 $160.02 $192.03 $81.76 "$1,046.89 " $58.40 $58.40 $70.08 $224.03 $58.40 $160.02 $160.02 $174.42 "$1,046.89 " "$1,112.32 " $58.40 $981.46 $119.72 $58.40 $654.30 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 $872.84 $58.40 $58.40 $136.02 $136.02 $160.02 $58.40 "$1,112.32 " 330104 77300 5611 477 333 HC RADIATION THERAPY DOSE PLAN O $772.54 $160.02 $160.02 $31.00 $386.27 $113.67 $103.33 $158.42 $31.00 $304.04 $31.00 $160.02 $579.40 $176.02 $486.70 $564.73 $37.20 $31.00 $463.52 $618.03 $544.07 $912.12 $31.00 $160.02 $192.03 $43.40 $618.03 $31.00 $31.00 $37.20 $224.03 $31.00 $160.02 $160.02 $174.42 $618.03 $656.66 $31.00 $579.40 $63.55 $31.00 $386.27 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 $515.28 $31.00 $31.00 $136.02 $136.02 $160.02 $31.00 $912.12 330104 77301 5613 478 333 HC RADIOTHERAPY DOSE PLAN IMRT O "$9,456.66 " "$1,608.46 " "$1,608.46 " $103.60 "$4,728.33 " "$3,200.82 " "$2,909.84 " "$1,592.37 " $103.60 "$3,056.07 " $103.60 "$1,608.46 " "$7,092.49 " "$1,769.30 " "$5,957.70 " "$6,912.82 " $124.32 $103.60 "$5,674.00 " "$7,565.33 " "$5,468.75 " "$9,168.20 " $103.60 "$1,608.46 " "$1,930.15 " $145.04 "$7,565.33 " $103.60 $103.60 $124.32 "$2,251.84 " $103.60 "$1,608.46 " "$1,608.46 " "$1,753.22 " "$7,565.33 " "$8,038.16 " $103.60 "$7,092.49 " $212.38 $103.60 "$4,728.33 " "$4,326.75 " "$2,533.32 " "$2,533.32 " "$2,533.32 " "$2,533.32 " N/A "$1,688.88 " "$1,608.46 " "$6,307.59 " $103.60 $103.60 "$1,367.19 " "$1,367.19 " "$1,608.46 " $103.60 "$9,168.20 " 330104 77295 5613 478 333 HC 3-D RADIOTHERAPY PLAN O "$12,485.83 " "$1,608.46 " "$1,608.46 " $103.60 "$6,242.91 " $820.11 $745.56 "$1,592.37 " $103.60 "$3,056.07 " $103.60 "$1,608.46 " "$9,364.37 " "$1,769.30 " "$7,866.07 " "$9,127.14 " $124.32 $103.60 "$7,491.50 " "$9,988.66 " "$5,468.75 " "$9,168.20 " $103.60 "$1,608.46 " "$1,930.15 " $145.04 "$9,988.66 " $103.60 $103.60 $124.32 "$2,251.84 " $103.60 "$1,608.46 " "$1,608.46 " "$1,753.22 " "$9,988.66 " "$10,612.96 " $103.60 "$9,364.37 " $212.38 $103.60 "$6,242.91 " "$4,326.75 " "$2,533.32 " "$2,533.32 " "$2,533.32 " "$2,533.32 " N/A "$1,688.88 " "$1,608.46 " "$8,328.05 " $103.60 $103.60 "$1,367.19 " "$1,367.19 " "$1,608.46 " $103.60 "$10,612.96 " 330104 77290 5612 477 333 HC SET RADIATION THERAPY FIELD; COMPLEX O "$2,907.19 " $430.37 $430.37 $103.60 "$1,453.60 " $788.21 $716.56 $426.07 $103.60 $817.70 $103.60 $430.37 "$2,180.39 " $473.41 "$1,831.53 " "$2,125.16 " $124.32 $103.60 "$1,744.31 " "$2,325.75 " "$1,463.26 " "$2,453.11 " $103.60 $430.37 $516.44 $145.04 "$2,325.75 " $103.60 $103.60 $124.32 $602.52 $103.60 $430.37 $430.37 $469.10 "$2,325.75 " "$2,471.11 " $103.60 "$2,180.39 " $212.38 $103.60 "$1,453.60 " "$1,157.70 " $677.83 $677.83 $677.83 $677.83 N/A $451.89 $430.37 "$1,939.10 " $103.60 $103.60 $365.82 $365.82 $430.37 $103.60 "$2,471.11 " 330104 77280 5611 476 333 HC SET RADIATION THERAPY FIELD; SIMPLE O "$1,546.15 " $160.02 $160.02 $47.40 $773.08 $471.33 $428.48 $158.42 $47.40 $304.04 $47.40 $160.02 "$1,159.61 " $176.02 $974.07 "$1,130.24 " $56.88 $47.40 $927.69 "$1,236.92 " $544.07 $912.12 $47.40 $160.02 $192.03 $66.36 "$1,236.92 " $47.40 $47.40 $56.88 $224.03 $47.40 $160.02 $160.02 $174.42 "$1,236.92 " "$1,314.23 " $47.40 "$1,159.61 " $97.17 $47.40 $773.08 $430.46 $252.03 $252.03 $252.03 $252.03 N/A $168.02 $160.02 "$1,031.28 " $47.40 $47.40 $136.02 $136.02 $160.02 $47.40 "$1,314.23 " 330104 76145 5723 476 333 HC MEDICAL PHYSICS DOSE EVAL RADIATION EXPOS W/RPRT O $561.75 $579.99 $579.99 $260.90 $280.88 "$1,630.44 " "$1,482.22 " $574.19 $260.90 "$1,101.98 " $260.90 $579.99 $421.31 $637.99 $353.90 $410.64 $313.08 $260.90 $337.05 $449.40 "$1,971.97 " "$3,305.94 " $260.90 $579.99 $695.99 $365.26 $449.40 $260.90 $260.90 $313.08 $811.99 $260.90 $579.99 $579.99 $632.19 $449.40 $477.49 $260.90 $421.31 $534.84 $260.90 $280.88 "$1,560.17 " $913.48 $913.48 $913.48 $913.48 N/A $608.99 $579.99 $374.69 $260.90 $260.90 $492.99 $492.99 $579.99 $260.90 "$3,305.94 " 330104 77307 5612 477 333 HC TELETHERAPY ISODOSE COMPLEX PLAN O "$2,038.35 " $430.37 $430.37 $84.50 "$1,019.17 " $488.14 $443.76 $426.07 $84.50 $817.70 $84.50 $430.37 "$1,528.76 " $473.41 "$1,284.16 " "$1,490.03 " $101.40 $84.50 "$1,223.01 " "$1,630.68 " "$1,463.26 " "$2,453.11 " $84.50 $430.37 $516.44 $118.30 "$1,630.68 " $84.50 $84.50 $101.40 $602.52 $84.50 $430.37 $430.37 $469.10 "$1,630.68 " "$1,732.60 " $84.50 "$1,528.76 " $173.22 $84.50 "$1,019.17 " "$1,157.70 " $677.83 $677.83 $677.83 $677.83 N/A $451.89 $430.37 "$1,359.58 " $84.50 $84.50 $365.82 $365.82 $430.37 $84.50 "$2,453.11 " 330104 96521 5693 109 335 HC REFILL/MAINT PORTABLE PUMP O $856.00 $247.83 $247.83 $15.00 $428.00 $223.55 $203.22 $245.35 $15.00 $470.88 $15.00 $247.83 $642.00 $272.61 "$1,609.63 " $649.70 $18.00 $15.00 $513.60 "$3,881.00 " $842.62 "$2,934.00 " $15.00 $247.83 $297.40 $21.00 "$2,883.13 " $15.00 $15.00 $18.00 $346.96 $15.00 $247.83 $247.83 $270.14 $684.80 $727.60 $15.00 $642.00 $30.75 $15.00 $428.00 "$1,515.00 " $390.33 $390.33 $390.33 $390.33 "$2,066.00 " $260.22 $247.83 "$2,424.00 " $15.00 $15.00 $270.00 $270.00 $247.83 $15.00 "$3,881.00 " 330104 G0498 5694 110 335 HC CHEMO EXTEND IV INFUS W/PUMP O "$1,912.09 " $399.06 $399.06 $723.83 $956.04 N/A N/A $395.07 $723.83 $758.21 $723.83 $399.06 "$1,434.07 " $438.96 "$1,609.63 " "$1,451.28 " $868.59 $723.83 "$1,147.25 " "$3,881.00 " "$1,356.80 " "$2,934.00 " $723.83 $399.06 $478.87 "$1,013.36 " "$2,883.13 " $723.83 $723.83 $868.59 $558.68 $723.83 $399.06 $399.06 $434.97 "$1,529.67 " "$1,625.28 " $723.83 "$1,434.07 " "$1,483.84 " $723.83 $956.04 "$1,515.00 " $628.52 $628.52 $628.52 $628.52 "$2,066.00 " $419.01 $399.06 "$2,424.00 " $723.83 $723.83 $270.00 $270.00 $399.06 $270.00 "$3,881.00 " 330104 96413 5694 111 335 HC CHEMO IV INFUSION 1 HR O "$2,022.30 " $399.06 $399.06 $35.00 "$1,011.15 " $230.65 $209.68 $395.07 $35.00 $758.21 $35.00 $399.06 "$1,516.72 " $438.96 "$1,609.63 " "$1,534.93 " $42.00 $35.00 "$1,213.38 " "$3,881.00 " "$1,356.80 " "$2,934.00 " $35.00 $399.06 $478.87 $49.00 "$2,883.13 " $35.00 $35.00 $42.00 $558.68 $35.00 $399.06 $399.06 $434.97 "$1,617.84 " "$1,718.95 " $35.00 "$1,516.72 " $71.75 $35.00 "$1,011.15 " "$1,515.00 " $628.52 $628.52 $628.52 $628.52 "$2,066.00 " $419.01 $399.06 "$2,424.00 " $35.00 $35.00 $270.00 $270.00 $399.06 $35.00 "$3,881.00 " 330104 96415 5692 110 335 HC CHEMO IV INFUSION ADDL HR O "$1,863.94 " $80.95 $80.95 $5.00 $931.97 $48.96 $44.51 $80.14 $5.00 $153.80 $5.00 $80.95 "$1,397.95 " $89.04 "$1,609.63 " "$1,414.73 " $6.00 $5.00 "$1,118.36 " "$3,881.00 " $275.22 "$2,934.00 " $5.00 $80.95 $97.14 $7.00 "$2,883.13 " $5.00 $5.00 $6.00 $113.33 $5.00 $80.95 $80.95 $88.23 "$1,491.15 " "$1,584.35 " $5.00 "$1,397.95 " $10.25 $5.00 $931.97 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $5.00 $5.00 $270.00 $270.00 $80.95 $5.00 "$3,881.00 " 330104 96416 5694 110 335 HC CHEMO PROLONG INFUSE W/PUMP O "$1,778.34 " $399.06 $399.06 $35.00 $889.17 $227.07 $206.43 $395.07 $35.00 $758.21 $35.00 $399.06 "$1,333.75 " $438.96 "$1,609.63 " "$1,349.76 " $42.00 $35.00 "$1,067.00 " "$3,881.00 " "$1,356.80 " "$2,934.00 " $35.00 $399.06 $478.87 $49.00 "$2,883.13 " $35.00 $35.00 $42.00 $558.68 $35.00 $399.06 $399.06 $434.97 "$1,422.67 " "$1,511.59 " $35.00 "$1,333.75 " $71.75 $35.00 $889.17 "$1,515.00 " $628.52 $628.52 $628.52 $628.52 "$2,066.00 " $419.01 $399.06 "$2,424.00 " $35.00 $35.00 $270.00 $270.00 $399.06 $35.00 "$3,881.00 " 330104 96523 5733 109 335 HC IRRIG DRUG DELIVERY DEVICE O $282.48 $68.96 $68.96 $38.26 $141.24 $44.86 $40.79 $68.27 $38.26 $131.03 $38.26 $68.96 $211.86 $75.86 "$1,609.63 " $214.40 $45.91 $38.26 $169.49 "$3,881.00 " $234.47 "$2,934.00 " $38.26 $68.96 $82.75 $53.56 "$2,883.13 " $38.26 $38.26 $45.91 $96.55 $38.26 $68.96 $68.96 $75.17 $225.98 $240.11 $38.26 $211.86 $78.43 $38.26 $141.24 "$1,515.00 " $108.61 $108.61 $108.61 $108.61 "$2,066.00 " $72.41 $68.96 "$2,424.00 " $38.26 $38.26 $270.00 $270.00 $68.96 $38.26 "$3,881.00 " 330104 96417 5692 111 335 HC CHEMO IV INFUS EACH ADDL SEQ O "$1,863.94 " $80.95 $80.95 $271.09 $931.97 $113.30 $103.00 $80.14 $271.09 $153.80 $271.09 $80.95 "$1,397.95 " $89.04 "$1,609.63 " "$1,414.73 " $325.31 $271.09 "$1,118.36 " "$3,881.00 " $275.22 "$2,934.00 " $271.09 $80.95 $97.14 $379.53 "$2,883.13 " $271.09 $271.09 $325.31 $113.33 $271.09 $80.95 $80.95 $88.23 "$1,491.15 " "$1,584.35 " $271.09 "$1,397.95 " $555.74 $271.09 $931.97 "$1,515.00 " $127.49 $127.49 $127.49 $127.49 "$2,066.00 " $84.99 $80.95 "$2,424.00 " $271.09 $271.09 $270.00 $270.00 $80.95 $80.14 "$3,881.00 " 330104 78452 5593 332 340 HC HT MUSCLE IMAGE SPECT MULT O "$7,564.90 " "$1,592.38 " "$1,592.38 " $238.74 "$3,782.45 " $764.63 $695.12 "$1,576.46 " $238.74 "$3,025.52 " $238.74 "$1,592.38 " "$5,673.67 " "$1,751.62 " "$4,765.89 " "$5,529.94 " $286.49 $238.74 "$4,538.94 " "$6,051.92 " "$5,414.09 " "$9,076.56 " $238.74 "$1,592.38 " "$1,910.85 " $334.24 "$6,051.92 " $238.74 $238.74 $286.49 "$2,229.33 " $238.74 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$6,051.92 " "$6,430.16 " $238.74 "$5,673.67 " $489.42 $238.74 "$3,782.45 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$1,215.84 " "$1,672.00 " "$1,592.38 " "$1,215.84 " $238.74 $238.74 "$1,353.52 " "$1,353.52 " "$1,592.38 " $238.74 "$9,076.56 " 330104 78451 5593 332 340 HC HT MUSCLE IMAGE SPECT SING O "$7,957.59 " "$1,592.38 " "$1,592.38 " $139.13 "$3,978.80 " $548.83 $498.94 "$1,576.46 " $139.13 "$3,025.52 " $139.13 "$1,592.38 " "$5,968.19 " "$1,751.62 " "$5,013.28 " "$5,817.00 " $166.96 $139.13 "$4,774.55 " "$6,366.07 " "$5,414.09 " "$9,076.56 " $139.13 "$1,592.38 " "$1,910.85 " $194.78 "$6,366.07 " $139.13 $139.13 $166.96 "$2,229.33 " $139.13 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$6,366.07 " "$6,763.95 " $139.13 "$5,968.19 " $285.22 $139.13 "$3,978.80 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$1,215.84 " "$1,672.00 " "$1,592.38 " "$1,215.84 " $139.13 $139.13 "$1,353.52 " "$1,353.52 " "$1,592.38 " $139.13 "$9,076.56 " 330104 78645 5592 332 341 HC CSF SHUNT EVALUATION O "$6,615.81 " $605.27 $605.27 $75.00 "$3,307.91 " $526.87 $478.98 $599.22 $75.00 "$1,150.01 " $75.00 $605.27 "$4,961.86 " $665.80 "$4,167.96 " "$4,836.16 " $90.00 $75.00 "$3,969.49 " "$5,292.65 " "$2,057.91 " "$3,450.03 " $75.00 $605.27 $726.32 $105.00 "$5,292.65 " $75.00 $75.00 $90.00 $847.38 $75.00 $605.27 $605.27 $659.74 "$5,292.65 " "$5,623.44 " $75.00 "$4,961.86 " $153.75 $75.00 "$3,307.91 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $384.37 $635.53 $605.27 $384.37 $75.00 $75.00 $514.48 $514.48 $605.27 $75.00 "$5,623.44 " 330104 78630 5592 332 341 HC CEREBROSPINAL FLUID SCAN CISTERNOGRAPHY O "$3,042.01 " $605.27 $605.27 $75.00 "$1,521.01 " $551.18 $501.08 $599.22 $75.00 "$1,150.01 " $75.00 $605.27 "$2,281.51 " $665.80 "$1,916.47 " "$2,223.71 " $90.00 $75.00 "$1,825.21 " "$2,433.61 " "$2,057.91 " "$3,450.03 " $75.00 $605.27 $726.32 $105.00 "$2,433.61 " $75.00 $75.00 $90.00 $847.38 $75.00 $605.27 $605.27 $659.74 "$2,433.61 " "$2,585.71 " $75.00 "$2,281.51 " $153.75 $75.00 "$1,521.01 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $954.03 $635.53 $605.27 $954.03 $75.00 $75.00 $514.48 $514.48 $605.27 $75.00 "$3,450.03 " 330104 78606 5592 331 341 HC BRAIN IMAGE W/FLOW 4 + VIEWS O "$5,488.03 " $605.27 $605.27 $70.00 "$2,744.01 " $535.04 $486.40 $599.22 $70.00 "$1,150.01 " $70.00 $605.27 "$4,116.02 " $665.80 "$3,457.46 " "$4,011.75 " $84.00 $70.00 "$3,292.82 " "$4,390.42 " "$2,057.91 " "$3,450.03 " $70.00 $605.27 $726.32 $98.00 "$4,390.42 " $70.00 $70.00 $84.00 $847.38 $70.00 $605.27 $605.27 $659.74 "$4,390.42 " "$4,664.83 " $70.00 "$4,116.02 " $143.50 $70.00 "$2,744.01 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $954.03 $635.53 $605.27 $954.03 $70.00 $70.00 $514.48 $514.48 $605.27 $70.00 "$4,664.83 " 330104 78580 5591 332 341 HC LUNG PERFUSION IMAGING O "$2,538.04 " $466.31 $466.31 $60.00 "$1,269.02 " $387.46 $352.23 $461.65 $60.00 $886.00 $60.00 $466.31 "$1,903.53 " $512.95 "$1,598.97 " "$1,855.31 " $72.00 $60.00 "$1,522.82 " "$2,030.43 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,030.43 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,030.43 " "$2,157.33 " $60.00 "$1,903.53 " $123.00 $60.00 "$1,269.02 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $314.93 $489.63 $466.31 $314.93 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,658.00 " 330104 78472 5591 331 341 HC GATED HEART PLANAR SINGLE O "$2,924.31 " $466.31 $466.31 $150.00 "$1,462.15 " $370.96 $337.24 $461.65 $150.00 $886.00 $150.00 $466.31 "$2,193.23 " $512.95 "$1,842.32 " "$2,137.67 " $180.00 $150.00 "$1,754.59 " "$2,339.45 " "$1,585.47 " "$2,658.00 " $150.00 $466.31 $559.58 $210.00 "$2,339.45 " $150.00 $150.00 $180.00 $652.84 $150.00 $466.31 $466.31 $508.28 "$2,339.45 " "$2,485.66 " $150.00 "$2,193.23 " $307.50 $150.00 "$1,462.15 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $466.22 $489.63 $466.31 $466.22 $150.00 $150.00 $396.37 $396.37 $466.31 $150.00 "$2,658.00 " 330104 78466 5591 331 341 HC HEART INFARCT IMAGE O "$2,639.69 " $466.31 $466.31 $60.00 "$1,319.85 " $305.02 $277.29 $461.65 $60.00 $886.00 $60.00 $466.31 "$1,979.77 " $512.95 "$1,663.00 " "$1,929.61 " $72.00 $60.00 "$1,583.81 " "$2,111.75 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,111.75 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,111.75 " "$2,243.74 " $60.00 "$1,979.77 " $123.00 $60.00 "$1,319.85 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $466.22 $489.63 $466.31 $466.22 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,658.00 " 330104 78264 5591 331 341 HC GASTRIC EMPTYING STUDY O "$2,576.56 " $466.31 $466.31 $40.00 "$1,288.28 " $539.78 $490.71 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,932.42 " $512.95 "$1,623.23 " "$1,883.47 " $48.00 $40.00 "$1,545.94 " "$2,061.25 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$2,061.25 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$2,061.25 " "$2,190.08 " $40.00 "$1,932.42 " $82.00 $40.00 "$1,288.28 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $382.88 $489.63 $466.31 $382.88 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78320 331 341 HC BONE IMAGING (3D) O "$5,862.53 " N/A N/A N/A "$2,931.26 " N/A N/A "$3,834.09 " N/A N/A N/A N/A "$4,396.90 " N/A "$3,693.39 " "$4,285.51 " N/A N/A "$3,517.52 " "$4,690.02 " N/A N/A N/A N/A N/A N/A "$4,690.02 " N/A N/A N/A N/A N/A N/A N/A N/A "$4,690.02 " "$4,983.15 " N/A "$4,396.90 " N/A N/A "$2,931.26 " "$3,810.64 " N/A N/A N/A N/A N/A N/A N/A "$3,910.31 " N/A N/A N/A N/A N/A "$2,931.26 " "$4,983.15 " 330104 78315 5591 331 341 HC BONE IMAGING 3 PHASE O "$3,447.54 " $466.31 $466.31 $80.00 "$1,723.77 " $563.88 $512.62 $461.65 $80.00 $886.00 $80.00 $466.31 "$2,585.65 " $512.95 "$2,171.95 " "$2,520.15 " $96.00 $80.00 "$2,068.52 " "$2,758.03 " "$1,585.47 " "$2,658.00 " $80.00 $466.31 $559.58 $112.00 "$2,758.03 " $80.00 $80.00 $96.00 $652.84 $80.00 $466.31 $466.31 $508.28 "$2,758.03 " "$2,930.41 " $80.00 "$2,585.65 " $164.00 $80.00 "$1,723.77 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $391.52 $489.63 $466.31 $391.52 $80.00 $80.00 $396.37 $396.37 $466.31 $80.00 "$2,930.41 " 330104 78305 5591 331 341 HC BONE IMAGING MULTIPLE AREAS O "$3,447.54 " $466.31 $466.31 $60.00 "$1,723.77 " $451.38 $410.35 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,585.65 " $512.95 "$2,171.95 " "$2,520.15 " $72.00 $60.00 "$2,068.52 " "$2,758.03 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,758.03 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,758.03 " "$2,930.41 " $60.00 "$2,585.65 " $123.00 $60.00 "$1,723.77 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $391.52 $489.63 $466.31 $391.52 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,930.41 " 330104 78300 5591 331 341 HC BONE IMAGING LIMITED AREA O "$3,447.54 " $466.31 $466.31 $60.00 "$1,723.77 " $372.51 $338.64 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,585.65 " $512.95 "$2,171.95 " "$2,520.15 " $72.00 $60.00 "$2,068.52 " "$2,758.03 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,758.03 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,758.03 " "$2,930.41 " $60.00 "$2,585.65 " $123.00 $60.00 "$1,723.77 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $391.52 $489.63 $466.31 $391.52 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,930.41 " 330104 78290 5591 331 341 HC MECKELS DIVERT EXAM O "$2,576.56 " $466.31 $466.31 $40.00 "$1,288.28 " $540.03 $490.93 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,932.42 " $512.95 "$1,623.23 " "$1,883.47 " $48.00 $40.00 "$1,545.94 " "$2,061.25 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$2,061.25 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$2,061.25 " "$2,190.08 " $40.00 "$1,932.42 " $82.00 $40.00 "$1,288.28 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $382.88 $489.63 $466.31 $382.88 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78278 5591 332 341 HC ACUTE GI BLOOD LOSS IMAGING O "$2,639.69 " $466.31 $466.31 $40.00 "$1,319.85 " $567.64 $516.03 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,979.77 " $512.95 "$1,663.00 " "$1,929.61 " $48.00 $40.00 "$1,583.81 " "$2,111.75 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$2,111.75 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$2,111.75 " "$2,243.74 " $40.00 "$1,979.77 " $82.00 $40.00 "$1,319.85 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $382.88 $489.63 $466.31 $382.88 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78266 5592 331 341 HC GASTRIC EMPTY IMG STUDY W/SM BOWEL/COLON O "$3,211.07 " $605.27 $605.27 $148.35 "$1,605.54 " $725.95 $659.95 $599.22 $148.35 "$1,150.01 " $148.35 $605.27 "$2,408.30 " $665.80 "$2,022.97 " "$2,347.29 " $178.02 $148.35 "$1,926.64 " "$2,568.86 " "$2,057.91 " "$3,450.03 " $148.35 $605.27 $726.32 $207.69 "$2,568.86 " $148.35 $148.35 $178.02 $847.38 $148.35 $605.27 $605.27 $659.74 "$2,568.86 " "$2,729.41 " $148.35 "$2,408.30 " $304.12 $148.35 "$1,605.54 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $706.18 $635.53 $605.27 $706.18 $148.35 $148.35 $514.48 $514.48 $605.27 $148.35 "$3,450.03 " 330104 78650 5593 332 341 HC CSF LEAKAGE IMAGING O "$10,003.43 " "$1,592.38 " "$1,592.38 " $75.00 "$5,001.72 " $442.06 $401.87 "$1,576.46 " $75.00 "$3,025.52 " $75.00 "$1,592.38 " "$7,502.57 " "$1,751.62 " "$6,302.16 " "$7,312.51 " $90.00 $75.00 "$6,002.06 " "$8,002.74 " "$5,414.09 " "$9,076.56 " $75.00 "$1,592.38 " "$1,910.85 " $105.00 "$8,002.74 " $75.00 $75.00 $90.00 "$2,229.33 " $75.00 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$8,002.74 " "$8,502.92 " $75.00 "$7,502.57 " $153.75 $75.00 "$5,001.72 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " $954.03 "$1,672.00 " "$1,592.38 " $954.03 $75.00 $75.00 "$1,353.52 " "$1,353.52 " "$1,592.38 " $75.00 "$9,076.56 " 330104 78428 5591 331 341 HC CARDIAC SHUNT IMAGING O "$1,571.83 " $466.31 $466.31 N/A $785.91 $307.28 $279.34 $461.65 N/A $886.00 N/A $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " N/A N/A $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " N/A $466.31 $559.58 N/A "$1,257.46 " N/A N/A N/A $652.84 N/A $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " N/A "$1,178.87 " N/A N/A $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $466.22 $489.63 $466.31 $466.22 N/A N/A $396.37 $396.37 $466.31 $279.34 "$2,658.00 " 330104 78262 5591 331 341 HC GASTROESOPHAGEAL REFLUX EXAM O "$1,571.83 " $466.31 $466.31 $40.00 $785.91 $404.35 $367.60 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " $48.00 $40.00 $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$1,257.46 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " $40.00 "$1,178.87 " $82.00 $40.00 $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $382.88 $489.63 $466.31 $382.88 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78226 5591 331 341 HC HEPATOBILIARY SYSTEM IMAGING O "$2,753.11 " $466.31 $466.31 $103.74 "$1,376.56 " $531.35 $483.05 $461.65 $103.74 $886.00 $103.74 $466.31 "$2,064.83 " $512.95 "$1,734.46 " "$2,012.52 " $124.49 $103.74 "$1,651.87 " "$2,202.49 " "$1,585.47 " "$2,658.00 " $103.74 $466.31 $559.58 $145.24 "$2,202.49 " $103.74 $103.74 $124.49 $652.84 $103.74 $466.31 $466.31 $508.28 "$2,202.49 " "$2,340.14 " $103.74 "$2,064.83 " $212.67 $103.74 "$1,376.56 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $469.49 $489.63 $466.31 $469.49 $103.74 $103.74 $396.37 $396.37 $466.31 $103.74 "$2,658.00 " 330104 78306 5591 331 341 HC BONE IMAGING WHOLE BODY O "$3,447.54 " $466.31 $466.31 $60.00 "$1,723.77 " $482.28 $438.44 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,585.65 " $512.95 "$2,171.95 " "$2,520.15 " $72.00 $60.00 "$2,068.52 " "$2,758.03 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,758.03 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,758.03 " "$2,930.41 " $60.00 "$2,585.65 " $123.00 $60.00 "$1,723.77 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $391.52 $489.63 $466.31 $391.52 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,930.41 " 330104 78700 5591 331 341 HC KIDNEY IMAGING MORPHOL O "$1,571.83 " $466.31 $466.31 $40.00 $785.91 $282.28 $256.62 $461.65 $40.00 $886.00 $40.00 $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " $48.00 $40.00 $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " $40.00 $466.31 $559.58 $56.00 "$1,257.46 " $40.00 $40.00 $48.00 $652.84 $40.00 $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " $40.00 "$1,178.87 " $82.00 $40.00 $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $514.34 $489.63 $466.31 $514.34 $40.00 $40.00 $396.37 $396.37 $466.31 $40.00 "$2,658.00 " 330104 78012 5591 331 341 HC THYROID UPTAKE MEASUREMENT O "$1,697.02 " $466.31 $466.31 $26.34 $848.51 $143.35 $130.32 $461.65 $26.34 $886.00 $26.34 $466.31 "$1,272.76 " $512.95 "$1,069.12 " "$1,240.52 " $31.61 $26.34 "$1,018.21 " "$1,357.62 " "$1,585.47 " "$2,658.00 " $26.34 $466.31 $559.58 $36.88 "$1,357.62 " $26.34 $26.34 $31.61 $652.84 $26.34 $466.31 $466.31 $508.28 "$1,357.62 " "$1,442.47 " $26.34 "$1,272.76 " $54.00 $26.34 $848.51 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $182.45 $489.63 $466.31 $182.45 $26.34 $26.34 $396.37 $396.37 $466.31 $26.34 "$2,658.00 " 330104 78014 5591 331 341 HC THYROID IMAGING W/BLOOD FLOW O "$3,149.01 " $466.31 $466.31 $82.78 "$1,574.51 " $390.56 $355.05 $461.65 $82.78 $886.00 $82.78 $466.31 "$2,361.76 " $512.95 "$1,983.88 " "$2,301.93 " $99.34 $82.78 "$1,889.41 " "$2,519.21 " "$1,585.47 " "$2,658.00 " $82.78 $466.31 $559.58 $115.89 "$2,519.21 " $82.78 $82.78 $99.34 $652.84 $82.78 $466.31 $466.31 $508.28 "$2,519.21 " "$2,676.66 " $82.78 "$2,361.76 " $169.70 $82.78 "$1,574.51 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $372.70 $489.63 $466.31 $372.70 $82.78 $82.78 $396.37 $396.37 $466.31 $82.78 "$2,676.66 " 330104 78015 5591 331 341 HC THYROID MET IMAGING O "$1,578.25 " $466.31 $466.31 $45.00 $789.12 $379.18 $344.71 $461.65 $45.00 $886.00 $45.00 $466.31 "$1,183.69 " $512.95 $994.30 "$1,153.70 " $54.00 $45.00 $946.95 "$1,262.60 " "$1,585.47 " "$2,658.00 " $45.00 $466.31 $559.58 $63.00 "$1,262.60 " $45.00 $45.00 $54.00 $652.84 $45.00 $466.31 $466.31 $508.28 "$1,262.60 " "$1,341.51 " $45.00 "$1,183.69 " $92.25 $45.00 $789.12 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $464.18 $489.63 $466.31 $464.18 $45.00 $45.00 $396.37 $396.37 $466.31 $45.00 "$2,658.00 " 330104 78018 5592 331 341 HC THYROID MET IMAGING BODY O "$3,350.17 " $605.27 $605.27 $90.00 "$1,675.09 " $508.71 $462.47 $599.22 $90.00 "$1,150.01 " $90.00 $605.27 "$2,512.63 " $665.80 "$2,110.61 " "$2,448.97 " $108.00 $90.00 "$2,010.10 " "$2,680.14 " "$2,057.91 " "$3,450.03 " $90.00 $605.27 $726.32 $126.00 "$2,680.14 " $90.00 $90.00 $108.00 $847.38 $90.00 $605.27 $605.27 $659.74 "$2,680.14 " "$2,847.64 " $90.00 "$2,512.63 " $184.50 $90.00 "$1,675.09 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $464.18 $635.53 $605.27 $464.18 $90.00 $90.00 $514.48 $514.48 $605.27 $90.00 "$3,450.03 " 330104 78020 331 341 HC THYROID MET UPTAKE O "$1,061.44 " N/A N/A $40.00 $530.72 $135.61 $123.28 $93.88 $40.00 N/A $40.00 N/A $796.08 N/A $668.71 $775.91 $48.00 $40.00 $636.86 $849.15 N/A N/A $40.00 N/A $689.94 $56.00 $849.15 $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A $849.15 $902.22 $54.00 $796.08 $82.00 $54.00 $530.72 $689.94 N/A N/A N/A N/A N/A N/A N/A $707.98 $40.00 $40.00 N/A N/A N/A $40.00 $902.22 330104 78070 5591 332 341 HC PARATHYROID PLANAR IMAGING O "$3,350.17 " $466.31 $466.31 $60.00 "$1,675.09 " $479.21 $435.65 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,512.63 " $512.95 "$2,110.61 " "$2,448.97 " $72.00 $60.00 "$2,010.10 " "$2,680.14 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,680.14 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,680.14 " "$2,847.64 " $60.00 "$2,512.63 " $123.00 $60.00 "$1,675.09 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $351.18 $489.63 $466.31 $351.18 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,847.64 " 330104 78071 5591 331 341 HC PARATHYRD PLANAR W/WO SUBTRJ O "$1,571.83 " $466.31 $466.31 $114.81 $785.91 $570.63 $518.76 $461.65 $114.81 $886.00 $114.81 $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " $137.77 $114.81 $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " $114.81 $466.31 $559.58 $160.73 "$1,257.46 " $114.81 $114.81 $137.77 $652.84 $114.81 $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " $114.81 "$1,178.87 " $235.36 $114.81 $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $515.26 $489.63 $466.31 $515.26 $114.81 $114.81 $396.37 $396.37 $466.31 $114.81 "$2,658.00 " 330104 78598 5592 332 341 HC LUNG PERF&VENTILAT DIFERENTL O "$2,014.81 " $605.27 $605.27 $95.46 "$1,007.40 " $493.52 $448.65 $599.22 $95.46 "$1,150.01 " $95.46 $605.27 "$1,511.11 " $665.80 "$1,269.33 " "$1,472.83 " $114.55 $95.46 "$1,208.89 " "$1,611.85 " "$2,057.91 " "$3,450.03 " $95.46 $605.27 $726.32 $133.64 "$1,611.85 " $95.46 $95.46 $114.55 $847.38 $95.46 $605.27 $605.27 $659.74 "$1,611.85 " "$1,712.59 " $95.46 "$1,511.11 " $195.69 $95.46 "$1,007.40 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $506.27 $635.53 $605.27 $506.27 $95.46 $95.46 $514.48 $514.48 $605.27 $95.46 "$3,450.03 " 330104 78072 5592 331 341 HC PARATHYRD PLANAR W/SPECT&CT O "$2,014.81 " $605.27 $605.27 N/A "$1,007.40 " $709.15 $644.68 $599.22 N/A "$1,150.01 " N/A $605.27 "$1,511.11 " $665.80 "$1,269.33 " "$1,472.83 " N/A N/A "$1,208.89 " "$1,611.85 " "$2,057.91 " "$3,450.03 " N/A $605.27 $726.32 N/A "$1,611.85 " N/A N/A N/A $847.38 N/A $605.27 $605.27 $659.74 "$1,611.85 " "$1,712.59 " N/A "$1,511.11 " N/A N/A "$1,007.40 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $515.26 $635.53 $605.27 $515.26 N/A N/A $514.48 $514.48 $605.27 $514.48 "$3,450.03 " 330104 78102 5591 331 341 HC BONE MARROW IMAGING LTD O "$2,554.09 " $466.31 $466.31 $45.00 "$1,277.05 " $284.46 $258.60 $461.65 $45.00 $886.00 $45.00 $466.31 "$1,915.57 " $512.95 "$1,609.08 " "$1,867.04 " $54.00 $45.00 "$1,532.45 " "$2,043.27 " "$1,585.47 " "$2,658.00 " $45.00 $466.31 $559.58 $63.00 "$2,043.27 " $45.00 $45.00 $54.00 $652.84 $45.00 $466.31 $466.31 $508.28 "$2,043.27 " "$2,170.98 " $45.00 "$1,915.57 " $92.25 $45.00 "$1,277.05 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $411.23 $489.63 $466.31 $411.23 $45.00 $45.00 $396.37 $396.37 $466.31 $45.00 "$2,658.00 " 330104 78103 5591 331 341 HC BONE MARROW IMAGING MULT O "$1,571.83 " $466.31 $466.31 $45.00 $785.91 $303.56 $275.97 $461.65 $45.00 $886.00 $45.00 $466.31 "$1,178.87 " $512.95 $990.25 "$1,149.01 " $54.00 $45.00 $943.10 "$1,257.46 " "$1,585.47 " "$2,658.00 " $45.00 $466.31 $559.58 $63.00 "$1,257.46 " $45.00 $45.00 $54.00 $652.84 $45.00 $466.31 $466.31 $508.28 "$1,257.46 " "$1,336.06 " $45.00 "$1,178.87 " $92.25 $45.00 $785.91 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $411.23 $489.63 $466.31 $411.23 $45.00 $45.00 $396.37 $396.37 $466.31 $45.00 "$2,658.00 " 330104 78195 5592 332 341 HC LYMPH SYSTEM IMAGING O "$4,208.31 " $605.27 $605.27 $40.00 "$2,104.16 " $575.92 $523.56 $599.22 $40.00 "$1,150.01 " $40.00 $605.27 "$3,156.23 " $665.80 "$2,651.24 " "$3,076.27 " $48.00 $40.00 "$2,524.99 " "$3,366.65 " "$2,057.91 " "$3,450.03 " $40.00 $605.27 $726.32 $56.00 "$3,366.65 " $40.00 $40.00 $48.00 $847.38 $40.00 $605.27 $605.27 $659.74 "$3,366.65 " "$3,577.06 " $40.00 "$3,156.23 " $82.00 $40.00 "$2,104.16 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $411.23 $635.53 $605.27 $411.23 $40.00 $40.00 $514.48 $514.48 $605.27 $40.00 "$3,577.06 " 330104 78215 5591 332 341 HC LIVER AND SPLEEN IMAGING O "$3,864.84 " $466.31 $466.31 $60.00 "$1,932.42 " $323.68 $294.25 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,898.63 " $512.95 "$2,434.85 " "$2,825.20 " $72.00 $60.00 "$2,318.90 " "$3,091.87 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$3,091.87 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$3,091.87 " "$3,285.11 " $60.00 "$2,898.63 " $123.00 $60.00 "$1,932.42 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $424.21 $489.63 $466.31 $424.21 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$3,285.11 " 330104 78227 5592 331 341 HC HEPATOBIL SYST IMAGE W/DRUG O "$3,514.95 " $605.27 $605.27 $142.01 "$1,757.47 " $714.98 $649.98 $599.22 $142.01 "$1,150.01 " $142.01 $605.27 "$2,636.21 " $665.80 "$2,214.42 " "$2,569.43 " $170.41 $142.01 "$2,108.97 " "$2,811.96 " "$2,057.91 " "$3,450.03 " $142.01 $605.27 $726.32 $198.81 "$2,811.96 " $142.01 $142.01 $170.41 $847.38 $142.01 $605.27 $605.27 $659.74 "$2,811.96 " "$2,987.71 " $142.01 "$2,636.21 " $291.12 $142.01 "$1,757.47 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $469.49 $635.53 $605.27 $469.49 $142.01 $142.01 $514.48 $514.48 $605.27 $142.01 "$3,450.03 " 330104 78582 5592 332 341 HC LUNG VENTILAT&PERFUS IMAGING O "$3,330.91 " $605.27 $605.27 $101.59 "$1,665.45 " $540.01 $490.92 $599.22 $101.59 "$1,150.01 " $101.59 $605.27 "$2,498.18 " $665.80 "$2,098.47 " "$2,434.90 " $121.91 $101.59 "$1,998.55 " "$2,664.73 " "$2,057.91 " "$3,450.03 " $101.59 $605.27 $726.32 $142.23 "$2,664.73 " $101.59 $101.59 $121.91 $847.38 $101.59 $605.27 $605.27 $659.74 "$2,664.73 " "$2,831.27 " $101.59 "$2,498.18 " $208.26 $101.59 "$1,665.45 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $506.27 $635.53 $605.27 $506.27 $101.59 $101.59 $514.48 $514.48 $605.27 $101.59 "$3,450.03 " 330104 78707 5592 331 341 HC K FLOW/FUNCT IMAGE W/O DRUG O "$2,349.72 " $605.27 $605.27 $95.00 "$1,174.86 " $381.09 $346.45 $599.22 $95.00 "$1,150.01 " $95.00 $605.27 "$1,762.29 " $665.80 "$1,480.32 " "$1,717.65 " $114.00 $95.00 "$1,409.83 " "$1,879.78 " "$2,057.91 " "$3,450.03 " $95.00 $605.27 $726.32 $133.00 "$1,879.78 " $95.00 $95.00 $114.00 $847.38 $95.00 $605.27 $605.27 $659.74 "$1,879.78 " "$1,997.26 " $95.00 "$1,762.29 " $194.75 $95.00 "$1,174.86 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $514.34 $635.53 $605.27 $514.34 $95.00 $95.00 $514.48 $514.48 $605.27 $95.00 "$3,450.03 " 330104 78709 5592 331 341 HC K FLOW/FUNCT IMAGE MULTIPLE O "$9,878.24 " $605.27 $605.27 $104.00 "$4,939.12 " $603.00 $548.18 $599.22 $104.00 "$1,150.01 " $104.00 $605.27 "$7,408.68 " $665.80 "$6,223.29 " "$7,220.99 " $124.80 $104.00 "$5,926.94 " "$7,902.59 " "$2,057.91 " "$3,450.03 " $104.00 $605.27 $726.32 $145.60 "$7,902.59 " $104.00 $104.00 $124.80 $847.38 $104.00 $605.27 $605.27 $659.74 "$7,902.59 " "$8,396.50 " $104.00 "$7,408.68 " $213.20 $104.00 "$4,939.12 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $514.34 $635.53 $605.27 $514.34 $104.00 $104.00 $514.48 $514.48 $605.27 $104.00 "$8,396.50 " 330104 78708 5592 331 341 HC K FLOW/FUNCT IMAGE W/DRUG O "$3,418.65 " $605.27 $605.27 $100.00 "$1,709.33 " $300.50 $273.19 $599.22 $100.00 "$1,150.01 " $100.00 $605.27 "$2,563.99 " $665.80 "$2,153.75 " "$2,499.03 " $120.00 $100.00 "$2,051.19 " "$2,734.92 " "$2,057.91 " "$3,450.03 " $100.00 $605.27 $726.32 $140.00 "$2,734.92 " $100.00 $100.00 $120.00 $847.38 $100.00 $605.27 $605.27 $659.74 "$2,734.92 " "$2,905.85 " $100.00 "$2,563.99 " $205.00 $100.00 "$1,709.33 " "$1,628.17 " $953.30 $953.30 $953.30 $953.30 $514.34 $635.53 $605.27 $514.34 $100.00 $100.00 $514.48 $514.48 $605.27 $100.00 "$3,450.03 " 330104 78830 5593 332 341 HC RP LOCLZJ TUM SPECT W/CT 1 AREA 1 DAY IMAGING O "$3,033.45 " "$1,592.38 " "$1,592.38 " $134.05 "$1,516.72 " $781.52 $710.48 "$1,576.46 " $134.05 "$3,025.52 " $134.05 "$1,592.38 " "$2,275.09 " "$1,751.62 " "$1,911.07 " "$2,217.45 " $160.86 $134.05 "$1,820.07 " "$2,426.76 " "$5,414.09 " "$9,076.56 " $134.05 "$1,592.38 " "$1,910.85 " $187.67 "$2,426.76 " $134.05 $134.05 $160.86 "$2,229.33 " $134.05 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$2,426.76 " "$2,578.43 " $134.05 "$2,275.09 " $274.80 $134.05 "$1,516.72 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,035.28 " "$1,672.00 " "$1,592.38 " "$2,035.28 " $134.05 $134.05 "$1,353.52 " "$1,353.52 " "$1,592.38 " $134.05 "$9,076.56 " 330104 78806 332 341 HC ABSCESS IMAGING WHOLE BODY O "$3,447.54 " N/A N/A N/A "$1,723.77 " N/A N/A "$2,254.69 " N/A N/A N/A N/A "$2,585.65 " N/A "$2,171.95 " "$2,520.15 " N/A N/A "$2,068.52 " "$2,758.03 " N/A N/A N/A N/A N/A N/A "$2,758.03 " N/A N/A N/A N/A N/A N/A N/A N/A "$2,758.03 " "$2,930.41 " N/A "$2,585.65 " N/A N/A "$1,723.77 " "$2,240.90 " N/A N/A N/A N/A N/A N/A N/A "$2,299.51 " N/A N/A N/A N/A N/A "$1,723.77 " "$2,930.41 " 330104 78805 332 341 HC ABSCESS IMAGING LTD AREA O "$3,447.54 " N/A N/A N/A "$1,723.77 " N/A N/A "$2,254.69 " N/A N/A N/A N/A "$2,585.65 " N/A "$2,171.95 " "$2,520.15 " N/A N/A "$2,068.52 " "$2,758.03 " N/A N/A N/A N/A N/A N/A "$2,758.03 " N/A N/A N/A N/A N/A N/A N/A N/A "$2,758.03 " "$2,930.41 " N/A "$2,585.65 " N/A N/A "$1,723.77 " "$2,240.90 " N/A N/A N/A N/A N/A N/A N/A "$2,299.51 " N/A N/A N/A N/A N/A "$1,723.77 " "$2,930.41 " 330104 78804 5593 332 341 HC LOCALIZATION OF TUMOR WH/BODY MULTP DAYS O "$6,573.01 " "$1,592.38 " "$1,592.38 " $60.00 "$3,286.51 " "$1,057.67 " $961.52 "$1,576.46 " $60.00 "$3,025.52 " $60.00 "$1,592.38 " "$4,929.76 " "$1,751.62 " "$4,141.00 " "$4,804.87 " $72.00 $60.00 "$3,943.81 " "$5,258.41 " "$5,414.09 " "$9,076.56 " $60.00 "$1,592.38 " "$1,910.85 " $84.00 "$5,258.41 " $60.00 $60.00 $72.00 "$2,229.33 " $60.00 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$5,258.41 " "$5,587.06 " $60.00 "$4,929.76 " $123.00 $60.00 "$3,286.51 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$1,320.43 " "$1,672.00 " "$1,592.38 " "$1,320.43 " $60.00 $60.00 "$1,353.52 " "$1,353.52 " "$1,592.38 " $60.00 "$9,076.56 " 330104 78803 5593 332 341 HC TUMOR IMAGING (3D) O "$5,862.53 " "$1,592.38 " "$1,592.38 " $115.00 "$2,931.26 " $620.33 $563.93 "$1,576.46 " $115.00 "$3,025.52 " $115.00 "$1,592.38 " "$4,396.90 " "$1,751.62 " "$3,693.39 " "$4,285.51 " $138.00 $115.00 "$3,517.52 " "$4,690.02 " "$5,414.09 " "$9,076.56 " $115.00 "$1,592.38 " "$1,910.85 " $161.00 "$4,690.02 " $115.00 $115.00 $138.00 "$2,229.33 " $115.00 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$4,690.02 " "$4,983.15 " $115.00 "$4,396.90 " $235.75 $115.00 "$2,931.26 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " $759.97 "$1,672.00 " "$1,592.38 " $759.97 $115.00 $115.00 "$1,353.52 " "$1,353.52 " "$1,592.38 " $115.00 "$9,076.56 " 330104 78832 5594 332 341 HC RP LOCLZJ TUM SPECT CT 2AREA 1D IMG/1 AR IMG>2+D O "$6,158.92 " "$1,786.83 " "$1,786.83 " $259.94 "$3,079.46 " "$1,482.85 " "$1,348.05 " "$1,768.96 " $259.94 "$3,394.98 " $259.94 "$1,786.83 " "$4,619.19 " "$1,965.52 " "$3,880.12 " "$4,502.17 " $311.93 $259.94 "$3,695.35 " "$4,927.14 " "$6,075.23 " "$10,184.95 " $259.94 "$1,786.83 " "$2,144.20 " $363.92 "$4,927.14 " $259.94 $259.94 $311.93 "$2,501.57 " $259.94 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,927.14 " "$5,235.08 " $259.94 "$4,619.19 " $532.88 $259.94 "$3,079.46 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,308.80 " "$1,876.17 " "$1,786.83 " "$2,308.80 " $259.94 $259.94 "$1,518.81 " "$1,518.81 " "$1,786.83 " $259.94 "$10,184.95 " 330104 78597 5591 332 341 HC LUNG PERFUSION DIFFERENTIAL O "$1,572.90 " $466.31 $466.31 $62.14 $786.45 $329.24 $299.31 $461.65 $62.14 $886.00 $62.14 $466.31 "$1,179.68 " $512.95 $990.93 "$1,149.79 " $74.57 $62.14 $943.74 "$1,258.32 " "$1,585.47 " "$2,658.00 " $62.14 $466.31 $559.58 $87.00 "$1,258.32 " $62.14 $62.14 $74.57 $652.84 $62.14 $466.31 $466.31 $508.28 "$1,258.32 " "$1,336.97 " $62.14 "$1,179.68 " $127.39 $62.14 $786.45 "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $323.92 $489.63 $466.31 $323.92 $62.14 $62.14 $396.37 $396.37 $466.31 $62.14 "$2,658.00 " 330104 78761 5591 331 341 HC INJECTION TESTOSTERONE PROPIONATE UP TO 100 MG O "$5,904.26 " $466.31 $466.31 $50.00 "$2,952.13 " $350.68 $318.80 $461.65 $50.00 $886.00 $50.00 $466.31 "$4,428.19 " $512.95 "$3,719.68 " "$4,316.01 " $60.00 $50.00 "$3,542.56 " "$4,723.41 " "$1,585.47 " "$2,658.00 " $50.00 $466.31 $559.58 $70.00 "$4,723.41 " $50.00 $50.00 $60.00 $652.84 $50.00 $466.31 $466.31 $508.28 "$4,723.41 " "$5,018.62 " $50.00 "$4,428.19 " $102.50 $50.00 "$2,952.13 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $514.34 $489.63 $466.31 $514.34 $50.00 $50.00 $396.37 $396.37 $466.31 $50.00 "$5,018.62 " 330104 78801 5591 332 341 HC TUMOR IMAGING MULT AREAS O "$3,513.88 " $466.31 $466.31 $60.00 "$1,756.94 " $448.03 $407.30 $461.65 $60.00 $886.00 $60.00 $466.31 "$2,635.41 " $512.95 "$2,213.74 " "$2,568.65 " $72.00 $60.00 "$2,108.33 " "$2,811.10 " "$1,585.47 " "$2,658.00 " $60.00 $466.31 $559.58 $84.00 "$2,811.10 " $60.00 $60.00 $72.00 $652.84 $60.00 $466.31 $466.31 $508.28 "$2,811.10 " "$2,986.80 " $60.00 "$2,635.41 " $123.00 $60.00 "$1,756.94 " "$1,254.39 " $734.45 $734.45 $734.45 $734.45 $759.97 $489.63 $466.31 $759.97 $60.00 $60.00 $396.37 $396.37 $466.31 $60.00 "$2,986.80 " 330104 78802 5593 332 341 HC LOCALIZATION OF TUMOR WHOLE BODY SGL DAY O "$5,862.53 " "$1,592.38 " "$1,592.38 " $60.00 "$2,931.26 " $505.64 $459.67 "$1,576.46 " $60.00 "$3,025.52 " $60.00 "$1,592.38 " "$4,396.90 " "$1,751.62 " "$3,693.39 " "$4,285.51 " $72.00 $60.00 "$3,517.52 " "$4,690.02 " "$5,414.09 " "$9,076.56 " $60.00 "$1,592.38 " "$1,910.85 " $84.00 "$4,690.02 " $60.00 $60.00 $72.00 "$2,229.33 " $60.00 "$1,592.38 " "$1,592.38 " "$1,735.69 " "$4,690.02 " "$4,983.15 " $60.00 "$4,396.90 " $123.00 $60.00 "$2,931.26 " "$4,283.50 " "$2,508.00 " "$2,508.00 " "$2,508.00 " "$2,508.00 " $759.97 "$1,672.00 " "$1,592.38 " $759.97 $60.00 $60.00 "$1,353.52 " "$1,353.52 " "$1,592.38 " $60.00 "$9,076.56 " 330104 79101 5661 340 342 HC NUCLEAR RX IV ADMIN O "$2,479.19 " $299.61 $299.61 $30.00 "$1,239.60 " $247.20 $224.73 $296.61 $30.00 $569.26 $30.00 $299.61 "$1,859.39 " $329.57 "$1,561.89 " "$1,812.29 " $36.00 $30.00 "$1,487.51 " "$1,983.35 " "$1,018.68 " "$1,707.78 " $30.00 $299.61 $359.53 $42.00 "$1,983.35 " $30.00 $30.00 $36.00 $419.46 $30.00 $299.61 $299.61 $326.58 "$1,983.35 " "$2,107.31 " $30.00 "$1,859.39 " $61.50 $30.00 "$1,239.60 " $805.95 $471.89 $471.89 $471.89 $471.89 $358.59 $314.59 $299.61 $358.59 $30.00 $30.00 $254.67 $254.67 $299.61 $30.00 "$2,107.31 " 330104 79005 5661 340 342 HC NUCLEAR RX ORAL ADMIN O "$2,479.19 " $299.61 $299.61 $30.00 "$1,239.60 " $227.27 $206.61 $296.61 $30.00 $569.26 $30.00 $299.61 "$1,859.39 " $329.57 "$1,561.89 " "$1,812.29 " $36.00 $30.00 "$1,487.51 " "$1,983.35 " "$1,018.68 " "$1,707.78 " $30.00 $299.61 $359.53 $42.00 "$1,983.35 " $30.00 $30.00 $36.00 $419.46 $30.00 $299.61 $299.61 $326.58 "$1,983.35 " "$2,107.31 " $30.00 "$1,859.39 " $61.50 $30.00 "$1,239.60 " $805.95 $471.89 $471.89 $471.89 $471.89 $358.59 $314.59 $299.61 $358.59 $30.00 $30.00 $254.67 $254.67 $299.61 $30.00 "$2,107.31 " 330104 G6014 343 342 "HC RAD DELIV-3AREAS,>119M EV" O "$1,865.01 " $288.65 $288.65 $352.72 $932.50 $412.77 $375.25 $285.77 $352.72 $548.44 $352.72 $288.65 "$1,398.76 " $317.52 "$1,174.96 " "$1,363.32 " $423.27 $352.72 "$1,119.01 " "$1,492.01 " $981.42 "$1,645.32 " $352.72 $288.65 "$1,212.26 " $493.81 "$1,492.01 " $352.72 $352.72 $423.27 $404.11 $352.72 $288.65 $288.65 $314.63 "$1,492.01 " "$1,585.26 " $476.18 "$1,398.76 " $723.08 $476.18 $932.50 "$1,212.26 " $454.63 $454.63 $454.63 $454.63 N/A $303.08 $288.65 "$1,243.96 " $352.72 $352.72 $245.35 $245.35 $288.65 $245.35 "$1,645.32 " 330104 G6013 343 342 "HC RADIATION TREATMENT DELIVERY, 3 OR MORE" O "$1,127.78 " $290.29 $290.29 $352.72 $563.89 $415.12 $377.38 $287.39 $352.72 $551.56 $352.72 $290.29 $845.84 $319.32 $710.50 $824.41 $423.27 $352.72 $676.67 $902.22 $987.00 "$1,654.68 " $352.72 $290.29 $733.06 $493.81 $902.22 $352.72 $352.72 $423.27 $406.41 $352.72 $290.29 $290.29 $316.42 $902.22 $958.61 $476.18 $845.84 $723.08 $476.18 $563.89 $733.06 $457.21 $457.21 $457.21 $457.21 N/A $304.81 $290.29 $752.23 $352.72 $352.72 $246.75 $246.75 $290.29 $246.75 "$1,654.68 " 330104 G6012 343 342 HC RADIATION TREATMENT DELIVERY 3 OR MORE O "$1,127.78 " $289.47 $289.47 $352.72 $563.89 $413.95 $376.32 $286.58 $352.72 $550.00 $352.72 $289.47 $845.84 $318.42 $710.50 $824.41 $423.27 $352.72 $676.67 $902.22 $984.21 "$1,650.00 " $352.72 $289.47 $733.06 $493.81 $902.22 $352.72 $352.72 $423.27 $405.26 $352.72 $289.47 $289.47 $315.53 $902.22 $958.61 $476.18 $845.84 $723.08 $476.18 $563.89 $733.06 $455.92 $455.92 $455.92 $455.92 N/A $303.95 $289.47 $752.23 $352.72 $352.72 $246.05 $246.05 $289.47 $246.05 "$1,650.00 " 330104 G6015 347 342 HC RADIATION TX DELIVERY IMRT O "$3,585.57 " $443.82 $443.82 $162.35 "$1,792.79 " $634.67 $576.97 $439.38 $162.35 $843.26 $162.35 $443.82 "$2,689.18 " $488.20 "$2,258.91 " "$2,621.05 " $194.82 $162.35 "$2,151.34 " "$2,868.46 " "$1,508.99 " "$2,529.79 " $162.35 $443.82 "$2,330.62 " $227.28 "$2,868.46 " $162.35 $162.35 $194.82 $621.35 $162.35 $443.82 $443.82 $483.77 "$2,868.46 " "$3,047.73 " $219.17 "$2,689.18 " $332.81 $219.17 "$1,792.79 " "$2,330.62 " $699.02 $699.02 $699.02 $699.02 N/A $466.01 $443.82 "$2,391.58 " $162.35 $162.35 $377.25 $377.25 $443.82 $162.35 "$3,047.73 " 330104 A9560 2000 343 HC TC99M LABELED RBC O $40.00 N/A N/A $40.00 $20.00 N/A N/A N/A $40.00 N/A $40.00 N/A $30.00 N/A $25.20 $29.24 $48.00 $40.00 $24.00 $32.00 N/A N/A $40.00 N/A $26.00 $56.00 $32.00 $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A $32.00 $34.00 $54.00 $30.00 $82.00 $54.00 $20.00 $26.00 N/A N/A N/A N/A N/A N/A N/A $26.68 $40.00 $40.00 N/A N/A N/A $20.00 $82.00 330104 A9556 2000 343 HC GA67 GALLIUM O $93.00 N/A N/A N/A $46.50 N/A N/A N/A N/A N/A N/A N/A $69.75 N/A $58.59 $67.98 N/A N/A $55.80 $74.40 N/A N/A N/A N/A $60.45 N/A $74.40 N/A N/A N/A N/A N/A N/A N/A N/A $74.40 $79.05 N/A $69.75 N/A N/A $46.50 $60.45 N/A N/A N/A N/A N/A N/A N/A $62.03 N/A N/A N/A N/A N/A $46.50 $79.05 330104 A9521 2000 343 HC TC99M EXAMETAZIME O "$5,551.00 " N/A N/A "$5,551.00 " "$2,775.50 " N/A N/A N/A "$5,551.00 " N/A "$5,551.00 " N/A "$4,163.25 " N/A "$3,497.13 " "$4,057.78 " "$6,661.20 " "$5,551.00 " "$3,330.60 " "$4,440.80 " N/A N/A "$5,551.00 " N/A "$3,608.15 " "$7,771.40 " "$4,440.80 " "$5,551.00 " "$5,551.00 " "$6,661.20 " N/A "$5,551.00 " N/A N/A N/A "$4,440.80 " "$4,718.35 " "$7,493.85 " "$4,163.25 " "$11,379.55 " "$7,493.85 " "$2,775.50 " "$3,608.15 " N/A N/A N/A N/A N/A N/A N/A "$3,702.52 " "$5,551.00 " "$5,551.00 " N/A N/A N/A "$2,775.50 " "$11,379.55 " 330104 A9528 2000 343 HC IODINE I-131 IODIDE CAP DX O $183.00 N/A N/A $183.00 $91.50 N/A N/A N/A $183.00 N/A $183.00 N/A $137.25 N/A $115.29 $133.77 $219.60 $183.00 $109.80 $146.40 N/A N/A $183.00 N/A $118.95 $256.20 $146.40 $183.00 $183.00 $219.60 N/A $183.00 N/A N/A N/A $146.40 $155.55 $247.05 $137.25 $375.15 $247.05 $91.50 $118.95 N/A N/A N/A N/A N/A N/A N/A $122.06 $183.00 $183.00 N/A N/A N/A $91.50 $375.15 330104 A9512 2000 343 HC TC99M PERTECHNETATE O $5.00 N/A N/A $5.00 $2.50 N/A N/A N/A $5.00 N/A $5.00 N/A $3.75 N/A $3.15 $3.65 $6.00 $5.00 $3.00 $4.00 N/A N/A $5.00 N/A $3.25 $7.00 $4.00 $5.00 $5.00 $6.00 N/A $5.00 N/A N/A N/A $4.00 $4.25 $6.75 $3.75 $10.25 $6.75 $2.50 $3.25 N/A N/A N/A N/A N/A N/A N/A $3.33 $5.00 $5.00 N/A N/A N/A $2.50 $10.25 330104 A9537 2000 343 HC TC99M MEBROFENIN O $297.00 N/A N/A $297.00 $148.50 N/A N/A N/A $297.00 N/A $297.00 N/A $222.75 N/A $187.11 $217.11 $356.40 $297.00 $178.20 $237.60 N/A N/A $297.00 N/A $193.05 $415.80 $237.60 $297.00 $297.00 $356.40 N/A $297.00 N/A N/A N/A $237.60 $252.45 $400.95 $222.75 $608.85 $400.95 $148.50 $193.05 N/A N/A N/A N/A N/A N/A N/A $198.10 $297.00 $297.00 N/A N/A N/A $148.50 $608.85 330104 A9538 2000 343 HC TC99M PYROPHOSPHATE O $252.00 N/A N/A $252.00 $126.00 N/A N/A N/A $252.00 N/A $252.00 N/A $189.00 N/A $158.76 $184.21 $302.40 $252.00 $151.20 $201.60 N/A N/A $252.00 N/A $163.80 $352.80 $201.60 $252.00 $252.00 $302.40 N/A $252.00 N/A N/A N/A $201.60 $214.20 $340.20 $189.00 $516.60 $340.20 $126.00 $163.80 N/A N/A N/A N/A N/A N/A N/A $168.08 $252.00 $252.00 N/A N/A N/A $126.00 $516.60 330104 A9539 2000 343 HC TC99M PENTETATE O $401.00 N/A N/A $401.00 $200.50 N/A N/A N/A $401.00 N/A $401.00 N/A $300.75 N/A $252.63 $293.13 $481.20 $401.00 $240.60 $320.80 N/A N/A $401.00 N/A $260.65 $561.40 $320.80 $401.00 $401.00 $481.20 N/A $401.00 N/A N/A N/A $320.80 $340.85 $541.35 $300.75 $822.05 $541.35 $200.50 $260.65 N/A N/A N/A N/A N/A N/A N/A $267.47 $401.00 $401.00 N/A N/A N/A $200.50 $822.05 330104 A9540 2000 343 HC TC99M MAA O $360.00 N/A N/A $360.00 $180.00 N/A N/A N/A $360.00 N/A $360.00 N/A $270.00 N/A $226.80 $263.16 $432.00 $360.00 $216.00 $288.00 N/A N/A $360.00 N/A $234.00 $504.00 $288.00 $360.00 $360.00 $432.00 N/A $360.00 N/A N/A N/A $288.00 $306.00 $486.00 $270.00 $738.00 $486.00 $180.00 $234.00 N/A N/A N/A N/A N/A N/A N/A $240.12 $360.00 $360.00 N/A N/A N/A $180.00 $738.00 330104 A9541 2000 343 HC TC99M SULFUR COLLOID UNFILTERED O $500.00 N/A N/A $500.00 $250.00 N/A N/A N/A $500.00 N/A $500.00 N/A $375.00 N/A $315.00 $365.50 $600.00 $500.00 $300.00 $400.00 N/A N/A $500.00 N/A $325.00 $700.00 $400.00 $500.00 $500.00 $600.00 N/A $500.00 N/A N/A N/A $400.00 $425.00 $675.00 $375.00 "$1,025.00 " $675.00 $250.00 $325.00 N/A N/A N/A N/A N/A N/A N/A $333.50 $500.00 $500.00 N/A N/A N/A $250.00 "$1,025.00 " 330104 A9547 2000 343 HC IN111 OXYQUINOLINE O $295.00 N/A N/A $295.00 $147.50 N/A N/A N/A $295.00 N/A $295.00 N/A $221.25 N/A $185.85 $215.64 $354.00 $295.00 $177.00 $236.00 N/A N/A $295.00 N/A $191.75 $413.00 $236.00 $295.00 $295.00 $354.00 N/A $295.00 N/A N/A N/A $236.00 $250.75 $398.25 $221.25 $604.75 $398.25 $147.50 $191.75 N/A N/A N/A N/A N/A N/A N/A $196.77 $295.00 $295.00 N/A N/A N/A $147.50 $604.75 330104 A9500 2000 343 HC TC99M SESTAMIBI DIAGNOSTIC PER STUDY DOSE O $888.00 N/A N/A $888.00 $444.00 N/A N/A N/A $888.00 N/A $888.00 N/A $666.00 N/A $559.44 $649.13 "$1,065.60 " $888.00 $532.80 $710.40 N/A N/A $888.00 N/A $577.20 "$1,243.20 " $710.40 $888.00 $888.00 "$1,065.60 " N/A $888.00 N/A N/A N/A $710.40 $754.80 "$1,198.80 " $666.00 "$1,820.40 " "$1,198.80 " $444.00 $577.20 N/A N/A N/A N/A N/A N/A N/A $592.30 $888.00 $888.00 N/A N/A N/A $444.00 "$1,820.40 " 330104 A9516 2000 343 HC IODINE I-123 SOD IODIDE MIC O $501.00 N/A N/A $501.00 $250.50 N/A N/A N/A $501.00 N/A $501.00 N/A $375.75 N/A $315.63 $366.23 $601.20 $501.00 $300.60 $400.80 N/A N/A $501.00 N/A $325.65 $701.40 $400.80 $501.00 $501.00 $601.20 N/A $501.00 N/A N/A N/A $400.80 $425.85 $676.35 $375.75 "$1,027.05 " $676.35 $250.50 $325.65 N/A N/A N/A N/A N/A N/A N/A $334.17 $501.00 $501.00 N/A N/A N/A $250.50 "$1,027.05 " 330104 A9509 2000 343 HC IODINE I-123 SOD IODIDE DIAG. PER MCI O $501.00 N/A N/A $501.00 $250.50 N/A N/A N/A $501.00 N/A $501.00 N/A $375.75 N/A $315.63 $366.23 $601.20 $501.00 $300.60 $400.80 N/A N/A $501.00 N/A $325.65 $701.40 $400.80 $501.00 $501.00 $601.20 N/A $501.00 N/A N/A N/A $400.80 $425.85 $676.35 $375.75 "$1,027.05 " $676.35 $250.50 $325.65 N/A N/A N/A N/A N/A N/A N/A $334.17 $501.00 $501.00 N/A N/A N/A $250.50 "$1,027.05 " 330104 A9503 2000 343 HC TC99M MEDRONATE DIAGNOSTIC UP TO 30 MCI O $213.00 N/A N/A $213.00 $106.50 N/A N/A N/A $213.00 N/A $213.00 N/A $159.75 N/A $134.19 $155.70 $255.60 $213.00 $127.80 $170.40 N/A N/A $213.00 N/A $138.45 $298.20 $170.40 $213.00 $213.00 $255.60 N/A $213.00 N/A N/A N/A $170.40 $181.05 $287.55 $159.75 $436.65 $287.55 $106.50 $138.45 N/A N/A N/A N/A N/A N/A N/A $142.07 $213.00 $213.00 N/A N/A N/A $106.50 $436.65 330104 A9567 2000 343 HC TECHNETIUM TC-99M AEROSOL O $105.00 N/A N/A $105.00 $52.50 N/A N/A N/A $105.00 N/A $105.00 N/A $78.75 N/A $66.15 $76.75 $126.00 $105.00 $63.00 $84.00 N/A N/A $105.00 N/A $68.25 $147.00 $84.00 $105.00 $105.00 $126.00 N/A $105.00 N/A N/A N/A $84.00 $89.25 $141.75 $78.75 $215.25 $141.75 $52.50 $68.25 N/A N/A N/A N/A N/A N/A N/A $70.04 $105.00 $105.00 N/A N/A N/A $52.50 $215.25 330104 A9570 2000 343 HC INDIUM IN-111 AUTO WBC O "$5,107.02 " N/A N/A "$5,107.02 " "$2,553.51 " N/A N/A N/A "$5,107.02 " N/A "$5,107.02 " N/A "$3,830.27 " N/A "$3,217.42 " "$3,733.23 " "$6,128.42 " "$5,107.02 " "$3,064.21 " "$4,085.62 " N/A N/A "$5,107.02 " N/A "$3,319.56 " "$7,149.83 " "$4,085.62 " "$5,107.02 " "$5,107.02 " "$6,128.42 " N/A "$5,107.02 " N/A N/A N/A "$4,085.62 " "$4,340.97 " "$6,894.48 " "$3,830.27 " "$10,469.39 " "$6,894.48 " "$2,553.51 " "$3,319.56 " N/A N/A N/A N/A N/A N/A N/A "$3,406.38 " "$5,107.02 " "$5,107.02 " N/A N/A N/A "$2,553.51 " "$10,469.39 " 330104 A9572 2000 343 HC INDIUM IN-111 PENTETREOTIDE O "$4,212.00 " N/A N/A "$4,212.00 " "$2,106.00 " N/A N/A N/A "$4,212.00 " N/A "$4,212.00 " N/A "$3,159.00 " N/A "$2,653.56 " "$3,078.97 " "$5,054.40 " "$4,212.00 " "$2,527.20 " "$3,369.60 " N/A N/A "$4,212.00 " N/A "$2,737.80 " "$5,896.80 " "$3,369.60 " "$4,212.00 " "$4,212.00 " "$5,054.40 " N/A "$4,212.00 " N/A N/A N/A "$3,369.60 " "$3,580.20 " "$5,686.20 " "$3,159.00 " "$8,634.60 " "$5,686.20 " "$2,106.00 " "$2,737.80 " N/A N/A N/A N/A N/A N/A N/A "$2,809.40 " "$4,212.00 " "$4,212.00 " N/A N/A N/A "$2,106.00 " "$8,634.60 " 330104 A9562 2000 343 HC TC99M MERTIATIDE O "$1,384.00 " N/A N/A "$1,384.00 " $692.00 N/A N/A N/A "$1,384.00 " N/A "$1,384.00 " N/A "$1,038.00 " N/A $871.92 "$1,011.70 " "$1,660.80 " "$1,384.00 " $830.40 "$1,107.20 " N/A N/A "$1,384.00 " N/A $899.60 "$1,937.60 " "$1,107.20 " "$1,384.00 " "$1,384.00 " "$1,660.80 " N/A "$1,384.00 " N/A N/A N/A "$1,107.20 " "$1,176.40 " "$1,868.40 " "$1,038.00 " "$2,837.20 " "$1,868.40 " $692.00 $899.60 N/A N/A N/A N/A N/A N/A N/A $923.13 "$1,384.00 " "$1,384.00 " N/A N/A N/A $692.00 "$2,837.20 " 330104 A4641 2000 343 HC SULFUR COLLOID(10MCI) =<20MCI O "$1,008.00 " N/A N/A "$1,008.00 " $504.00 N/A N/A N/A "$1,008.00 " N/A "$1,008.00 " N/A $756.00 N/A $635.04 $736.85 "$1,209.60 " "$1,008.00 " $604.80 $806.40 N/A N/A "$1,008.00 " N/A $655.20 "$1,411.20 " $806.40 "$1,008.00 " "$1,008.00 " "$1,209.60 " N/A "$1,008.00 " N/A N/A N/A $806.40 $856.80 "$1,360.80 " $756.00 "$2,066.40 " "$1,360.80 " $504.00 $655.20 N/A N/A N/A N/A N/A N/A N/A $672.34 "$1,008.00 " "$1,008.00 " N/A N/A N/A $504.00 "$2,066.40 " 330104 A4641 2000 343 HC PYPá TECHNETIUM O $438.00 N/A N/A $438.00 $219.00 N/A N/A N/A $438.00 N/A $438.00 N/A $328.50 N/A $275.94 $320.18 $525.60 $438.00 $262.80 $350.40 N/A N/A $438.00 N/A $284.70 $613.20 $350.40 $438.00 $438.00 $525.60 N/A $438.00 N/A N/A N/A $350.40 $372.30 $591.30 $328.50 $897.90 $591.30 $219.00 $284.70 N/A N/A N/A N/A N/A N/A N/A $292.15 $438.00 $438.00 N/A N/A N/A $219.00 $897.90 330104 A9541 2000 343 HC TC99M SULFUR COLLOID FILTERED O "$1,008.00 " N/A N/A "$1,008.00 " $504.00 N/A N/A N/A "$1,008.00 " N/A "$1,008.00 " N/A $756.00 N/A $635.04 $736.85 "$1,209.60 " "$1,008.00 " $604.80 $806.40 N/A N/A "$1,008.00 " N/A $655.20 "$1,411.20 " $806.40 "$1,008.00 " "$1,008.00 " "$1,209.60 " N/A "$1,008.00 " N/A N/A N/A $806.40 $856.80 "$1,360.80 " $756.00 "$2,066.40 " "$1,360.80 " $504.00 $655.20 N/A N/A N/A N/A N/A N/A N/A $672.34 "$1,008.00 " "$1,008.00 " N/A N/A N/A $504.00 "$2,066.40 " 330104 A9517 1064 244 344 HC I131 IODIDE CAP RX O $178.00 $28.47 $28.47 $178.00 $89.00 N/A N/A $28.19 $178.00 $54.09 $178.00 $28.47 $133.50 $31.32 $112.14 $130.12 $213.60 $178.00 $106.80 $142.40 $96.80 $162.28 $178.00 $28.47 $34.16 $249.20 $142.40 $178.00 $178.00 $213.60 $39.86 $178.00 $28.47 $28.47 $31.03 $142.40 $151.30 $178.00 $133.50 $364.90 $178.00 $89.00 $76.58 $44.84 $44.84 $44.84 $44.84 N/A $29.89 $28.47 $118.73 $178.00 $178.00 $24.20 $24.20 $28.47 $24.20 $364.90 330104 A9606 1745 245 344 HC RADIUM RA-223 DICHLORIDE TX PER MICROCUR O $520.00 $185.59 $185.59 $520.00 $260.00 N/A N/A $183.73 $520.00 $352.61 $520.00 $185.59 $390.00 $204.14 $327.60 $380.12 $624.00 $520.00 $312.00 $416.00 $630.99 "$1,057.84 " $520.00 $185.59 $222.70 $728.00 $416.00 $520.00 $520.00 $624.00 $259.82 $520.00 $185.59 $185.59 $202.29 $416.00 $442.00 $520.00 $390.00 "$1,066.00 " $520.00 $260.00 $499.22 $292.30 $292.30 $292.30 $292.30 N/A $194.86 $185.59 $346.84 $520.00 $520.00 $157.75 $157.75 $185.59 $157.75 "$1,066.00 " 330104 72191 5571 302 350 HC CT ANGIOGRAPH PELV W/O&W/DYE O "$5,698.82 " $216.36 $216.36 $254.00 "$2,849.41 " $552.29 $502.08 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,274.11 " $238.00 "$3,590.26 " "$4,165.84 " $304.80 $254.00 "$3,419.29 " "$4,559.06 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$4,559.06 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$4,559.06 " "$4,844.00 " $254.00 "$4,274.11 " $520.70 $254.00 "$2,849.41 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,844.00 " 330104 73200 5522 299 350 HC CT UPPER EXTREMITY W/O DYE O "$1,692.74 " $128.23 $128.23 $140.00 $846.37 $290.52 $264.10 $126.95 $140.00 $243.63 $140.00 $128.23 "$1,269.56 " $141.05 "$1,066.43 " "$1,237.39 " $168.00 $140.00 "$1,015.64 " "$1,354.19 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$1,354.19 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$1,354.19 " "$1,438.83 " $140.00 "$1,269.56 " $287.00 $140.00 $846.37 $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$1,438.83 " 330104 73201 5572 300 350 HC CT UPPER EXTREMITY W/DYE O "$3,589.85 " $442.02 $442.02 $170.00 "$1,794.92 " $364.31 $331.19 $437.60 $170.00 $839.84 $170.00 $442.02 "$2,692.39 " $486.22 "$2,261.61 " "$2,624.18 " $204.00 $170.00 "$2,153.91 " "$2,871.88 " "$1,502.87 " "$2,519.52 " $170.00 $442.02 $530.42 $238.00 "$2,871.88 " $170.00 $170.00 $204.00 $618.83 $170.00 $442.02 $442.02 $481.80 "$2,871.88 " "$3,051.37 " $170.00 "$2,692.39 " $348.50 $170.00 "$1,794.92 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $479.70 $464.12 $442.02 $479.70 $170.00 $170.00 $375.72 $375.72 $442.02 $170.00 "$3,051.37 " 330104 73206 5571 302 350 HC CT ANGIO UPR EXTRM W/O&W/DYE O "$4,544.29 " $216.36 $216.36 $254.00 "$2,272.14 " $538.19 $489.26 $214.20 $254.00 $411.09 $254.00 $216.36 "$3,408.22 " $238.00 "$2,862.90 " "$3,321.88 " $304.80 $254.00 "$2,726.57 " "$3,635.43 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$3,635.43 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$3,635.43 " "$3,862.65 " $254.00 "$3,408.22 " $520.70 $254.00 "$2,272.14 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,862.65 " 330104 73701 5571 300 350 HC CT LOWER EXTREMITY W/DYE O "$3,323.42 " $216.36 $216.36 $170.00 "$1,661.71 " $299.71 $272.46 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,492.57 " $238.00 "$2,093.75 " "$2,429.42 " $204.00 $170.00 "$1,994.05 " "$2,658.74 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$2,658.74 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$2,658.74 " "$2,824.91 " $170.00 "$2,492.57 " $348.50 $170.00 "$1,661.71 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$2,824.91 " 330104 73706 5571 302 350 HC CT ANGIO LWR EXTR W/O&W/DYE O "$4,544.29 " $216.36 $216.36 $254.00 "$2,272.14 " $585.08 $531.89 $214.20 $254.00 $411.09 $254.00 $216.36 "$3,408.22 " $238.00 "$2,862.90 " "$3,321.88 " $304.80 $254.00 "$2,726.57 " "$3,635.43 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$3,635.43 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$3,635.43 " "$3,862.65 " $254.00 "$3,408.22 " $520.70 $254.00 "$2,272.14 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,862.65 " 330104 74174 5572 302 350 HC CT ANGIO ABD&PELV W/O&W/DYE O "$5,698.82 " $442.02 $442.02 $177.48 "$2,849.41 " $688.42 $625.84 $437.60 $177.48 $839.84 $177.48 $442.02 "$4,274.11 " $486.22 "$3,590.26 " "$4,165.84 " $212.98 $177.48 "$3,419.29 " "$4,559.06 " "$1,502.87 " "$2,519.52 " $177.48 $442.02 $530.42 $248.47 "$4,559.06 " $177.48 $177.48 $212.98 $618.83 $177.48 $442.02 $442.02 $481.80 "$4,559.06 " "$4,844.00 " $177.48 "$4,274.11 " $363.83 $177.48 "$2,849.41 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $929.66 $464.12 $442.02 $929.66 $177.48 $177.48 $375.72 $375.72 $442.02 $177.48 "$4,844.00 " 330104 71275 5571 302 350 HC CT ANGIOGRAPHY CHEST O "$4,708.00 " $216.36 $216.36 $140.00 "$2,354.00 " $507.57 $461.43 $214.20 $140.00 $411.09 $140.00 $216.36 "$3,531.00 " $238.00 "$2,966.04 " "$3,441.55 " $168.00 $140.00 "$2,824.80 " "$3,766.40 " $735.63 "$1,233.26 " $140.00 $216.36 $259.63 $196.00 "$3,766.40 " $140.00 $140.00 $168.00 $302.91 $140.00 $216.36 $216.36 $235.83 "$3,766.40 " "$4,001.80 " $140.00 "$3,531.00 " $287.00 $140.00 "$2,354.00 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $140.00 $140.00 $183.91 $183.91 $216.36 $140.00 "$4,001.80 " 330104 74175 5571 302 350 HC CT ANGIO ABDOM W/O & W/DYE O "$6,342.96 " $216.36 $216.36 $254.00 "$3,171.48 " $555.15 $504.68 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,757.22 " $238.00 "$3,996.06 " "$4,636.70 " $304.80 $254.00 "$3,805.78 " "$5,074.37 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$5,074.37 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$5,074.37 " "$5,391.52 " $254.00 "$4,757.22 " $520.70 $254.00 "$3,171.48 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$5,391.52 " 330104 75571 5521 299 350 HC CT HRT W/O DYE W/CA TEST O $656.98 $104.23 $104.23 N/A $328.49 $179.75 $163.41 $103.19 N/A $198.04 N/A $104.23 $492.74 $114.66 $413.90 $480.25 N/A N/A $394.19 $525.58 $354.39 $594.13 N/A $104.23 $125.08 N/A $525.58 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $525.58 $558.43 N/A $492.74 N/A N/A $328.49 $280.39 $164.17 $164.17 $164.17 $164.17 $73.97 $109.45 $104.23 $73.97 N/A N/A $88.60 $88.60 $104.23 $73.97 $594.13 330104 73700 5522 299 350 HC CT LOWER EXTREMITY W/O DYE O "$3,323.42 " $128.23 $128.23 $140.00 "$1,661.71 " $230.61 $209.64 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,492.57 " $141.05 "$2,093.75 " "$2,429.42 " $168.00 $140.00 "$1,994.05 " "$2,658.74 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,658.74 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,658.74 " "$2,824.91 " $140.00 "$2,492.57 " $287.00 $140.00 "$1,661.71 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,824.91 " 330104 71271 5522 299 350 HC CT THORAX LW DOSE LNG CA SCR C- O $337.05 $128.23 $128.23 $34.83 $168.53 $246.34 $223.94 $126.95 $34.83 $243.63 $34.83 $128.23 $252.79 $141.05 $212.34 $246.38 $41.80 $34.83 $202.23 $269.64 $435.98 $730.90 $34.83 $128.23 $153.87 $48.76 $269.64 $34.83 $34.83 $41.80 $179.52 $34.83 $128.23 $128.23 $139.77 $269.64 $286.49 $34.83 $252.79 $71.40 $34.83 $168.53 $344.93 $201.96 $201.96 $201.96 $201.96 N/A $134.64 $128.23 $224.81 $34.83 $34.83 $108.99 $108.99 $128.23 $34.83 $730.90 330104 70486 5522 299 350 HC CT MAXILLOFACIAL W/O DYE O "$3,323.42 " $128.23 $128.23 $120.00 "$1,661.71 " $229.98 $209.07 $126.95 $120.00 $243.63 $120.00 $128.23 "$2,492.57 " $141.05 "$2,093.75 " "$2,429.42 " $144.00 $120.00 "$1,994.05 " "$2,658.74 " $435.98 $730.90 $120.00 $128.23 $153.87 $168.00 "$2,658.74 " $120.00 $120.00 $144.00 $179.52 $120.00 $128.23 $128.23 $139.77 "$2,658.74 " "$2,824.91 " $120.00 "$2,492.57 " $246.00 $120.00 "$1,661.71 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $120.00 $120.00 $108.99 $108.99 $128.23 $108.99 "$2,824.91 " 330104 70492 5571 300 350 HC CT SFT TSUE NCK W/O & W/DYE O "$3,562.03 " $216.36 $216.36 $254.00 "$1,781.02 " $398.31 $362.10 $214.20 $254.00 $411.09 $254.00 $216.36 "$2,671.52 " $238.00 "$2,244.08 " "$2,603.84 " $304.80 $254.00 "$2,137.22 " "$2,849.62 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$2,849.62 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$2,849.62 " "$3,027.73 " $254.00 "$2,671.52 " $520.70 $254.00 "$1,781.02 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,027.73 " 330104 70488 5571 300 350 HC CT MAXILLOFACIAL W/O & W/DYE O "$3,816.69 " $216.36 $216.36 $217.00 "$1,908.35 " $332.88 $302.62 $214.20 $217.00 $411.09 $217.00 $216.36 "$2,862.52 " $238.00 "$2,404.51 " "$2,790.00 " $260.40 $217.00 "$2,290.01 " "$3,053.35 " $735.63 "$1,233.26 " $217.00 $216.36 $259.63 $303.80 "$3,053.35 " $217.00 $217.00 $260.40 $302.91 $217.00 $216.36 $216.36 $235.83 "$3,053.35 " "$3,244.19 " $217.00 "$2,862.52 " $444.85 $217.00 "$1,908.35 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $217.00 $217.00 $183.91 $183.91 $216.36 $183.91 "$3,244.19 " 330104 70487 5571 300 350 HC CT MAXILLOFACIAL W/DYE O "$3,323.42 " $216.36 $216.36 $145.00 "$1,661.71 " $272.39 $247.62 $214.20 $145.00 $411.09 $145.00 $216.36 "$2,492.57 " $238.00 "$2,093.75 " "$2,429.42 " $174.00 $145.00 "$1,994.05 " "$2,658.74 " $735.63 "$1,233.26 " $145.00 $216.36 $259.63 $203.00 "$2,658.74 " $145.00 $145.00 $174.00 $302.91 $145.00 $216.36 $216.36 $235.83 "$2,658.74 " "$2,824.91 " $145.00 "$2,492.57 " $297.25 $145.00 "$1,661.71 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $145.00 $145.00 $183.91 $183.91 $216.36 $145.00 "$2,824.91 " 330104 49180 5072 150 350 HC PERCUT BIOPSY ABDOMINAL MASS O "$12,721.23 " "$1,799.07 " "$1,799.07 " $609.85 "$6,360.61 " $140.37 $127.61 "$1,781.08 " $609.85 "$3,418.23 " $609.85 "$1,799.07 " "$9,540.92 " "$1,978.98 " "$8,014.37 " "$9,299.22 " $731.82 $609.85 "$7,632.74 " "$10,176.98 " "$6,116.84 " "$10,254.70 " $609.85 "$1,799.07 " "$2,158.88 " $853.79 "$10,176.98 " $609.85 $609.85 $731.82 "$2,518.70 " $609.85 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$10,176.98 " "$10,813.05 " $609.85 "$3,883.00 " "$1,250.19 " $609.85 "$6,360.61 " "$4,839.50 " "$2,833.54 " "$2,833.54 " "$2,833.54 " "$2,833.54 " N/A "$1,889.02 " "$1,799.07 " "$8,485.06 " $609.85 $609.85 "$1,529.21 " "$1,529.21 " "$1,799.07 " $127.61 "$10,813.05 " 330104 27369 278 350 HC NJX CNTRST KNE ARTHG/CT/MRI O "$1,011.15 " N/A N/A $468.99 $505.57 $69.96 $63.60 $48.44 $468.99 N/A $468.99 N/A $758.36 N/A $637.02 $739.15 $562.78 $468.99 $606.69 $808.92 N/A N/A $468.99 N/A $657.25 $656.58 $808.92 $468.99 $468.99 $562.78 N/A $468.99 N/A N/A N/A $808.92 $859.48 $633.13 $758.36 $961.42 $633.13 $505.57 $657.25 N/A N/A N/A N/A N/A N/A N/A $674.44 $468.99 $468.99 N/A N/A N/A $48.44 $961.42 330104 20600 5441 49 350 HC DRAIN/INJECT SMALL JOINT/BURSA CT O "$1,182.35 " $326.20 $326.20 $296.51 $591.17 $60.92 $55.39 $322.94 $296.51 $619.77 $296.51 $326.20 $886.76 $358.82 $744.88 $864.30 $355.81 $296.51 $709.41 $945.88 "$1,109.07 " "$1,859.32 " $296.51 $326.20 $391.44 $415.11 $945.88 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $945.88 "$1,005.00 " $296.51 $886.76 $607.85 $296.51 $591.17 $877.47 $513.76 $513.76 $513.76 $513.76 N/A $342.51 $326.20 $788.63 $296.51 $296.51 $277.27 $277.27 $326.20 $55.39 "$1,859.32 " 330104 0712T 5521 301 350 HC N-INVAS ARTL PLAQ ALYS QUAN STRUX&COMPOS VSL WAL O $214.00 $104.23 $104.23 N/A $107.00 N/A N/A $103.19 N/A $198.04 N/A $104.23 $160.50 $114.66 $134.82 $156.43 N/A N/A $128.40 $171.20 $354.39 $594.13 N/A $104.23 $125.08 N/A $171.20 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $171.20 $181.90 N/A $160.50 N/A N/A $107.00 $280.39 $164.17 $164.17 $164.17 $164.17 N/A $109.45 $104.23 $142.74 N/A N/A $88.60 $88.60 $104.23 $88.60 $594.13 330104 0711T 2002 350 HC N-INVAS ARTL PLAQ ALYS DATA PREP & TRANSMISSION O $181.90 N/A N/A N/A $90.95 N/A N/A N/A N/A N/A N/A N/A $136.43 N/A $114.60 $132.97 N/A N/A $109.14 $145.52 N/A N/A N/A N/A $118.24 N/A $145.52 N/A N/A N/A N/A N/A N/A N/A N/A $145.52 $154.62 N/A $136.43 N/A N/A $90.95 $118.24 N/A N/A N/A N/A N/A N/A N/A $121.33 N/A N/A N/A N/A N/A $90.95 $154.62 330104 0691T 291 350 HC AUTO ALYS XST CT VRT FX ASMT B1 DNS DATA PRP I&R O "$1,605.00 " N/A N/A N/A $802.50 N/A N/A N/A N/A N/A N/A N/A "$1,203.75 " N/A "$1,011.15 " "$1,173.25 " N/A N/A $963.00 "$1,284.00 " N/A N/A N/A N/A "$1,043.25 " N/A "$1,284.00 " N/A N/A N/A N/A N/A N/A N/A N/A "$1,284.00 " "$1,364.25 " N/A "$1,203.75 " N/A N/A $802.50 "$1,043.25 " N/A N/A N/A N/A N/A N/A N/A "$1,070.54 " N/A N/A N/A N/A N/A $802.50 "$1,364.25 " 330104 72193 5571 300 350 HC CT PELVIS W/DYE O "$3,921.55 " $216.36 $216.36 $170.00 "$1,960.78 " $417.76 $379.78 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,941.16 " $238.00 "$2,470.58 " "$2,866.65 " $204.00 $170.00 "$2,352.93 " "$3,137.24 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$3,137.24 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$3,137.24 " "$3,333.32 " $170.00 "$2,941.16 " $348.50 $170.00 "$1,960.78 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$3,333.32 " 330104 72192 5522 299 350 HC CT PELVIS W/O DYE O "$3,921.55 " $128.23 $128.23 $140.00 "$1,960.78 " $238.04 $216.40 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,941.16 " $141.05 "$2,470.58 " "$2,866.65 " $168.00 $140.00 "$2,352.93 " "$3,137.24 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$3,137.24 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$3,137.24 " "$3,333.32 " $140.00 "$2,941.16 " $287.00 $140.00 "$1,960.78 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$3,333.32 " 330104 70498 5571 302 350 HC CT ANGIOGRAPHY NECK O "$4,708.00 " $216.36 $216.36 $254.00 "$2,354.00 " $498.12 $452.84 $214.20 $254.00 $411.09 $254.00 $216.36 "$3,531.00 " $238.00 "$2,966.04 " "$3,441.55 " $304.80 $254.00 "$2,824.80 " "$3,766.40 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$3,766.40 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$3,766.40 " "$4,001.80 " $254.00 "$3,531.00 " $520.70 $254.00 "$2,354.00 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,001.80 " 330104 0042T 300 350 HC CT PERFUSION W/CONTRAST CBF O "$3,033.45 " N/A N/A N/A "$1,516.72 " N/A N/A N/A N/A N/A N/A N/A "$2,275.09 " N/A "$1,911.07 " "$2,217.45 " N/A N/A "$1,820.07 " "$2,426.76 " N/A N/A N/A N/A "$1,971.74 " N/A "$2,426.76 " N/A N/A N/A N/A N/A N/A N/A N/A "$2,426.76 " "$2,578.43 " N/A "$2,275.09 " N/A N/A "$1,516.72 " "$1,971.74 " N/A N/A N/A N/A N/A N/A N/A "$2,023.31 " N/A N/A N/A N/A N/A "$1,516.72 " "$2,578.43 " 330104 75635 5571 302 350 HC CT ANGIO ABDOMINAL ARTERIES O "$4,708.00 " $216.36 $216.36 $254.00 "$2,354.00 " $738.00 $670.91 $214.20 $254.00 $411.09 $254.00 $216.36 "$3,531.00 " $238.00 "$2,966.04 " "$3,441.55 " $304.80 $254.00 "$2,824.80 " "$3,766.40 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$3,766.40 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$3,766.40 " "$4,001.80 " $254.00 "$3,531.00 " $520.70 $254.00 "$2,354.00 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,001.80 " 330104 77012 473 350 HC CT SCAN FOR NEEDLE BIOPSY O "$3,237.82 " N/A N/A $90.00 "$1,618.91 " $243.52 $221.38 $168.59 $90.00 N/A $90.00 N/A "$2,428.37 " N/A "$2,039.83 " "$2,366.85 " $108.00 $90.00 "$1,942.69 " "$2,590.26 " N/A N/A $90.00 N/A "$2,104.58 " $126.00 "$2,590.26 " $90.00 $90.00 $108.00 N/A $90.00 N/A N/A N/A "$2,590.26 " "$2,752.15 " $121.50 "$2,428.37 " $184.50 $121.50 "$1,618.91 " "$2,104.58 " N/A N/A N/A N/A N/A N/A N/A "$2,159.63 " $90.00 $90.00 N/A N/A N/A $90.00 "$2,752.15 " 330104 75574 5571 302 350 HC CT ANGIO HRT W/3D IMAGE O "$1,311.82 " $216.36 $216.36 $126.31 $655.91 $573.02 $520.93 $214.20 $126.31 $411.09 $126.31 $216.36 $983.87 $238.00 $826.45 $958.94 $151.57 $126.31 $787.09 "$1,049.46 " $735.63 "$1,233.26 " $126.31 $216.36 $259.63 $176.83 "$1,049.46 " $126.31 $126.31 $151.57 $302.91 $126.31 $216.36 $216.36 $235.83 "$1,049.46 " "$1,115.05 " $126.31 $983.87 $258.94 $126.31 $655.91 $582.01 $340.77 $340.77 $340.77 $340.77 $410.98 $227.18 $216.36 $410.98 $126.31 $126.31 $183.91 $183.91 $216.36 $126.31 "$1,233.26 " 330104 77014 473 350 HC CT SCAN FOR THERAPY GUIDE O "$1,247.62 " N/A N/A N/A $623.81 $208.25 $189.32 $144.17 N/A N/A N/A N/A $935.71 N/A $786.00 $912.01 N/A N/A $748.57 $998.10 N/A N/A N/A N/A $810.95 N/A $998.10 N/A N/A N/A N/A N/A N/A N/A N/A $998.10 "$1,060.48 " N/A $935.71 N/A N/A $623.81 $810.95 N/A N/A N/A N/A N/A N/A N/A $832.16 N/A N/A N/A N/A N/A $144.17 "$1,060.48 " 330104 70496 5571 302 351 HC CT ANGIOGRAPHY HEAD O "$4,419.10 " $216.36 $216.36 $217.00 "$2,209.55 " $498.71 $453.37 $214.20 $217.00 $411.09 $217.00 $216.36 "$3,314.33 " $238.00 "$2,784.03 " "$3,230.36 " $260.40 $217.00 "$2,651.46 " "$3,535.28 " $735.63 "$1,233.26 " $217.00 $216.36 $259.63 $303.80 "$3,535.28 " $217.00 $217.00 $260.40 $302.91 $217.00 $216.36 $216.36 $235.83 "$3,535.28 " "$3,756.24 " $217.00 "$3,314.33 " $444.85 $217.00 "$2,209.55 " $582.01 $340.77 $340.77 $340.77 $340.77 $541.65 $227.18 $216.36 $541.65 $217.00 $217.00 $183.91 $183.91 $216.36 $183.91 "$3,756.24 " 330104 70491 5571 300 351 HC CT SOFT TISSUE NECK W/DYE O "$3,339.47 " $216.36 $216.36 $170.00 "$1,669.74 " $331.46 $301.33 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,504.60 " $238.00 "$2,103.87 " "$2,441.15 " $204.00 $170.00 "$2,003.68 " "$2,671.58 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$2,671.58 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$2,671.58 " "$2,838.55 " $170.00 "$2,504.60 " $348.50 $170.00 "$1,669.74 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$2,838.55 " 330104 70482 5571 300 351 HC CT ORBIT/EAR/FOSSA W/O&W/DYE O "$3,816.69 " $216.36 $216.36 $217.00 "$1,908.35 " $380.46 $345.87 $214.20 $217.00 $411.09 $217.00 $216.36 "$2,862.52 " $238.00 "$2,404.51 " "$2,790.00 " $260.40 $217.00 "$2,290.01 " "$3,053.35 " $735.63 "$1,233.26 " $217.00 $216.36 $259.63 $303.80 "$3,053.35 " $217.00 $217.00 $260.40 $302.91 $217.00 $216.36 $216.36 $235.83 "$3,053.35 " "$3,244.19 " $217.00 "$2,862.52 " $444.85 $217.00 "$1,908.35 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $217.00 $217.00 $183.91 $183.91 $216.36 $183.91 "$3,244.19 " 330104 70481 5571 300 351 HC CT ORBIT/EAR/FOSSA W/DYE O "$2,816.24 " $216.36 $216.36 $145.00 "$1,408.12 " $325.78 $296.16 $214.20 $145.00 $411.09 $145.00 $216.36 "$2,112.18 " $238.00 "$1,774.23 " "$2,058.67 " $174.00 $145.00 "$1,689.74 " "$2,252.99 " $735.63 "$1,233.26 " $145.00 $216.36 $259.63 $203.00 "$2,252.99 " $145.00 $145.00 $174.00 $302.91 $145.00 $216.36 $216.36 $235.83 "$2,252.99 " "$2,393.80 " $145.00 "$2,112.18 " $297.25 $145.00 "$1,408.12 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $145.00 $145.00 $183.91 $183.91 $216.36 $145.00 "$2,393.80 " 330104 70480 5522 299 351 HC CT ORBIT/EAR/FOSSA W/O DYE O "$2,816.24 " $128.23 $128.23 $120.00 "$1,408.12 " $283.53 $257.75 $126.95 $120.00 $243.63 $120.00 $128.23 "$2,112.18 " $141.05 "$1,774.23 " "$2,058.67 " $144.00 $120.00 "$1,689.74 " "$2,252.99 " $435.98 $730.90 $120.00 $128.23 $153.87 $168.00 "$2,252.99 " $120.00 $120.00 $144.00 $179.52 $120.00 $128.23 $128.23 $139.77 "$2,252.99 " "$2,393.80 " $120.00 "$2,112.18 " $246.00 $120.00 "$1,408.12 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $120.00 $120.00 $108.99 $108.99 $128.23 $108.99 "$2,393.80 " 330104 70450 5522 300 351 HC CT HEAD/BRAIN W/O DYE O "$3,323.42 " $128.23 $128.23 $120.00 "$1,661.71 " $189.46 $172.23 $126.95 $120.00 $243.63 $120.00 $128.23 "$2,492.57 " $141.05 "$2,093.75 " "$2,429.42 " $144.00 $120.00 "$1,994.05 " "$2,658.74 " $435.98 $730.90 $120.00 $128.23 $153.87 $168.00 "$2,658.74 " $120.00 $120.00 $144.00 $179.52 $120.00 $128.23 $128.23 $139.77 "$2,658.74 " "$2,824.91 " $120.00 "$2,492.57 " $246.00 $120.00 "$1,661.71 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $120.00 $120.00 $108.99 $108.99 $128.23 $108.99 "$2,824.91 " 330104 70470 5571 300 351 HC CT HEAD/BRAIN W/O & W/DYE O "$4,054.23 " $216.36 $216.36 $217.00 "$2,027.12 " $312.33 $283.93 $214.20 $217.00 $411.09 $217.00 $216.36 "$3,040.67 " $238.00 "$2,554.16 " "$2,963.64 " $260.40 $217.00 "$2,432.54 " "$3,243.38 " $735.63 "$1,233.26 " $217.00 $216.36 $259.63 $303.80 "$3,243.38 " $217.00 $217.00 $260.40 $302.91 $217.00 $216.36 $216.36 $235.83 "$3,243.38 " "$3,446.10 " $217.00 "$3,040.67 " $444.85 $217.00 "$2,027.12 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $217.00 $217.00 $183.91 $183.91 $216.36 $183.91 "$3,446.10 " 330104 70460 5571 300 351 HC CT HEAD/BRAIN W/DYE O "$3,657.26 " $216.36 $216.36 $145.00 "$1,828.63 " $264.75 $240.68 $214.20 $145.00 $411.09 $145.00 $216.36 "$2,742.95 " $238.00 "$2,304.07 " "$2,673.46 " $174.00 $145.00 "$2,194.36 " "$2,925.81 " $735.63 "$1,233.26 " $145.00 $216.36 $259.63 $203.00 "$2,925.81 " $145.00 $145.00 $174.00 $302.91 $145.00 $216.36 $216.36 $235.83 "$2,925.81 " "$3,108.67 " $145.00 "$2,742.95 " $297.25 $145.00 "$1,828.63 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $145.00 $145.00 $183.91 $183.91 $216.36 $145.00 "$3,108.67 " 330104 70490 5522 299 351 HC CT SOFT TISSUE NECK W/O DYE O "$3,022.75 " $128.23 $128.23 $140.00 "$1,511.38 " $268.26 $243.87 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,267.06 " $141.05 "$1,904.33 " "$2,209.63 " $168.00 $140.00 "$1,813.65 " "$2,418.20 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,418.20 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,418.20 " "$2,569.34 " $140.00 "$2,267.06 " $287.00 $140.00 "$1,511.38 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,569.34 " 330104 71270 5571 300 352 HC CT THORAX W/O & W/DYE O "$3,657.26 " $216.36 $216.36 $254.00 "$1,828.63 " $353.65 $321.50 $214.20 $254.00 $411.09 $254.00 $216.36 "$2,742.95 " $238.00 "$2,304.07 " "$2,673.46 " $304.80 $254.00 "$2,194.36 " "$2,925.81 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$2,925.81 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$2,925.81 " "$3,108.67 " $254.00 "$2,742.95 " $520.70 $254.00 "$1,828.63 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,108.67 " 330104 74176 5523 300 352 HC CT ABD & PELVIS W/O CONTRAST O "$5,359.63 " $280.16 $280.16 $68.69 "$2,679.82 " $326.81 $297.10 $277.36 $68.69 $532.31 $68.69 $280.16 "$4,019.72 " $308.18 "$3,376.57 " "$3,917.89 " $82.43 $68.69 "$3,215.78 " "$4,287.70 " $952.56 "$1,596.93 " $68.69 $280.16 $336.20 $96.17 "$4,287.70 " $68.69 $68.69 $82.43 $392.23 $68.69 $280.16 $280.16 $305.38 "$4,287.70 " "$4,555.69 " $68.69 "$4,019.72 " $140.81 $68.69 "$2,679.82 " $753.64 $441.26 $441.26 $441.26 $441.26 $310.16 $294.17 $280.16 $310.16 $68.69 $68.69 $238.14 $238.14 $280.16 $68.69 "$4,555.69 " 330104 G0297 299 352 HB LDCT FOR LUNG CA SCREEN O $342.40 N/A N/A N/A $171.20 N/A N/A $223.93 N/A N/A N/A N/A $256.80 N/A $215.71 $250.29 N/A N/A $205.44 $273.92 N/A N/A N/A N/A N/A N/A $273.92 N/A N/A N/A N/A N/A N/A N/A N/A $273.92 $291.04 N/A $256.80 N/A N/A $171.20 $222.56 N/A N/A N/A N/A $179.98 N/A N/A $179.98 N/A N/A N/A N/A N/A $171.20 $291.04 330104 71250 5522 299 352 HC CT THORAX W/O DYE O "$3,022.75 " $128.23 $128.23 $140.00 "$1,511.38 " $238.11 $216.47 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,267.06 " $141.05 "$1,904.33 " "$2,209.63 " $168.00 $140.00 "$1,813.65 " "$2,418.20 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,418.20 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,418.20 " "$2,569.34 " $140.00 "$2,267.06 " $287.00 $140.00 "$1,511.38 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,569.34 " 330104 72125 5522 299 352 HC CT NECK SPINE W/O DYE O "$3,676.52 " $128.23 $128.23 $140.00 "$1,838.26 " $231.20 $210.18 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,757.39 " $141.05 "$2,316.21 " "$2,687.54 " $168.00 $140.00 "$2,205.91 " "$2,941.22 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,941.22 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,941.22 " "$3,125.04 " $140.00 "$2,757.39 " $287.00 $140.00 "$1,838.26 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$3,125.04 " 330104 72126 5572 300 352 HC CT NECK SPINE W/DYE O "$4,059.58 " $442.02 $442.02 $170.00 "$2,029.79 " $302.78 $275.25 $437.60 $170.00 $839.84 $170.00 $442.02 "$3,044.68 " $486.22 "$2,557.54 " "$2,967.55 " $204.00 $170.00 "$2,435.75 " "$3,247.66 " "$1,502.87 " "$2,519.52 " $170.00 $442.02 $530.42 $238.00 "$3,247.66 " $170.00 $170.00 $204.00 $618.83 $170.00 $442.02 $442.02 $481.80 "$3,247.66 " "$3,450.64 " $170.00 "$3,044.68 " $348.50 $170.00 "$2,029.79 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $479.70 $464.12 $442.02 $479.70 $170.00 $170.00 $375.72 $375.72 $442.02 $170.00 "$3,450.64 " 330104 72127 5571 300 352 HC CT NECK SPINE W/O & W/DYE O "$5,363.91 " $216.36 $216.36 $254.00 "$2,681.95 " $355.79 $323.44 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,022.93 " $238.00 "$3,379.26 " "$3,921.02 " $304.80 $254.00 "$3,218.35 " "$4,291.13 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$4,291.13 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$4,291.13 " "$4,559.32 " $254.00 "$4,022.93 " $520.70 $254.00 "$2,681.95 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,559.32 " 330104 74170 5571 300 352 HC CT ABDOMEN W/O & W/DYE O "$3,370.50 " $216.36 $216.36 $254.00 "$1,685.25 " $476.38 $433.07 $214.20 $254.00 $411.09 $254.00 $216.36 "$2,527.88 " $238.00 "$2,123.41 " "$2,463.84 " $304.80 $254.00 "$2,022.30 " "$2,696.40 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$2,696.40 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$2,696.40 " "$2,864.92 " $254.00 "$2,527.88 " $520.70 $254.00 "$1,685.25 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$2,864.92 " 330104 72128 5522 299 352 HC CT CHEST SPINE W/O DYE O "$2,816.24 " $128.23 $128.23 $140.00 "$1,408.12 " $231.20 $210.18 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,112.18 " $141.05 "$1,774.23 " "$2,058.67 " $168.00 $140.00 "$1,689.74 " "$2,252.99 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,252.99 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,252.99 " "$2,393.80 " $140.00 "$2,112.18 " $287.00 $140.00 "$1,408.12 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,393.80 " 330104 72129 5571 300 352 HC CT CHEST SPINE W/DYE O "$3,323.42 " $216.36 $216.36 $170.00 "$1,661.71 " $305.66 $277.87 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,492.57 " $238.00 "$2,093.75 " "$2,429.42 " $204.00 $170.00 "$1,994.05 " "$2,658.74 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$2,658.74 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$2,658.74 " "$2,824.91 " $170.00 "$2,492.57 " $348.50 $170.00 "$1,661.71 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$2,824.91 " 330104 72194 5571 300 352 HC CT PELVIS W/O & W/DYE O "$3,657.26 " $216.36 $216.36 $254.00 "$1,828.63 " $460.77 $418.88 $214.20 $254.00 $411.09 $254.00 $216.36 "$2,742.95 " $238.00 "$2,304.07 " "$2,673.46 " $304.80 $254.00 "$2,194.36 " "$2,925.81 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$2,925.81 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$2,925.81 " "$3,108.67 " $254.00 "$2,742.95 " $520.70 $254.00 "$1,828.63 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$3,108.67 " 330104 72132 5572 300 352 HC CT LUMBAR SPINE W/DYE O "$3,477.50 " $442.02 $442.02 $170.00 "$1,738.75 " $303.37 $275.79 $437.60 $170.00 $839.84 $170.00 $442.02 "$2,608.12 " $486.22 "$2,190.82 " "$2,542.05 " $204.00 $170.00 "$2,086.50 " "$2,782.00 " "$1,502.87 " "$2,519.52 " $170.00 $442.02 $530.42 $238.00 "$2,782.00 " $170.00 $170.00 $204.00 $618.83 $170.00 $442.02 $442.02 $481.80 "$2,782.00 " "$2,955.88 " $170.00 "$2,608.12 " $348.50 $170.00 "$1,738.75 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $479.70 $464.12 $442.02 $479.70 $170.00 $170.00 $375.72 $375.72 $442.02 $170.00 "$2,955.88 " 330104 71260 5571 300 352 HC CT THORAX W/DYE O "$3,676.52 " $216.36 $216.36 $170.00 "$1,838.26 " $299.71 $272.46 $214.20 $170.00 $411.09 $170.00 $216.36 "$2,757.39 " $238.00 "$2,316.21 " "$2,687.54 " $204.00 $170.00 "$2,205.91 " "$2,941.22 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$2,941.22 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$2,941.22 " "$3,125.04 " $170.00 "$2,757.39 " $348.50 $170.00 "$1,838.26 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$3,125.04 " 330104 74150 5522 299 352 HC CT ABDOMEN W/O DYE O "$2,767.02 " $128.23 $128.23 $140.00 "$1,383.51 " $243.74 $221.58 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,075.26 " $141.05 "$1,743.22 " "$2,022.69 " $168.00 $140.00 "$1,660.21 " "$2,213.62 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,213.62 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,213.62 " "$2,351.97 " $140.00 "$2,075.26 " $287.00 $140.00 "$1,383.51 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$2,351.97 " 330104 71250 5522 299 352 HC CT LUNG CANCER SCREENING O $342.40 $128.23 $128.23 $140.00 $171.20 $238.11 $216.47 $126.95 $140.00 $243.63 $140.00 $128.23 $256.80 $141.05 $215.71 $250.29 $168.00 $140.00 $205.44 $273.92 $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 $273.92 $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 $273.92 $291.04 $140.00 $256.80 $287.00 $140.00 $171.20 $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 $730.90 330104 72130 5571 300 352 HC CT CHEST SPINE W/O & W/DYE O "$5,363.91 " $216.36 $216.36 $254.00 "$2,681.95 " $359.31 $326.65 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,022.93 " $238.00 "$3,379.26 " "$3,921.02 " $304.80 $254.00 "$3,218.35 " "$4,291.13 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$4,291.13 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$4,291.13 " "$4,559.32 " $254.00 "$4,022.93 " $520.70 $254.00 "$2,681.95 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,559.32 " 330104 72133 5571 300 352 HC CT LUMBAR SPINE W/O & W/DYE O "$5,363.91 " $216.36 $216.36 $254.00 "$2,681.95 " $356.96 $324.51 $214.20 $254.00 $411.09 $254.00 $216.36 "$4,022.93 " $238.00 "$3,379.26 " "$3,921.02 " $304.80 $254.00 "$3,218.35 " "$4,291.13 " $735.63 "$1,233.26 " $254.00 $216.36 $259.63 $355.60 "$4,291.13 " $254.00 $254.00 $304.80 $302.91 $254.00 $216.36 $216.36 $235.83 "$4,291.13 " "$4,559.32 " $254.00 "$4,022.93 " $520.70 $254.00 "$2,681.95 " $582.01 $340.77 $340.77 $340.77 $340.77 $534.78 $227.18 $216.36 $534.78 $254.00 $254.00 $183.91 $183.91 $216.36 $183.91 "$4,559.32 " 330104 74177 5572 300 352 HC CT ABD & PELV W/CONTRAST O "$7,472.88 " $442.02 $442.02 $107.93 "$3,736.44 " $551.74 $501.58 $437.60 $107.93 $839.84 $107.93 $442.02 "$5,604.66 " $486.22 "$4,707.91 " "$5,462.68 " $129.52 $107.93 "$4,483.73 " "$5,978.30 " "$1,502.87 " "$2,519.52 " $107.93 $442.02 $530.42 $151.10 "$5,978.30 " $107.93 $107.93 $129.52 $618.83 $107.93 $442.02 $442.02 $481.80 "$5,978.30 " "$6,351.95 " $107.93 "$5,604.66 " $221.26 $107.93 "$3,736.44 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $479.70 $464.12 $442.02 $479.70 $107.93 $107.93 $375.72 $375.72 $442.02 $107.93 "$6,351.95 " 330104 74178 5572 300 352 HC CT ABD & PELV 1/> REGNS O "$7,472.88 " $442.02 $442.02 $136.74 "$3,736.44 " $617.26 $561.14 $437.60 $136.74 $839.84 $136.74 $442.02 "$5,604.66 " $486.22 "$4,707.91 " "$5,462.68 " $164.09 $136.74 "$4,483.73 " "$5,978.30 " "$1,502.87 " "$2,519.52 " $136.74 $442.02 $530.42 $191.44 "$5,978.30 " $136.74 $136.74 $164.09 $618.83 $136.74 $442.02 $442.02 $481.80 "$5,978.30 " "$6,351.95 " $136.74 "$5,604.66 " $280.32 $136.74 "$3,736.44 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $534.78 $464.12 $442.02 $534.78 $136.74 $136.74 $375.72 $375.72 $442.02 $136.74 "$6,351.95 " 330104 74160 5571 300 352 HC CT ABDOMEN W/DYE O "$4,151.60 " $216.36 $216.36 $170.00 "$2,075.80 " $425.09 $386.45 $214.20 $170.00 $411.09 $170.00 $216.36 "$3,113.70 " $238.00 "$2,615.51 " "$3,034.82 " $204.00 $170.00 "$2,490.96 " "$3,321.28 " $735.63 "$1,233.26 " $170.00 $216.36 $259.63 $238.00 "$3,321.28 " $170.00 $170.00 $204.00 $302.91 $170.00 $216.36 $216.36 $235.83 "$3,321.28 " "$3,528.86 " $170.00 "$3,113.70 " $348.50 $170.00 "$2,075.80 " $582.01 $340.77 $340.77 $340.77 $340.77 $479.70 $227.18 $216.36 $479.70 $170.00 $170.00 $183.91 $183.91 $216.36 $170.00 "$3,528.86 " 330104 72131 5522 299 352 HC CT LUMBAR SPINE W/O DYE O "$3,676.52 " $128.23 $128.23 $140.00 "$1,838.26 " $230.02 $209.11 $126.95 $140.00 $243.63 $140.00 $128.23 "$2,757.39 " $141.05 "$2,316.21 " "$2,687.54 " $168.00 $140.00 "$2,205.91 " "$2,941.22 " $435.98 $730.90 $140.00 $128.23 $153.87 $196.00 "$2,941.22 " $140.00 $140.00 $168.00 $179.52 $140.00 $128.23 $128.23 $139.77 "$2,941.22 " "$3,125.04 " $140.00 "$2,757.39 " $287.00 $140.00 "$1,838.26 " $344.93 $201.96 $201.96 $201.96 $201.96 $310.16 $134.64 $128.23 $310.16 $140.00 $140.00 $108.99 $108.99 $128.23 $108.99 "$3,125.04 " 330104 360 HC BIRTH CTR-PROC ROOM EA ADDL 1/2 HOUR O $677.31 N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " $442.96 N/A N/A N/A N/A $507.98 $474.12 $440.25 $450.41 $237.06 $237.06 $406.39 "$14,074.00 " N/A "$9,788.00 " $237.06 N/A N/A N/A $541.85 N/A $541.85 N/A N/A $541.85 N/A N/A N/A $541.85 $575.71 $338.65 $507.98 $338.65 $338.65 N/A $440.25 "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " $338.65 N/A N/A N/A N/A $237.06 "$14,074.00 " 330104 360 HC LABOR AND DELIVERY OR INITIAL 30 MIN O "$5,423.83 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$3,547.18 " N/A N/A N/A N/A "$4,067.87 " "$3,796.68 " "$3,525.49 " "$3,606.85 " "$1,898.34 " "$1,898.34 " "$3,254.30 " "$14,074.00 " N/A "$9,788.00 " "$1,898.34 " N/A N/A N/A "$4,339.06 " N/A "$4,339.06 " N/A N/A "$4,339.06 " N/A N/A N/A "$4,339.06 " "$4,610.26 " "$2,711.91 " "$4,067.87 " "$2,711.91 " "$2,711.91 " N/A "$3,525.49 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$2,711.91 " N/A N/A N/A N/A "$1,898.34 " "$14,074.00 " 330104 360 HC LABOR AND DELIVERY OR 30 MIN EA ADDL O "$1,912.09 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$1,250.51 " N/A N/A N/A N/A "$1,434.07 " "$1,338.46 " "$1,242.86 " "$1,271.54 " $669.23 $669.23 "$1,147.25 " "$14,074.00 " N/A "$9,788.00 " $669.23 N/A N/A N/A "$1,529.67 " N/A "$1,529.67 " N/A N/A "$1,529.67 " N/A N/A N/A "$1,529.67 " "$1,625.28 " $956.04 "$1,434.07 " $956.04 $956.04 N/A "$1,242.86 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " $956.04 N/A N/A N/A N/A $669.23 "$14,074.00 " 330104 360 HC AAA-ENDO-VAS REPAIR O "$11,439.37 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,481.35 " N/A N/A N/A N/A "$8,579.53 " "$8,007.56 " "$7,435.59 " "$7,607.18 " "$4,003.78 " "$4,003.78 " "$6,863.62 " "$14,074.00 " N/A "$9,788.00 " "$4,003.78 " N/A N/A N/A "$9,151.50 " N/A "$9,151.50 " N/A N/A "$9,151.50 " N/A N/A N/A "$9,151.50 " "$9,723.46 " "$5,719.69 " "$8,579.53 " "$5,719.69 " "$5,719.69 " N/A "$7,435.59 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$5,719.69 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC 1.0 HR RAD SPECIAL PROCEDURE O "$5,855.04 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$3,829.20 " N/A N/A N/A N/A "$4,391.28 " "$4,098.53 " "$3,805.78 " "$3,893.60 " "$2,049.26 " "$2,049.26 " "$3,513.02 " "$14,074.00 " N/A "$9,788.00 " "$2,049.26 " N/A N/A N/A "$4,684.03 " N/A "$4,684.03 " N/A N/A "$4,684.03 " N/A N/A N/A "$4,684.03 " "$4,976.78 " "$2,927.52 " "$4,391.28 " "$2,927.52 " "$2,927.52 " N/A "$3,805.78 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$2,927.52 " N/A N/A N/A N/A "$2,049.26 " "$14,074.00 " 330104 360 HC D & C O "$2,861.18 " N/A N/A N/A N/A 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"$11,053.53 " "$11,744.37 " "$1,403.13 " "$3,883.00 " "$2,876.41 " "$1,403.13 " "$6,908.45 " "$10,523.23 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$5,375.00 " "$4,107.58 " "$3,911.98 " "$5,659.00 " "$1,403.13 " "$1,403.13 " "$3,325.18 " "$1,571.50 " "$3,911.98 " "$1,403.13 " "$14,074.00 " 330104 360 HC OR OVER 30 MIN LEV 1 O "$10,750.29 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,030.69 " N/A N/A N/A N/A "$8,062.72 " "$7,525.20 " "$6,987.69 " "$7,148.94 " "$3,762.60 " "$3,762.60 " "$6,450.17 " "$14,074.00 " N/A "$9,788.00 " "$3,762.60 " N/A N/A N/A "$8,600.23 " N/A "$8,600.23 " N/A N/A "$8,600.23 " N/A N/A N/A "$8,600.23 " "$9,137.75 " "$5,375.15 " "$8,062.72 " "$5,375.15 " "$5,375.15 " N/A "$6,987.69 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$5,375.15 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC OVARIAN CYSTECTOMY O "$16,825.75 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$11,004.04 " N/A N/A N/A N/A "$12,619.31 " "$11,778.02 " "$10,936.74 " "$11,189.12 " "$5,889.01 " "$5,889.01 " "$10,095.45 " "$14,074.00 " N/A "$9,788.00 " "$5,889.01 " N/A N/A N/A "$13,460.60 " N/A "$13,460.60 " N/A N/A "$13,460.60 " N/A N/A N/A "$13,460.60 " "$14,301.89 " "$8,412.88 " "$12,619.31 " "$8,412.88 " "$8,412.88 " N/A "$10,936.74 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$8,412.88 " N/A N/A N/A N/A "$2,215.00 " "$14,301.89 " 330104 360 HC LEV 2 OPERATING RM 30 MIN INITIAL O "$11,645.88 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,616.41 " N/A N/A N/A N/A "$8,734.41 " "$8,152.12 " "$7,569.82 " "$7,744.51 " "$4,076.06 " "$4,076.06 " "$6,987.53 " "$14,074.00 " N/A "$9,788.00 " "$4,076.06 " N/A N/A N/A "$9,316.70 " N/A "$9,316.70 " N/A N/A "$9,316.70 " N/A N/A N/A "$9,316.70 " "$9,899.00 " "$5,822.94 " "$8,734.41 " "$5,822.94 " "$5,822.94 " N/A "$7,569.82 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$5,822.94 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC LEV 3 OPERATING RM 30 MIN INITIAL O "$12,541.47 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$8,202.12 " N/A N/A N/A N/A "$9,406.10 " "$8,779.03 " "$8,151.96 " "$8,340.08 " "$4,389.51 " "$4,389.51 " "$7,524.88 " "$14,074.00 " N/A "$9,788.00 " "$4,389.51 " N/A N/A N/A "$10,033.18 " N/A "$10,033.18 " N/A N/A "$10,033.18 " N/A N/A N/A "$10,033.18 " "$10,660.25 " "$6,270.73 " "$9,406.10 " "$6,270.73 " "$6,270.73 " N/A "$8,151.96 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$6,270.73 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC TUBAL LIGATION O "$6,349.38 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$4,152.49 " N/A N/A N/A N/A "$4,762.03 " "$4,444.57 " "$4,127.10 " "$4,222.34 " "$2,222.28 " "$2,222.28 " "$3,809.63 " "$14,074.00 " N/A "$9,788.00 " "$2,222.28 " N/A N/A N/A "$5,079.50 " N/A "$5,079.50 " N/A N/A "$5,079.50 " N/A N/A N/A "$5,079.50 " "$5,396.97 " "$3,174.69 " "$4,762.03 " "$3,174.69 " "$3,174.69 " N/A "$4,127.10 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$3,174.69 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC C-SECTION W/ TUBAL LIGATION O "$16,056.42 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$10,500.90 " N/A N/A N/A N/A "$12,042.32 " "$11,239.49 " "$10,436.67 " "$10,677.52 " "$5,619.75 " "$5,619.75 " "$9,633.85 " "$14,074.00 " N/A "$9,788.00 " "$5,619.75 " N/A N/A N/A "$12,845.14 " N/A "$12,845.14 " N/A N/A "$12,845.14 " N/A N/A N/A "$12,845.14 " "$13,647.96 " "$8,028.21 " "$12,042.32 " "$8,028.21 " "$8,028.21 " N/A "$10,436.67 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$8,028.21 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 360 HC LEV 1 OPERATING RM 30 MIN EA ADDL O "$2,466.35 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$1,612.99 " N/A N/A N/A N/A "$1,849.76 " "$1,726.44 " "$1,603.13 " "$1,640.12 " $863.22 $863.22 "$1,479.81 " "$14,074.00 " N/A "$9,788.00 " $863.22 N/A N/A N/A 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"$2,303.18 " "$2,149.63 " "$1,996.09 " "$2,042.15 " "$1,074.82 " "$1,074.82 " "$1,842.54 " "$14,074.00 " N/A "$9,788.00 " "$1,074.82 " N/A N/A N/A "$2,456.72 " N/A "$2,456.72 " N/A N/A "$2,456.72 " N/A N/A N/A "$2,456.72 " "$2,610.26 " "$1,535.45 " "$2,303.18 " "$1,535.45 " "$1,535.45 " N/A "$1,996.09 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$1,535.45 " N/A N/A N/A N/A "$1,074.82 " "$14,074.00 " 330104 360 HC OOPHORECTOMY O "$23,451.19 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$15,337.08 " N/A N/A N/A N/A "$17,588.39 " "$16,415.83 " "$15,243.27 " "$15,595.04 " "$8,207.92 " "$8,207.92 " "$14,070.71 " "$14,074.00 " N/A "$9,788.00 " "$8,207.92 " N/A N/A N/A "$18,760.95 " N/A "$18,760.95 " N/A N/A "$18,760.95 " N/A N/A N/A "$18,760.95 " "$19,933.51 " "$11,725.59 " "$17,588.39 " "$11,725.59 " "$11,725.59 " N/A "$15,243.27 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$11,725.59 " N/A N/A N/A N/A "$2,215.00 " "$19,933.51 " 330104 360 HC DELIVERY RM C SECTION O "$12,158.41 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,951.60 " N/A N/A N/A N/A "$9,118.81 " "$8,510.89 " "$7,902.97 " "$8,085.34 " "$4,255.44 " "$4,255.44 " "$7,295.05 " "$14,074.00 " N/A "$9,788.00 " "$4,255.44 " N/A N/A N/A "$9,726.73 " N/A "$9,726.73 " N/A N/A "$9,726.73 " N/A N/A N/A "$9,726.73 " "$10,334.65 " "$6,079.20 " "$9,118.81 " "$6,079.20 " "$6,079.20 " N/A "$7,902.97 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$6,079.20 " N/A N/A N/A N/A "$2,215.00 " "$14,074.00 " 330104 49505 5341 3033 360 Repair of groin hernia patient age 5 years or older O "$12,970.00 " "$4,249.40 " "$4,249.40 " "$2,246.26 " "$3,553.00 " "$2,973.00 " "$2,708.00 " "$4,206.90 " "$2,246.26 " "$8,073.85 " "$2,246.26 " "$4,249.40 " "$9,727.50 " "$4,674.33 " "$8,430.50 " "$8,625.05 " "$2,695.51 " "$2,246.26 " "$7,782.00 " "$14,074.00 " "$14,447.94 " "$9,788.00 " "$2,246.26 " "$4,249.40 " "$5,099.27 " "$3,144.77 " "$10,376.00 " "$2,246.26 " "$2,246.26 " "$2,695.51 " "$5,949.15 " "$2,246.26 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$10,376.00 " "$11,024.50 " "$2,246.26 " "$4,965.00 " "$4,604.84 " "$2,246.26 " "$6,485.00 " "$11,430.87 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$2,246.26 " "$2,246.26 " "$3,611.99 " "$2,515.81 " "$4,249.40 " "$2,246.26 " "$14,447.94 " 330104 36555 5183 75 361 HC INSERT NON-TUNNEL CV CATH; YOUNGER THAN 5YRS O "$7,469.67 " "$3,573.99 " "$3,573.99 " $251.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$3,538.25 " $251.30 "$6,790.58 " $251.30 "$3,573.99 " "$5,602.25 " "$3,931.39 " "$4,855.29 " "$4,967.33 " $301.56 $251.30 "$4,481.80 " "$7,492.00 " "$12,151.56 " "$4,407.00 " $251.30 "$3,573.99 " "$4,288.79 " $351.82 "$5,975.74 " $251.30 $251.30 $301.56 "$5,003.59 " $251.30 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$5,975.74 " "$6,349.22 " $251.30 "$3,883.00 " $515.17 $251.30 "$3,734.84 " "$9,614.03 " "$5,042.03 " "$5,042.03 " "$5,042.03 " "$5,042.03 " "$3,548.00 " "$3,752.69 " "$3,573.99 " "$3,780.00 " $251.30 $251.30 "$3,037.89 " $281.46 "$3,573.99 " $251.30 "$12,151.56 " 330104 19030 278 361 HC INJECTION FOR BREAST X-RAY O "$1,212.31 " N/A N/A $499.80 $482.00 "$1,717.00 " "$1,565.00 " $90.13 $499.80 N/A $499.80 N/A $909.23 N/A $788.00 $806.19 $599.76 $499.80 $727.39 "$7,492.00 " N/A "$4,407.00 " $499.80 N/A $788.00 $699.72 $969.85 $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A $969.85 "$1,030.46 " $674.73 $909.23 "$1,024.59 " $674.73 $606.15 $788.00 $818.31 $818.31 $818.31 $818.31 "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $90.13 "$7,492.00 " 330104 11771 5073 11 361 HC EXCISION PILONIDAL CYST/SINUS EXTENSIVE O "$13,579.37 " "$3,099.23 " "$3,099.23 " "$2,234.79 " "$2,886.00 " "$2,949.00 " "$2,686.00 " "$3,068.24 " "$2,234.79 " "$5,888.53 " "$2,234.79 " "$3,099.23 " "$10,184.53 " "$3,409.15 " "$8,826.59 " "$9,030.28 " "$2,681.74 " "$2,234.79 " "$8,147.62 " "$7,492.00 " "$10,537.38 " "$4,407.00 " "$2,234.79 " "$3,099.23 " "$3,719.07 " "$3,128.70 " "$10,863.50 " "$2,234.79 " "$2,234.79 " "$2,681.74 " "$4,338.92 " "$2,234.79 " "$3,099.23 " "$3,099.23 " "$3,378.16 " "$10,863.50 " "$11,542.46 " "$2,234.79 " "$3,883.00 " "$4,581.31 " "$2,234.79 " "$6,789.69 " "$8,336.92 " "$9,166.07 " "$9,166.07 " "$9,166.07 " "$9,166.07 " "$5,375.00 " "$3,254.19 " "$3,099.23 " "$5,659.00 " "$2,234.79 " "$2,234.79 " "$2,634.34 " "$2,502.96 " "$3,099.23 " "$2,234.79 " "$11,542.46 " 330104 10035 5071 4 361 HC PERQ DEV SOFT TISS 1ST IMAG O "$1,872.50 " $778.60 $778.60 $656.76 "$1,099.00 " "$2,802.00 " "$2,551.00 " $770.81 $656.76 "$1,479.33 " $656.76 $778.60 "$1,404.38 " $856.45 "$1,217.12 " "$1,245.21 " $788.11 $656.76 "$1,123.50 " "$7,492.00 " "$2,647.22 " "$4,407.00 " $656.76 $778.60 $934.31 $919.46 "$1,498.00 " $656.76 $656.76 $788.11 "$1,090.03 " $656.76 $778.60 $778.60 $848.67 "$1,498.00 " "$1,591.62 " $656.76 "$1,404.38 " "$1,346.35 " $656.76 $936.25 "$2,094.42 " "$1,263.94 " "$1,263.94 " "$1,263.94 " "$1,263.94 " "$3,548.00 " $817.53 $778.60 "$3,780.00 " $656.76 $656.76 $661.81 $735.57 $778.60 $656.76 "$7,492.00 " 330104 0673T 5072 252 361 HC ABLTJ B9 THYR NDUL PERQ LASR O "$3,597.34 " "$1,799.07 " "$1,799.07 " "$1,342.60 " N/A "$2,432.00 " "$2,215.00 " "$1,781.08 " "$1,342.60 " "$3,418.23 " "$1,342.60 " "$1,799.07 " "$2,698.01 " "$1,978.98 " "$2,338.27 " "$2,392.23 " "$1,611.12 " "$1,342.60 " "$2,158.40 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,342.60 " "$1,799.07 " "$2,158.88 " "$1,879.64 " "$2,877.87 " "$1,342.60 " "$1,342.60 " "$1,611.12 " "$2,518.70 " "$1,342.60 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$2,877.87 " "$3,057.74 " "$1,342.60 " "$2,698.01 " "$2,752.33 " "$1,342.60 " "$1,798.67 " "$4,839.50 " "$2,428.20 " "$2,428.20 " "$2,428.20 " "$2,428.20 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " "$1,342.60 " "$1,342.60 " "$1,529.21 " "$1,503.71 " "$1,799.07 " "$1,342.60 " "$7,492.00 " 330104 0671T 5491 234 361 HC INSJ ANT SGM DRG DEV TRAB MW W/O RES&CTRC RMVL1+ O "$4,782.90 " "$2,590.77 " "$2,590.77 " "$1,764.31 " N/A "$2,432.00 " "$2,215.00 " "$2,564.86 " "$1,764.31 " "$4,922.46 " "$1,764.31 " "$2,590.77 " "$3,587.17 " "$2,849.84 " "$3,108.88 " "$3,180.63 " "$2,117.17 " "$1,764.31 " "$2,869.74 " "$7,492.00 " "$8,808.61 " "$4,407.00 " "$1,764.31 " "$2,590.77 " "$3,108.92 " "$2,470.03 " "$3,826.32 " "$1,764.31 " "$1,764.31 " "$2,117.17 " "$3,627.07 " "$1,764.31 " "$2,590.77 " "$2,590.77 " "$2,823.94 " "$3,826.32 " "$4,065.46 " "$1,764.31 " "$3,587.17 " "$3,616.84 " "$1,764.31 " "$2,391.45 " "$6,969.16 " "$3,228.46 " "$3,228.46 " "$3,228.46 " "$3,228.46 " "$5,375.00 " "$2,720.30 " "$2,590.77 " "$5,659.00 " "$1,764.31 " "$1,764.31 " "$2,202.15 " "$1,976.03 " "$2,590.77 " "$1,764.31 " "$8,808.61 " 330104 361 HC LEV 2 ENDOSCOPY 30 MIN EA ADDL O "$1,248.69 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " $816.64 N/A N/A N/A N/A $936.52 $874.08 $811.65 $830.38 $437.04 $437.04 $749.21 "$7,492.00 " N/A "$4,407.00 " $437.04 N/A N/A N/A $998.95 N/A $998.95 N/A N/A $998.95 N/A N/A N/A $998.95 "$1,061.39 " $624.35 $936.52 $624.35 $624.35 N/A $811.65 $842.87 $842.87 $842.87 $842.87 N/A N/A N/A "$3,372.00 " $624.35 N/A N/A N/A N/A $437.04 "$7,492.00 " 330104 361 HC ENDOSCOPY 30 MIN EA ADDL O "$1,216.59 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " $795.65 N/A N/A N/A N/A $912.44 $851.61 $790.78 $809.03 $425.81 $425.81 $729.95 "$7,492.00 " N/A "$4,407.00 " $425.81 N/A N/A N/A $973.27 N/A $973.27 N/A N/A $973.27 N/A N/A N/A $973.27 "$1,034.10 " $608.29 $912.44 $608.29 $608.29 N/A $790.78 $821.20 $821.20 $821.20 $821.20 N/A N/A N/A "$3,372.00 " $608.29 N/A N/A N/A N/A $425.81 "$7,492.00 " 330104 361 HC LEV 2 ENDOSCOPY 30 MIN INITIAL O "$7,336.99 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$4,798.39 " N/A N/A N/A N/A "$5,502.74 " "$5,135.89 " "$4,769.04 " "$4,879.10 " "$2,567.95 " "$2,567.95 " "$4,402.19 " "$7,492.00 " N/A "$4,407.00 " "$2,567.95 " N/A N/A N/A "$5,869.59 " N/A "$5,869.59 " N/A N/A "$5,869.59 " N/A N/A N/A "$5,869.59 " "$6,236.44 " "$3,668.49 " "$5,502.74 " "$3,668.49 " "$3,668.49 " N/A "$4,769.04 " "$4,952.47 " "$4,952.47 " "$4,952.47 " "$4,952.47 " N/A N/A N/A "$3,372.00 " "$3,668.49 " N/A N/A N/A N/A "$2,215.00 " "$7,492.00 " 330104 361 HC IR PROCEDURE ADDTL 30 MINUTES O "$2,426.76 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$1,587.10 " N/A N/A N/A N/A "$1,820.07 " "$1,698.73 " "$1,577.39 " "$1,613.80 " $849.37 $849.37 "$1,456.06 " "$7,492.00 " N/A "$4,407.00 " $849.37 N/A N/A N/A "$1,941.41 " N/A "$1,941.41 " N/A N/A "$1,941.41 " N/A N/A N/A "$1,941.41 " "$2,062.75 " "$1,213.38 " "$1,820.07 " "$1,213.38 " "$1,213.38 " N/A "$1,577.39 " "$1,638.06 " "$1,638.06 " "$1,638.06 " "$1,638.06 " N/A N/A N/A "$3,372.00 " "$1,213.38 " N/A N/A N/A N/A $849.37 "$7,492.00 " 330104 361 HC IR PROCEDURE INITIAL 30 MINUTES O "$4,246.83 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$2,777.43 " N/A N/A N/A N/A "$3,185.12 " "$2,972.78 " "$2,760.44 " "$2,824.14 " "$1,486.39 " "$1,486.39 " "$2,548.10 " "$7,492.00 " N/A "$4,407.00 " "$1,486.39 " N/A N/A N/A "$3,397.46 " N/A "$3,397.46 " N/A N/A "$3,397.46 " N/A N/A N/A "$3,397.46 " "$3,609.81 " "$2,123.41 " "$3,185.12 " "$2,123.41 " "$2,123.41 " N/A "$2,760.44 " "$2,866.61 " "$2,866.61 " "$2,866.61 " "$2,866.61 " N/A N/A N/A "$3,372.00 " "$2,123.41 " N/A N/A N/A N/A "$1,486.39 " "$7,492.00 " 330104 361 HC ENDOSCOPY 30 MIN INITIAL O "$6,167.48 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$4,033.53 " N/A N/A N/A N/A "$4,625.61 " "$4,317.24 " "$4,008.86 " "$4,101.37 " "$2,158.62 " "$2,158.62 " "$3,700.49 " "$7,492.00 " N/A "$4,407.00 " "$2,158.62 " N/A N/A N/A "$4,933.98 " N/A "$4,933.98 " N/A N/A "$4,933.98 " N/A N/A N/A "$4,933.98 " "$5,242.36 " "$3,083.74 " "$4,625.61 " "$3,083.74 " "$3,083.74 " N/A "$4,008.86 " "$4,163.05 " "$4,163.05 " "$4,163.05 " "$4,163.05 " N/A N/A N/A "$3,372.00 " "$3,083.74 " N/A N/A N/A N/A "$2,158.62 " "$7,492.00 " 330104 361 HC PERC DR/STENT PLC URETER O "$11,439.37 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$7,481.35 " N/A N/A N/A N/A "$8,579.53 " "$8,007.56 " "$7,435.59 " "$7,607.18 " "$4,003.78 " "$4,003.78 " "$6,863.62 " "$7,492.00 " N/A "$4,407.00 " "$4,003.78 " N/A N/A N/A "$9,151.50 " N/A "$9,151.50 " N/A N/A "$9,151.50 " N/A N/A N/A "$9,151.50 " "$9,723.46 " "$5,719.69 " "$8,579.53 " "$5,719.69 " "$5,719.69 " N/A "$7,435.59 " "$7,721.57 " "$7,721.57 " "$7,721.57 " "$7,721.57 " N/A N/A N/A "$3,372.00 " "$5,719.69 " N/A N/A N/A N/A "$2,215.00 " "$9,723.46 " 330104 361 HC PAIN MANG PROC LEV MINOR O "$3,873.40 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$2,533.20 " N/A N/A N/A N/A "$2,905.05 " "$2,711.38 " "$2,517.71 " "$2,575.81 " "$1,355.69 " "$1,355.69 " "$2,324.04 " "$7,492.00 " N/A "$4,407.00 " "$1,355.69 " N/A N/A N/A "$3,098.72 " N/A "$3,098.72 " N/A N/A "$3,098.72 " N/A N/A N/A "$3,098.72 " "$3,292.39 " "$1,936.70 " "$2,905.05 " "$1,936.70 " "$1,936.70 " N/A "$2,517.71 " "$2,614.55 " "$2,614.55 " "$2,614.55 " "$2,614.55 " N/A N/A N/A "$3,372.00 " "$1,936.70 " N/A N/A N/A N/A "$1,355.69 " "$7,492.00 " 330104 361 HC PAIN MANG PROC LEV MAJOR O "$6,290.53 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$4,114.01 " N/A N/A N/A N/A "$4,717.90 " "$4,403.37 " "$4,088.84 " "$4,183.20 " "$2,201.69 " "$2,201.69 " "$3,774.32 " "$7,492.00 " N/A "$4,407.00 " "$2,201.69 " N/A N/A N/A "$5,032.42 " N/A "$5,032.42 " N/A N/A "$5,032.42 " N/A N/A N/A "$5,032.42 " "$5,346.95 " "$3,145.26 " "$4,717.90 " "$3,145.26 " "$3,145.26 " N/A "$4,088.84 " "$4,246.11 " "$4,246.11 " "$4,246.11 " "$4,246.11 " N/A N/A N/A "$3,372.00 " "$3,145.26 " N/A N/A N/A N/A "$2,201.69 " "$7,492.00 " 330104 361 HC PAIN MANG PROC LEV INTERM O "$4,836.40 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$3,163.01 " N/A N/A N/A N/A "$3,627.30 " "$3,385.48 " "$3,143.66 " "$3,216.21 " "$1,692.74 " "$1,692.74 " "$2,901.84 " "$7,492.00 " N/A "$4,407.00 " "$1,692.74 " N/A N/A N/A "$3,869.12 " N/A "$3,869.12 " N/A N/A "$3,869.12 " N/A N/A N/A "$3,869.12 " "$4,110.94 " "$2,418.20 " "$3,627.30 " "$2,418.20 " "$2,418.20 " N/A "$3,143.66 " "$3,264.57 " "$3,264.57 " "$3,264.57 " "$3,264.57 " N/A N/A N/A "$3,372.00 " "$2,418.20 " N/A N/A N/A N/A "$1,692.74 " "$7,492.00 " 330104 361 HC KYPHOPLASTY O "$23,717.62 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$15,511.32 " N/A N/A N/A N/A "$17,788.22 " "$16,602.33 " "$15,416.45 " "$15,772.22 " "$8,301.17 " "$8,301.17 " "$14,230.57 " "$7,492.00 " N/A "$4,407.00 " "$8,301.17 " N/A N/A N/A "$18,974.10 " N/A "$18,974.10 " N/A N/A "$18,974.10 " N/A N/A N/A "$18,974.10 " "$20,159.98 " "$11,858.81 " "$17,788.22 " "$11,858.81 " "$11,858.81 " N/A "$15,416.45 " "$16,009.39 " "$16,009.39 " "$16,009.39 " "$16,009.39 " N/A N/A N/A "$3,372.00 " "$11,858.81 " N/A N/A N/A N/A "$2,215.00 " "$20,159.98 " 330104 361 HC FNA O "$2,927.52 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$1,914.60 " N/A N/A N/A N/A "$2,195.64 " "$2,049.26 " "$1,902.89 " "$1,946.80 " "$1,024.63 " "$1,024.63 " "$1,756.51 " "$7,492.00 " N/A "$4,407.00 " "$1,024.63 " N/A N/A N/A "$2,342.02 " N/A "$2,342.02 " N/A N/A "$2,342.02 " N/A N/A N/A "$2,342.02 " "$2,488.39 " "$1,463.76 " "$2,195.64 " "$1,463.76 " "$1,463.76 " N/A "$1,902.89 " "$1,976.08 " "$1,976.08 " "$1,976.08 " "$1,976.08 " N/A N/A N/A "$3,372.00 " "$1,463.76 " N/A N/A N/A N/A "$1,024.63 " "$7,492.00 " 330104 361 HC BRONCH PROCEDURE O "$8,939.85 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$5,846.66 " N/A N/A N/A N/A "$6,704.89 " "$6,257.89 " "$5,810.90 " "$5,945.00 " "$3,128.95 " "$3,128.95 " "$5,363.91 " "$7,492.00 " N/A "$4,407.00 " "$3,128.95 " N/A N/A N/A "$7,151.88 " N/A "$7,151.88 " N/A N/A "$7,151.88 " N/A N/A N/A "$7,151.88 " "$7,598.87 " "$4,469.93 " "$6,704.89 " "$4,469.93 " "$4,469.93 " N/A "$5,810.90 " "$6,034.40 " "$6,034.40 " "$6,034.40 " "$6,034.40 " N/A N/A N/A "$3,372.00 " "$4,469.93 " N/A N/A N/A N/A "$2,215.00 " "$7,598.87 " 330104 36245 423 361 HC INS CATH ABD/L-EXT ART 1ST O "$7,437.57 " N/A N/A $205.12 "$2,523.00 " "$2,802.00 " "$2,551.00 " $284.39 $205.12 N/A $205.12 N/A "$5,578.18 " N/A "$4,834.42 " "$4,945.98 " $246.15 $205.12 "$4,462.54 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$4,834.42 " $287.17 "$5,950.06 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$5,950.06 " "$6,321.93 " $276.91 "$3,883.00 " $420.50 $276.91 "$3,718.78 " "$4,834.42 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $205.12 "$7,492.00 " 330104 19081 5072 20 361 HC BX BREAST 1ST LESION STRTCTC O "$6,324.77 " "$1,799.07 " "$1,799.07 " "$1,693.42 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$1,781.08 " "$1,693.42 " "$3,418.23 " "$1,693.42 " "$1,799.07 " "$4,743.58 " "$1,978.98 " "$4,111.10 " "$4,205.97 " "$2,032.11 " "$1,693.42 " "$3,794.86 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,693.42 " "$1,799.07 " "$2,158.88 " "$2,370.79 " "$5,059.82 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$2,518.70 " "$1,693.42 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " "$1,693.42 " "$4,743.58 " "$3,471.51 " "$1,693.42 " "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " "$1,693.42 " "$1,693.42 " "$1,529.21 " "$1,896.63 " "$1,799.07 " "$1,529.21 " "$7,492.00 " 330104 19082 20 361 HC BX BREAST ADD LESION STRTCTC O $423.72 N/A N/A "$1,693.42 " "$2,523.00 " "$1,717.00 " "$1,565.00 " $96.78 "$1,693.42 " N/A "$1,693.42 " N/A $317.79 N/A $275.42 $281.77 "$2,032.11 " "$1,693.42 " $254.23 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $275.42 "$2,370.79 " $338.98 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $338.98 $360.16 "$2,286.12 " $317.79 "$3,471.51 " "$2,286.12 " $211.86 $275.42 $286.01 $286.01 $286.01 $286.01 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $96.78 "$7,492.00 " 330104 19083 5072 20 361 HC BX BREAST 1ST LESION US IMAG O "$6,324.77 " "$1,799.07 " "$1,799.07 " "$1,693.42 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$1,781.08 " "$1,693.42 " "$3,418.23 " "$1,693.42 " "$1,799.07 " "$4,743.58 " "$1,978.98 " "$4,111.10 " "$4,205.97 " "$2,032.11 " "$1,693.42 " "$3,794.86 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,693.42 " "$1,799.07 " "$2,158.88 " "$2,370.79 " "$5,059.82 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$2,518.70 " "$1,693.42 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " "$1,693.42 " "$4,743.58 " "$3,471.51 " "$1,693.42 " "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " "$1,693.42 " "$1,693.42 " "$1,529.21 " "$1,896.63 " "$1,799.07 " "$1,529.21 " "$7,492.00 " 330104 19084 20 361 HC BX BREAST ADD LESION US IMAG O $400.18 N/A N/A "$1,693.42 " "$2,523.00 " "$1,717.00 " "$1,565.00 " $91.25 "$1,693.42 " N/A "$1,693.42 " N/A $300.13 N/A $260.12 $266.12 "$2,032.11 " "$1,693.42 " $240.11 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $260.12 "$2,370.79 " $320.14 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $320.14 $340.15 "$2,286.12 " $300.13 "$3,471.51 " "$2,286.12 " $200.09 $260.12 $270.12 $270.12 $270.12 $270.12 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $91.25 "$7,492.00 " 330104 36215 423 361 HC PLACE CATH EA 1ST ORDER THOR/BRACHIOCEPHALC BRANCH O "$7,437.57 " N/A N/A $205.12 "$2,523.00 " "$2,802.00 " "$2,551.00 " $251.58 $205.12 N/A $205.12 N/A "$5,578.18 " N/A "$4,834.42 " "$4,945.98 " $246.15 $205.12 "$4,462.54 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$4,834.42 " $287.17 "$5,950.06 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$5,950.06 " "$6,321.93 " $276.91 "$3,883.00 " $420.50 $276.91 "$3,718.78 " "$4,834.42 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $205.12 "$7,492.00 " 330104 36200 423 361 HC PLACE CATHETER IN AORTA O "$2,969.25 " N/A N/A $205.12 "$1,099.00 " "$2,802.00 " "$2,551.00 " $171.85 $205.12 N/A $205.12 N/A "$2,226.94 " N/A "$1,930.01 " "$1,974.55 " $246.15 $205.12 "$1,781.55 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$1,930.01 " $287.17 "$2,375.40 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$2,375.40 " "$2,523.86 " $276.91 "$3,883.00 " $420.50 $276.91 "$1,484.62 " "$1,930.01 " "$2,004.24 " "$2,004.24 " "$2,004.24 " "$2,004.24 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $171.85 "$7,492.00 " 330104 36140 423 361 HC ESTABLISH ACCESS TO EXTREMITY ARTERY O "$2,419.27 " N/A N/A $205.12 $482.00 "$1,717.00 " "$1,565.00 " $109.36 $205.12 N/A $205.12 N/A "$1,814.45 " N/A "$1,572.53 " "$1,608.81 " $246.15 $205.12 "$1,451.56 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$1,572.53 " $287.17 "$1,935.42 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$1,935.42 " "$2,056.38 " $276.91 "$3,883.00 " $420.50 $276.91 "$1,209.63 " "$1,572.53 " "$1,633.01 " "$1,633.01 " "$1,633.01 " "$1,633.01 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $109.36 "$7,492.00 " 330104 36005 423 361 HC INJECTION EXT VENOGRAPHY O "$6,505.60 " N/A N/A $205.12 $482.00 "$1,717.00 " "$1,565.00 " $58.60 $205.12 N/A $205.12 N/A "$4,879.20 " N/A "$4,228.64 " "$4,326.22 " $246.15 $205.12 "$3,903.36 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$4,228.64 " $287.17 "$5,204.48 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$5,204.48 " "$5,529.76 " $276.91 "$4,879.20 " $420.50 $276.91 "$3,252.80 " "$4,228.64 " "$4,391.28 " "$4,391.28 " "$4,391.28 " "$4,391.28 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $58.60 "$7,492.00 " 330104 33010 68 361 HC DRAINAGE OF HEART SAC O "$5,301.85 " N/A N/A $649.92 N/A "$2,432.00 " "$2,215.00 " "$3,467.41 " $649.92 N/A $649.92 N/A "$3,976.39 " N/A "$3,446.20 " "$3,525.73 " $779.90 $649.92 "$3,181.11 " "$7,492.00 " N/A "$4,407.00 " $649.92 N/A N/A $909.89 "$4,241.48 " $649.92 $649.92 $779.90 N/A $649.92 N/A N/A N/A "$4,241.48 " "$4,506.57 " $877.39 "$3,883.00 " "$1,332.34 " $877.39 "$2,650.93 " "$3,446.20 " "$3,578.75 " "$3,578.75 " "$3,578.75 " "$3,578.75 " N/A N/A N/A "$3,372.00 " $649.92 $649.92 N/A $727.91 N/A $649.92 "$7,492.00 " 330104 32551 5182 68 361 HC INSERTION OF CHEST TUBE O "$7,515.68 " "$1,785.03 " "$1,785.03 " $649.92 "$1,099.00 " "$2,802.00 " "$2,551.00 " "$1,767.18 " $649.92 "$3,391.56 " $649.92 "$1,785.03 " "$5,636.76 " "$1,963.54 " "$4,885.19 " "$4,997.93 " $779.90 $649.92 "$4,509.41 " "$7,492.00 " "$6,069.11 " "$4,407.00 " $649.92 "$1,785.03 " "$2,142.04 " $909.89 "$6,012.54 " $649.92 $649.92 $779.90 "$2,499.05 " $649.92 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$6,012.54 " "$6,388.33 " $649.92 "$3,883.00 " "$1,332.34 " $649.92 "$3,757.84 " "$4,801.74 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$3,548.00 " "$1,874.28 " "$1,785.03 " "$3,780.00 " $649.92 $649.92 "$1,517.28 " $727.91 "$1,785.03 " $649.92 "$7,492.00 " 330104 32550 5341 68 361 HC INSERT PLEURAL CATH O "$5,350.00 " "$4,249.40 " "$4,249.40 " $649.92 "$4,069.00 " "$2,802.00 " "$2,551.00 " "$4,206.90 " $649.92 "$8,073.85 " $649.92 "$4,249.40 " "$4,012.50 " "$4,674.33 " "$3,477.50 " "$3,557.75 " $779.90 $649.92 "$3,210.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " $649.92 "$4,249.40 " "$5,099.27 " $909.89 "$4,280.00 " $649.92 $649.92 $779.90 "$5,949.15 " $649.92 "$4,249.40 " "$4,249.40 " "$4,631.84 " "$4,280.00 " "$4,547.50 " $649.92 "$3,883.00 " "$1,332.34 " $649.92 "$2,675.00 " "$11,430.87 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " $649.92 $649.92 "$3,611.99 " $727.91 "$4,249.40 " $649.92 "$14,447.94 " 330104 32405 68 361 HC PERCUT BX LUNG/MEDIASTINUM O "$14,326.23 " N/A N/A $649.92 N/A "$2,432.00 " "$2,215.00 " "$9,369.35 " $649.92 N/A $649.92 N/A "$10,744.67 " N/A "$9,312.05 " "$9,526.94 " $779.90 $649.92 "$8,595.74 " "$7,492.00 " N/A "$4,407.00 " $649.92 N/A N/A $909.89 "$11,460.98 " $649.92 $649.92 $779.90 N/A $649.92 N/A N/A N/A "$11,460.98 " "$12,177.30 " $877.39 "$3,883.00 " "$1,332.34 " $877.39 "$7,163.11 " "$9,312.05 " "$9,670.21 " "$9,670.21 " "$9,670.21 " "$9,670.21 " N/A N/A N/A "$3,372.00 " $649.92 $649.92 N/A $727.91 N/A $649.92 "$12,177.30 " 330104 31653 5154 71 361 HC BRONCHOSCOPY WITH EBUS 3 OR MORE NODES O "$13,532.29 " "$3,999.51 " "$3,999.51 " "$1,389.58 " "$4,069.00 " "$2,802.00 " "$2,551.00 " "$3,959.52 " "$1,389.58 " "$7,599.08 " "$1,389.58 " "$3,999.51 " "$10,149.22 " "$4,399.46 " "$8,795.99 " "$8,998.97 " "$1,667.49 " "$1,389.58 " "$8,119.37 " "$7,492.00 " "$13,598.35 " "$4,407.00 " "$1,389.58 " "$3,999.51 " "$4,799.42 " "$1,945.41 " "$10,825.83 " "$1,389.58 " "$1,389.58 " "$1,667.49 " "$5,599.32 " "$1,389.58 " "$3,999.51 " "$3,999.51 " "$4,359.47 " "$10,825.83 " "$11,502.45 " "$1,389.58 " "$10,149.22 " "$2,848.64 " "$1,389.58 " "$6,766.15 " "$10,758.69 " "$9,134.30 " "$9,134.30 " "$9,134.30 " "$9,134.30 " "$5,375.00 " "$4,199.49 " "$3,999.51 " "$5,659.00 " "$1,389.58 " "$1,389.58 " "$3,399.59 " "$1,556.33 " "$3,999.51 " "$1,389.58 " "$13,598.35 " 330104 36246 423 361 HC INS CATH ABD/L-EXT ART 2ND O "$12,218.33 " N/A N/A $205.12 "$2,523.00 " "$2,802.00 " "$2,551.00 " $307.77 $205.12 N/A $205.12 N/A "$9,163.75 " N/A "$7,941.91 " "$8,125.19 " $246.15 $205.12 "$7,331.00 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$7,941.91 " $287.17 "$9,774.66 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$9,774.66 " "$10,385.58 " $276.91 "$3,883.00 " $420.50 $276.91 "$6,109.16 " "$7,941.91 " "$8,247.37 " "$8,247.37 " "$8,247.37 " "$8,247.37 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $205.12 "$10,385.58 " 330104 31652 5154 71 361 HC BRONCHOSCOPY WITH EBUS 1 OR 2 NODES O "$13,532.29 " "$3,999.51 " "$3,999.51 " "$1,389.58 " "$4,069.00 " "$2,802.00 " "$2,551.00 " "$3,959.52 " "$1,389.58 " "$7,599.08 " "$1,389.58 " "$3,999.51 " "$10,149.22 " "$4,399.46 " "$8,795.99 " "$8,998.97 " "$1,667.49 " "$1,389.58 " "$8,119.37 " "$7,492.00 " "$13,598.35 " "$4,407.00 " "$1,389.58 " "$3,999.51 " "$4,799.42 " "$1,945.41 " "$10,825.83 " "$1,389.58 " "$1,389.58 " "$1,667.49 " "$5,599.32 " "$1,389.58 " "$3,999.51 " "$3,999.51 " "$4,359.47 " "$10,825.83 " "$11,502.45 " "$1,389.58 " "$10,149.22 " "$2,848.64 " "$1,389.58 " "$6,766.15 " "$10,758.69 " "$9,134.30 " "$9,134.30 " "$9,134.30 " "$9,134.30 " "$5,375.00 " "$4,199.49 " "$3,999.51 " "$5,659.00 " "$1,389.58 " "$1,389.58 " "$3,399.59 " "$1,556.33 " "$3,999.51 " "$1,389.58 " "$13,598.35 " 330104 19499 5091 20 361 HC BREAST SURGERY PROCEDURE O "$13,959.22 " "$4,124.47 " "$4,124.47 " "$1,693.42 " "$2,523.00 " "$1,717.00 " "$1,565.00 " "$4,083.22 " "$1,693.42 " "$7,836.49 " "$1,693.42 " "$4,124.47 " "$10,469.41 " "$4,536.91 " "$9,073.49 " "$9,282.88 " "$2,032.11 " "$1,693.42 " "$8,375.53 " "$7,492.00 " "$14,023.18 " "$4,407.00 " "$1,693.42 " "$4,124.47 " "$4,949.36 " "$2,370.79 " "$11,167.38 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$5,774.25 " "$1,693.42 " "$4,124.47 " "$4,124.47 " "$4,495.67 " "$11,167.38 " "$11,865.34 " "$1,693.42 " "$10,469.41 " "$3,471.51 " "$1,693.42 " "$6,979.61 " "$11,094.81 " "$9,422.47 " "$9,422.47 " "$9,422.47 " "$9,422.47 " "$5,375.00 " "$4,330.69 " "$4,124.47 " "$5,659.00 " "$1,693.42 " "$1,693.42 " "$3,505.80 " "$1,896.63 " "$4,124.47 " "$1,565.00 " "$14,023.18 " 330104 19288 20 361 HC PERQ DEV BREAST ADD MR GUIDE O $296.39 N/A N/A "$1,693.42 " $482.00 "$1,717.00 " "$1,565.00 " $72.97 "$1,693.42 " N/A "$1,693.42 " N/A $222.29 N/A $192.65 $197.10 "$2,032.11 " "$1,693.42 " $177.83 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $192.65 "$2,370.79 " $237.11 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $237.11 $251.93 "$2,286.12 " $222.29 "$3,471.51 " "$2,286.12 " $148.19 $192.65 $200.06 $200.06 $200.06 $200.06 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $72.97 "$7,492.00 " 330104 19287 5071 20 361 HC PERQ DEV BREAST 1ST MR GUIDE O "$2,813.03 " $778.60 $778.60 "$1,693.42 " $482.00 "$2,949.00 " "$2,686.00 " $770.81 "$1,693.42 " "$1,479.33 " "$1,693.42 " $778.60 "$2,109.77 " $856.45 "$1,828.47 " "$1,870.66 " "$2,032.11 " "$1,693.42 " "$1,687.82 " "$7,492.00 " "$2,647.22 " "$4,407.00 " "$1,693.42 " $778.60 $934.31 "$2,370.79 " "$2,250.42 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$1,090.03 " "$1,693.42 " $778.60 $778.60 $848.67 "$2,250.42 " "$2,391.08 " "$1,693.42 " "$2,109.77 " "$3,471.51 " "$1,693.42 " "$1,406.52 " "$2,094.42 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$3,548.00 " $817.53 $778.60 "$3,780.00 " "$1,693.42 " "$1,693.42 " $661.81 "$1,896.63 " $778.60 $482.00 "$7,492.00 " 330104 19286 20 361 HC PERQ DEV BREAST ADD US IMAG O $201.16 N/A N/A "$1,693.42 " $482.00 "$1,717.00 " "$1,565.00 " $50.46 "$1,693.42 " N/A "$1,693.42 " N/A $150.87 N/A $130.75 $133.77 "$2,032.11 " "$1,693.42 " $120.70 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $130.75 "$2,370.79 " $160.93 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $160.93 $170.99 "$2,286.12 " $150.87 "$3,471.51 " "$2,286.12 " $100.58 $130.75 $135.78 $135.78 $135.78 $135.78 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $50.46 "$7,492.00 " 330104 19285 5071 20 361 HC PERQ DEV BREAST 1ST US IMAG O "$2,813.03 " $778.60 $778.60 "$1,693.42 " $482.00 "$2,802.00 " "$2,551.00 " $770.81 "$1,693.42 " "$1,479.33 " "$1,693.42 " $778.60 "$2,109.77 " $856.45 "$1,828.47 " "$1,870.66 " "$2,032.11 " "$1,693.42 " "$1,687.82 " "$7,492.00 " "$2,647.22 " "$4,407.00 " "$1,693.42 " $778.60 $934.31 "$2,370.79 " "$2,250.42 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$1,090.03 " "$1,693.42 " $778.60 $778.60 $848.67 "$2,250.42 " "$2,391.08 " "$1,693.42 " "$2,109.77 " "$3,471.51 " "$1,693.42 " "$1,406.52 " "$2,094.42 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$3,548.00 " $817.53 $778.60 "$3,780.00 " "$1,693.42 " "$1,693.42 " $661.81 "$1,896.63 " $778.60 $482.00 "$7,492.00 " 330104 19282 20 361 HC PERQ DEVICE BREAST EA IMAG O $227.91 N/A N/A "$1,693.42 " $482.00 "$1,717.00 " "$1,565.00 " $58.21 "$1,693.42 " N/A "$1,693.42 " N/A $170.93 N/A $148.14 $151.56 "$2,032.11 " "$1,693.42 " $136.75 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $148.14 "$2,370.79 " $182.33 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $182.33 $193.72 "$2,286.12 " $170.93 "$3,471.51 " "$2,286.12 " $113.95 $148.14 $153.84 $153.84 $153.84 $153.84 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $58.21 "$7,492.00 " 330104 19281 5072 20 361 HC PERQ DEVICE BREAST 1ST IMAG O "$2,813.03 " "$1,799.07 " "$1,799.07 " "$1,693.42 " $482.00 "$2,802.00 " "$2,551.00 " "$1,781.08 " "$1,693.42 " "$3,418.23 " "$1,693.42 " "$1,799.07 " "$2,109.77 " "$1,978.98 " "$1,828.47 " "$1,870.66 " "$2,032.11 " "$1,693.42 " "$1,687.82 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,693.42 " "$1,799.07 " "$2,158.88 " "$2,370.79 " "$2,250.42 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$2,518.70 " "$1,693.42 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$2,250.42 " "$2,391.08 " "$1,693.42 " "$2,109.77 " "$3,471.51 " "$1,693.42 " "$1,406.52 " "$4,839.50 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$3,548.00 " "$1,889.02 " "$1,799.07 " "$3,780.00 " "$1,693.42 " "$1,693.42 " "$1,529.21 " "$1,896.63 " "$1,799.07 " $482.00 "$7,492.00 " 330104 19086 20 361 HC BX BREAST ADD LESION MR IMAG O $415.16 N/A N/A "$1,693.42 " "$2,523.00 " "$1,717.00 " "$1,565.00 " $104.47 "$1,693.42 " N/A "$1,693.42 " N/A $311.37 N/A $269.85 $276.08 "$2,032.11 " "$1,693.42 " $249.10 "$7,492.00 " N/A "$4,407.00 " "$1,693.42 " N/A $269.85 "$2,370.79 " $332.13 "$1,693.42 " "$1,693.42 " "$2,032.11 " N/A "$1,693.42 " N/A N/A N/A $332.13 $352.89 "$2,286.12 " $311.37 "$3,471.51 " "$2,286.12 " $207.58 $269.85 $280.23 $280.23 $280.23 $280.23 "$2,688.00 " N/A N/A "$2,954.00 " "$1,693.42 " "$1,693.42 " N/A "$1,896.63 " N/A $104.47 "$7,492.00 " 330104 19085 5072 20 361 HC BX BREAST 1ST LESION MR IMAG O "$6,324.77 " "$1,799.07 " "$1,799.07 " "$1,693.42 " "$2,523.00 " "$2,949.00 " "$2,686.00 " "$1,781.08 " "$1,693.42 " "$3,418.23 " "$1,693.42 " "$1,799.07 " "$4,743.58 " "$1,978.98 " "$4,111.10 " "$4,205.97 " "$2,032.11 " "$1,693.42 " "$3,794.86 " "$7,492.00 " "$6,116.84 " "$4,407.00 " "$1,693.42 " "$1,799.07 " "$2,158.88 " "$2,370.79 " "$5,059.82 " "$1,693.42 " "$1,693.42 " "$2,032.11 " "$2,518.70 " "$1,693.42 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " "$1,693.42 " "$4,743.58 " "$3,471.51 " "$1,693.42 " "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " "$1,693.42 " "$1,693.42 " "$1,529.21 " "$1,896.63 " "$1,799.07 " "$1,529.21 " "$7,492.00 " 330104 24071 5073 51 361 HC EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM O "$13,579.37 " "$3,099.23 " "$3,099.23 " "$1,157.33 " "$2,523.00 " "$2,949.00 " "$2,686.00 " "$3,068.24 " "$1,157.33 " "$5,888.53 " "$1,157.33 " "$3,099.23 " "$10,184.53 " "$3,409.15 " "$8,826.59 " "$9,030.28 " "$1,388.79 " "$1,157.33 " "$8,147.62 " "$7,492.00 " "$10,537.38 " "$4,407.00 " "$1,157.33 " "$3,099.23 " "$3,719.07 " "$1,620.26 " "$10,863.50 " "$1,157.33 " "$1,157.33 " "$1,388.79 " "$4,338.92 " "$1,157.33 " "$3,099.23 " "$3,099.23 " "$3,378.16 " "$10,863.50 " "$11,542.46 " "$1,157.33 " "$3,883.00 " "$2,372.52 " "$1,157.33 " "$6,789.69 " "$8,336.92 " "$9,166.07 " "$9,166.07 " "$9,166.07 " "$9,166.07 " "$5,375.00 " "$3,254.19 " "$3,099.23 " "$5,659.00 " "$1,157.33 " "$1,157.33 " "$2,634.34 " "$1,296.21 " "$3,099.23 " "$1,157.33 " "$11,542.46 " 330104 36216 423 361 HC PLACE CATH; INITIAL 2ND ORDER THOR/BRACHIOCEPHALIC O "$7,437.57 " N/A N/A $205.12 "$2,523.00 " "$2,802.00 " "$2,551.00 " $330.74 $205.12 N/A $205.12 N/A "$5,578.18 " N/A "$4,834.42 " "$4,945.98 " $246.15 $205.12 "$4,462.54 " "$7,492.00 " N/A "$4,407.00 " $205.12 N/A "$4,834.42 " $287.17 "$5,950.06 " $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A "$5,950.06 " "$6,321.93 " $276.91 "$3,883.00 " $420.50 $276.91 "$3,718.78 " "$4,834.42 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$5,020.36 " "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $205.12 "$7,492.00 " 330104 36227 280 361 HC PLACE CATH XTRNL CAROTID O "$1,653.15 " N/A N/A $998.13 "$5,449.00 " "$1,717.00 " "$1,565.00 " $154.67 $998.13 N/A $998.13 N/A "$1,239.86 " N/A "$1,074.55 " "$1,099.34 " "$1,197.75 " $998.13 $991.89 "$7,492.00 " N/A "$4,407.00 " $998.13 N/A "$1,074.55 " "$1,397.38 " "$1,322.52 " $998.13 $998.13 "$1,197.75 " N/A $998.13 N/A N/A N/A "$1,322.52 " "$1,405.18 " "$1,347.47 " "$3,883.00 " "$2,046.16 " "$1,347.47 " $826.58 "$1,074.55 " "$1,115.88 " "$1,115.88 " "$1,115.88 " "$1,115.88 " "$2,688.00 " N/A N/A "$2,954.00 " $998.13 $998.13 N/A "$1,117.90 " N/A $154.67 "$7,492.00 " 330104 36558 5183 83 361 HC INSERT TUNNELED CV CATH W/O PORT; 5YRS AND OLDER O "$12,768.31 " "$3,573.99 " "$3,573.99 " "$1,495.25 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$3,538.25 " "$1,495.25 " "$6,790.58 " "$1,495.25 " "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,299.40 " "$8,490.93 " "$1,794.30 " "$1,495.25 " "$7,660.99 " "$7,492.00 " "$12,151.56 " "$4,407.00 " "$1,495.25 " "$3,573.99 " "$4,288.79 " "$2,093.35 " "$10,214.65 " "$1,495.25 " "$1,495.25 " "$1,794.30 " "$5,003.59 " "$1,495.25 " "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " "$1,495.25 " "$3,883.00 " "$3,065.26 " "$1,495.25 " "$6,384.15 " "$9,614.03 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$6,665.00 " "$3,752.69 " "$3,573.99 " "$7,069.00 " "$1,495.25 " "$1,495.25 " "$3,037.89 " "$1,674.68 " "$3,573.99 " "$1,495.25 " "$12,151.56 " 330104 49405 5072 150 361 HC IMAGE CATH FLUID COLXN VISC O "$8,560.00 " "$1,799.07 " "$1,799.07 " $649.92 "$1,878.00 " "$2,802.00 " "$2,551.00 " "$1,781.08 " $649.92 "$3,418.23 " $649.92 "$1,799.07 " "$6,420.00 " "$1,978.98 " "$5,564.00 " "$5,692.40 " $779.90 $649.92 "$5,136.00 " "$7,492.00 " "$6,116.84 " "$4,407.00 " $649.92 "$1,799.07 " "$2,158.88 " $909.89 "$6,848.00 " $649.92 $649.92 $779.90 "$2,518.70 " $649.92 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$6,848.00 " "$7,276.00 " $649.92 "$6,420.00 " "$1,332.34 " $649.92 "$4,280.00 " "$4,839.50 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " $649.92 $649.92 "$1,529.21 " $727.91 "$1,799.07 " $649.92 "$7,492.00 " 330104 36556 5183 75 361 HC INSERT NON-TUNNEL CV CATH; 5YRS OR OLDER O "$7,515.68 " "$3,573.99 " "$3,573.99 " $251.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$3,538.25 " $251.30 "$6,790.58 " $251.30 "$3,573.99 " "$5,636.76 " "$3,931.39 " "$4,885.19 " "$4,997.93 " $301.56 $251.30 "$4,509.41 " "$7,492.00 " "$12,151.56 " "$4,407.00 " $251.30 "$3,573.99 " "$4,288.79 " $351.82 "$6,012.54 " $251.30 $251.30 $301.56 "$5,003.59 " $251.30 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$6,012.54 " "$6,388.33 " $251.30 "$3,883.00 " $515.17 $251.30 "$3,757.84 " "$9,614.03 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$3,548.00 " "$3,752.69 " "$3,573.99 " "$3,780.00 " $251.30 $251.30 "$3,037.89 " $281.46 "$3,573.99 " $251.30 "$12,151.56 " 330104 49421 5341 108 361 HC INS TUN IP CATH FOR DIAL OPN O "$14,326.23 " "$4,249.40 " "$4,249.40 " "$2,241.88 " "$1,878.00 " "$2,802.00 " "$2,551.00 " "$4,206.90 " "$2,241.88 " "$8,073.85 " "$2,241.88 " "$4,249.40 " "$10,744.67 " "$4,674.33 " "$9,312.05 " "$9,526.94 " "$2,690.25 " "$2,241.88 " "$8,595.74 " "$7,492.00 " "$14,447.94 " "$4,407.00 " "$2,241.88 " "$4,249.40 " "$5,099.27 " "$3,138.63 " "$11,460.98 " "$2,241.88 " "$2,241.88 " "$2,690.25 " "$5,949.15 " "$2,241.88 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$11,460.98 " "$12,177.30 " "$2,241.88 " "$3,883.00 " "$4,595.85 " "$2,241.88 " "$7,163.11 " "$11,430.87 " "$9,670.21 " "$9,670.21 " "$9,670.21 " "$9,670.21 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$2,241.88 " "$2,241.88 " "$3,611.99 " "$2,510.90 " "$4,249.40 " "$1,878.00 " "$14,447.94 " 330104 49423 5302 150 361 HC EXCHANGE DRAINAGE CATHETER O "$5,350.00 " "$2,089.46 " "$2,089.46 " $649.92 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$2,068.56 " $649.92 "$3,969.96 " $649.92 "$2,089.46 " "$4,012.50 " "$2,298.40 " "$3,477.50 " "$3,557.75 " $779.90 $649.92 "$3,210.00 " "$7,492.00 " "$7,104.15 " "$4,407.00 " $649.92 "$2,089.46 " "$2,507.35 " $909.89 "$4,280.00 " $649.92 $649.92 $779.90 "$2,925.24 " $649.92 "$2,089.46 " "$2,089.46 " "$2,277.51 " "$4,280.00 " "$4,547.50 " $649.92 "$4,012.50 " "$1,332.34 " $649.92 "$2,675.00 " "$5,620.63 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$4,838.00 " "$2,193.93 " "$2,089.46 " "$5,150.00 " $649.92 $649.92 "$1,776.04 " $727.91 "$2,089.46 " $649.92 "$7,492.00 " 330104 49424 278 361 HC ASSESS CYST CONTRAST INJECT O "$2,057.61 " N/A N/A $499.80 $482.00 "$1,717.00 " "$1,565.00 " $43.69 $499.80 N/A $499.80 N/A "$1,543.21 " N/A "$1,337.45 " "$1,368.31 " $599.76 $499.80 "$1,234.57 " "$7,492.00 " N/A "$4,407.00 " $499.80 N/A "$1,337.45 " $699.72 "$1,646.09 " $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A "$1,646.09 " "$1,748.97 " $674.73 "$1,543.21 " "$1,024.59 " $674.73 "$1,028.81 " "$1,337.45 " "$1,388.89 " "$1,388.89 " "$1,388.89 " "$1,388.89 " "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $43.69 "$7,492.00 " 330104 50389 5372 161 361 HC REMOVE RENAL TUBE W/FLUORO O "$2,354.00 " $750.25 $750.25 $458.30 "$1,099.00 " "$1,717.00 " "$1,565.00 " $742.74 $458.30 "$1,425.47 " $458.30 $750.25 "$1,765.50 " $825.27 "$1,530.10 " "$1,565.41 " $549.96 $458.30 "$1,412.40 " "$7,492.00 " "$2,550.83 " "$4,407.00 " $458.30 $750.25 $900.29 $641.62 "$1,883.20 " $458.30 $458.30 $549.96 "$1,050.34 " $458.30 $750.25 $750.25 $817.77 "$1,883.20 " "$2,000.90 " $458.30 "$1,765.50 " $939.52 $458.30 "$1,177.00 " "$2,018.16 " "$1,588.95 " "$1,588.95 " "$1,588.95 " "$1,588.95 " "$3,548.00 " $787.76 $750.25 "$3,780.00 " $458.30 $458.30 $637.71 $513.30 $750.25 $458.30 "$7,492.00 " 330104 50390 5071 161 361 HC DRAINAGE OF KIDNEY LESION O "$2,461.00 " $778.60 $778.60 $458.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " $770.81 $458.30 "$1,479.33 " $458.30 $778.60 "$1,845.75 " $856.45 "$1,599.65 " "$1,636.57 " $549.96 $458.30 "$1,476.60 " "$7,492.00 " "$2,647.22 " "$4,407.00 " $458.30 $778.60 $934.31 $641.62 "$1,968.80 " $458.30 $458.30 $549.96 "$1,090.03 " $458.30 $778.60 $778.60 $848.67 "$1,968.80 " "$2,091.85 " $458.30 "$3,883.00 " $939.52 $458.30 "$1,230.50 " "$2,094.42 " "$1,661.18 " "$1,661.18 " "$1,661.18 " "$1,661.18 " "$3,548.00 " $817.53 $778.60 "$3,780.00 " $458.30 $458.30 $661.81 $513.30 $778.60 $458.30 "$7,492.00 " 330104 50694 5374 171 361 HC PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH O "$8,560.00 " "$3,845.31 " "$3,845.31 " "$1,558.06 " "$2,886.00 " "$2,949.00 " "$2,686.00 " "$3,806.86 " "$1,558.06 " "$7,306.09 " "$1,558.06 " "$3,845.31 " "$6,420.00 " "$4,229.84 " "$5,564.00 " "$5,692.40 " "$1,869.67 " "$1,558.06 " "$5,136.00 " "$7,492.00 " "$13,074.06 " "$4,407.00 " "$1,558.06 " "$3,845.31 " "$4,614.37 " "$2,181.28 " "$6,848.00 " "$1,558.06 " "$1,558.06 " "$1,869.67 " "$5,383.43 " "$1,558.06 " "$3,845.31 " "$3,845.31 " "$4,191.39 " "$6,848.00 " "$7,276.00 " "$1,558.06 " "$6,420.00 " "$3,194.02 " "$1,558.06 " "$4,280.00 " "$10,343.89 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,037.58 " "$3,845.31 " "$7,069.00 " "$1,558.06 " "$1,558.06 " "$3,268.51 " "$1,745.02 " "$3,845.31 " "$1,558.06 " "$13,074.06 " 330104 51102 5373 173 361 HC DRAIN BL W/CATH INSERTION O "$8,164.10 " "$2,225.37 " "$2,225.37 " "$1,747.88 " "$2,886.00 " "$1,717.00 " "$1,565.00 " "$2,203.12 " "$1,747.88 " "$4,228.21 " "$1,747.88 " "$2,225.37 " "$6,123.08 " "$2,447.91 " "$5,306.66 " "$5,429.13 " "$2,097.46 " "$1,747.88 " "$4,898.46 " "$7,492.00 " "$7,566.27 " "$4,407.00 " "$1,747.88 " "$2,225.37 " "$2,670.45 " "$2,447.04 " "$6,531.28 " "$1,747.88 " "$1,747.88 " "$2,097.46 " "$3,115.52 " "$1,747.88 " "$2,225.37 " "$2,225.37 " "$2,425.66 " "$6,531.28 " "$6,939.49 " "$1,747.88 " "$3,883.00 " "$3,583.16 " "$1,747.88 " "$4,082.05 " "$5,986.26 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$5,375.00 " "$2,336.64 " "$2,225.37 " "$5,659.00 " "$1,747.88 " "$1,747.88 " "$1,891.57 " "$1,957.63 " "$2,225.37 " "$1,565.00 " "$7,566.27 " 330104 51600 278 361 HC INJ CYSTOGRAPHY/VOIDING URETHROCYSTOGRAPHY O "$2,325.11 " N/A N/A $499.80 $482.00 "$2,432.00 " "$2,215.00 " $51.52 $499.80 N/A $499.80 N/A "$1,743.83 " N/A "$1,511.32 " "$1,546.20 " $599.76 $499.80 "$1,395.07 " "$7,492.00 " N/A "$4,407.00 " $499.80 N/A "$1,511.32 " $699.72 "$1,860.09 " $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A "$1,860.09 " "$1,976.34 " $674.73 "$1,743.83 " "$1,024.59 " $674.73 "$1,162.56 " "$1,511.32 " "$1,569.45 " "$1,569.45 " "$1,569.45 " "$1,569.45 " "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $51.52 "$7,492.00 " 330104 51610 278 361 HC INJ FOR RETROGRADE URETHROCYSTOGRAPHY O $609.90 N/A N/A $499.80 $482.00 "$2,432.00 " "$2,215.00 " $75.76 $499.80 N/A $499.80 N/A $457.42 N/A $396.44 $405.58 $599.76 $499.80 $365.94 "$7,492.00 " N/A "$4,407.00 " $499.80 N/A $396.44 $699.72 $487.92 $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A $487.92 $518.41 $674.73 $457.42 "$1,024.59 " $674.73 $304.95 $396.44 $411.68 $411.68 $411.68 $411.68 "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $75.76 "$7,492.00 " 330104 51703 5721 159 361 HC INSERT BLADDER CATH COMPLEX O $736.16 $174.48 $174.48 $421.95 $482.00 "$1,717.00 " "$1,565.00 " $172.73 $421.95 $331.51 $421.95 $174.48 $552.12 $191.93 $478.50 $489.55 $506.34 $421.95 $441.70 "$7,492.00 " $593.23 "$4,407.00 " $421.95 $174.48 $209.37 $590.73 $588.93 $421.95 $421.95 $506.34 $244.27 $421.95 $174.48 $174.48 $190.18 $588.93 $625.74 $421.95 $552.12 $864.99 $421.95 $368.08 $469.35 $496.91 $496.91 $496.91 $496.91 "$2,688.00 " $183.20 $174.48 "$2,954.00 " $421.95 $421.95 $148.31 $472.58 $174.48 $148.31 "$7,492.00 " 330104 55700 5373 176 361 HC BIOPSY OF PROSTATE O "$8,164.10 " "$2,225.37 " "$2,225.37 " "$2,146.70 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$2,203.12 " "$2,146.70 " "$4,228.21 " "$2,146.70 " "$2,225.37 " "$6,123.08 " "$2,447.91 " "$5,306.66 " "$5,429.13 " "$2,576.04 " "$2,146.70 " "$4,898.46 " "$7,492.00 " "$7,566.27 " "$4,407.00 " "$2,146.70 " "$2,225.37 " "$2,670.45 " "$3,005.38 " "$6,531.28 " "$2,146.70 " "$2,146.70 " "$2,576.04 " "$3,115.52 " "$2,146.70 " "$2,225.37 " "$2,225.37 " "$2,425.66 " "$6,531.28 " "$6,939.49 " "$2,146.70 " "$6,123.08 " "$4,400.73 " "$2,146.70 " "$4,082.05 " "$5,986.26 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$4,838.00 " "$2,336.64 " "$2,225.37 " "$5,150.00 " "$2,146.70 " "$2,146.70 " "$1,891.57 " "$2,404.30 " "$2,225.37 " "$1,891.57 " "$7,566.27 " 330104 58340 278 361 HC CATHETER FOR HYSTEROGRAPHY O "$1,258.32 " N/A N/A $499.80 "$1,878.00 " "$1,717.00 " "$1,565.00 " $70.07 $499.80 N/A $499.80 N/A $943.74 N/A $817.91 $836.78 $599.76 $499.80 $754.99 "$7,492.00 " N/A "$4,407.00 " $499.80 N/A $817.91 $699.72 "$1,006.66 " $499.80 $499.80 $599.76 N/A $499.80 N/A N/A N/A "$1,006.66 " "$1,069.57 " $674.73 $943.74 "$1,024.59 " $674.73 $629.16 $817.91 $849.37 $849.37 $849.37 $849.37 "$2,688.00 " N/A N/A "$2,954.00 " $499.80 $499.80 N/A $559.78 N/A $70.07 "$7,492.00 " 330104 20611 5441 50 361 HC US GUIDED JOINT ASP/INJECTION - LARGE O "$1,070.00 " $326.20 $326.20 $573.45 $482.00 "$1,717.00 " "$1,565.00 " $322.94 $573.45 $619.77 $573.45 $326.20 $802.50 $358.82 $695.50 $711.55 $688.14 $573.45 $642.00 "$7,492.00 " "$1,109.07 " "$4,407.00 " $573.45 $326.20 $391.44 $802.83 $856.00 $573.45 $573.45 $688.14 $456.68 $573.45 $326.20 $326.20 $355.56 $856.00 $909.50 $573.45 $802.50 "$1,175.57 " $573.45 $535.00 $877.47 $722.25 $722.25 $722.25 $722.25 "$2,688.00 " $342.51 $326.20 "$2,954.00 " $573.45 $573.45 $277.27 $642.26 $326.20 $277.27 "$7,492.00 " 330104 49180 5072 150 361 HC BIOPSY ABDOMINAL MASS O "$13,738.80 " "$1,799.07 " "$1,799.07 " $649.92 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,781.08 " $649.92 "$3,418.23 " $649.92 "$1,799.07 " "$10,304.10 " "$1,978.98 " "$8,930.22 " "$9,136.30 " $779.90 $649.92 "$8,243.28 " "$7,492.00 " "$6,116.84 " "$4,407.00 " $649.92 "$1,799.07 " "$2,158.88 " $909.89 "$10,991.04 " $649.92 $649.92 $779.90 "$2,518.70 " $649.92 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$10,991.04 " "$11,677.98 " $649.92 "$3,883.00 " "$1,332.34 " $649.92 "$6,869.40 " "$4,839.50 " "$9,273.69 " "$9,273.69 " "$9,273.69 " "$9,273.69 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " $649.92 $649.92 "$1,529.21 " $727.91 "$1,799.07 " $649.92 "$11,677.98 " 330104 47535 5341 151 361 HC CONV EXT BIL DRG CATH TO INT-EXT BIL DRG CATH O "$8,560.00 " "$4,249.40 " "$4,249.40 " "$1,559.80 " $482.00 "$2,802.00 " "$2,551.00 " "$4,206.90 " "$1,559.80 " "$8,073.85 " "$1,559.80 " "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,564.00 " "$5,692.40 " "$1,871.75 " "$1,559.80 " "$5,136.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " "$1,559.80 " "$4,249.40 " "$5,099.27 " "$2,183.71 " "$6,848.00 " "$1,559.80 " "$1,559.80 " "$1,871.75 " "$5,949.15 " "$1,559.80 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " "$1,559.80 " "$6,420.00 " "$3,197.58 " "$1,559.80 " "$4,280.00 " "$11,430.87 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$1,559.80 " "$1,559.80 " "$3,611.99 " "$1,746.97 " "$4,249.40 " $482.00 "$14,447.94 " 330104 49418 5341 108 361 HC INSERT TUN IP CATH PERC O "$8,560.00 " "$4,249.40 " "$4,249.40 " "$2,241.88 " "$4,069.00 " "$2,802.00 " "$2,551.00 " "$4,206.90 " "$2,241.88 " "$8,073.85 " "$2,241.88 " "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,564.00 " "$5,692.40 " "$2,690.25 " "$2,241.88 " "$5,136.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " "$2,241.88 " "$4,249.40 " "$5,099.27 " "$3,138.63 " "$6,848.00 " "$2,241.88 " "$2,241.88 " "$2,690.25 " "$5,949.15 " "$2,241.88 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " "$2,241.88 " "$3,883.00 " "$4,595.85 " "$2,241.88 " "$4,280.00 " "$11,430.87 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$2,241.88 " "$2,241.88 " "$3,611.99 " "$2,510.90 " "$4,249.40 " "$2,241.88 " "$14,447.94 " 330104 47532 5341 279 361 HC NJX CHOLANGIO PRQ W/IMG GID RS&I NEW ACCESS O "$8,560.00 " "$4,249.40 " "$4,249.40 " $382.18 $482.00 "$2,802.00 " "$2,551.00 " "$4,206.90 " $382.18 "$8,073.85 " $382.18 "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,564.00 " "$5,692.40 " $458.62 $382.18 "$5,136.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " $382.18 "$4,249.40 " "$5,099.27 " $535.05 "$6,848.00 " $382.18 $382.18 $458.62 "$5,949.15 " $382.18 "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " $382.18 "$6,420.00 " $783.47 $382.18 "$4,280.00 " "$11,430.87 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " $382.18 $382.18 "$3,611.99 " $428.04 "$4,249.40 " $382.18 "$14,447.94 " 330104 36568 5182 75 361 HC INSERT PICC CATH; YOUNGER THAN 5YRS O "$12,462.29 " "$1,785.03 " "$1,785.03 " $251.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,767.18 " $251.30 "$3,391.56 " $251.30 "$1,785.03 " "$9,346.72 " "$1,963.54 " "$8,100.49 " "$8,287.42 " $301.56 $251.30 "$7,477.37 " "$7,492.00 " "$6,069.11 " "$4,407.00 " $251.30 "$1,785.03 " "$2,142.04 " $351.82 "$9,969.83 " $251.30 $251.30 $301.56 "$2,499.05 " $251.30 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$9,969.83 " "$10,592.95 " $251.30 "$3,883.00 " $515.17 $251.30 "$6,231.15 " "$4,801.74 " "$8,412.05 " "$8,412.05 " "$8,412.05 " "$8,412.05 " "$3,548.00 " "$1,874.28 " "$1,785.03 " "$3,780.00 " $251.30 $251.30 "$1,517.28 " $281.46 "$1,785.03 " $251.30 "$10,592.95 " 330104 36569 5182 75 361 HC INSERT PICC CATH; 5YRS OR OLDER O "$7,912.65 " "$1,785.03 " "$1,785.03 " $251.30 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,767.18 " $251.30 "$3,391.56 " $251.30 "$1,785.03 " "$5,934.49 " "$1,963.54 " "$5,143.22 " "$5,261.91 " $301.56 $251.30 "$4,747.59 " "$7,492.00 " "$6,069.11 " "$4,407.00 " $251.30 "$1,785.03 " "$2,142.04 " $351.82 "$6,330.12 " $251.30 $251.30 $301.56 "$2,499.05 " $251.30 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$6,330.12 " "$6,725.75 " $251.30 "$3,883.00 " $515.17 $251.30 "$3,956.32 " "$4,801.74 " "$5,341.04 " "$5,341.04 " "$5,341.04 " "$5,341.04 " "$3,548.00 " "$1,874.28 " "$1,785.03 " "$3,780.00 " $251.30 $251.30 "$1,517.28 " $281.46 "$1,785.03 " $251.30 "$7,492.00 " 330104 36571 5183 75 361 HC INSERT PICVAD CATH;5YRS OR OLDER O "$12,768.31 " "$3,573.99 " "$3,573.99 " $251.30 "$2,886.00 " "$2,949.00 " "$2,686.00 " "$3,538.25 " $251.30 "$6,790.58 " $251.30 "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,299.40 " "$8,490.93 " $301.56 $251.30 "$7,660.99 " "$7,492.00 " "$12,151.56 " "$4,407.00 " $251.30 "$3,573.99 " "$4,288.79 " $351.82 "$10,214.65 " $251.30 $251.30 $301.56 "$5,003.59 " $251.30 "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " $251.30 "$3,883.00 " $515.17 $251.30 "$6,384.15 " "$9,614.03 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$6,665.00 " "$3,752.69 " "$3,573.99 " "$7,069.00 " $251.30 $251.30 "$3,037.89 " $281.46 "$3,573.99 " $251.30 "$12,151.56 " 330104 47534 5341 151 361 HC PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I INT-EXT O "$8,560.00 " "$4,249.40 " "$4,249.40 " "$1,559.80 " $482.00 "$2,802.00 " "$2,551.00 " "$4,206.90 " "$1,559.80 " "$8,073.85 " "$1,559.80 " "$4,249.40 " "$6,420.00 " "$4,674.33 " "$5,564.00 " "$5,692.40 " "$1,871.75 " "$1,559.80 " "$5,136.00 " "$7,492.00 " "$14,447.94 " "$4,407.00 " "$1,559.80 " "$4,249.40 " "$5,099.27 " "$2,183.71 " "$6,848.00 " "$1,559.80 " "$1,559.80 " "$1,871.75 " "$5,949.15 " "$1,559.80 " "$4,249.40 " "$4,249.40 " "$4,631.84 " "$6,848.00 " "$7,276.00 " "$1,559.80 " "$6,420.00 " "$3,197.58 " "$1,559.80 " "$4,280.00 " "$11,430.87 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$6,665.00 " "$4,461.86 " "$4,249.40 " "$7,069.00 " "$1,559.80 " "$1,559.80 " "$3,611.99 " "$1,746.97 " "$4,249.40 " $482.00 "$14,447.94 " 330104 36590 5182 76 361 HC REMOVAL TUNNELED CV CATH W/PORT/PUMP O "$2,906.12 " "$1,785.03 " "$1,785.03 " $885.24 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,767.18 " $885.24 "$3,391.56 " $885.24 "$1,785.03 " "$2,179.59 " "$1,963.54 " "$1,888.98 " "$1,932.57 " "$1,062.29 " $885.24 "$1,743.67 " "$7,492.00 " "$6,069.11 " "$4,407.00 " $885.24 "$1,785.03 " "$2,142.04 " "$1,239.34 " "$2,324.90 " $885.24 $885.24 "$1,062.29 " "$2,499.05 " $885.24 "$1,785.03 " "$1,785.03 " "$1,945.69 " "$2,324.90 " "$2,470.20 " $885.24 "$3,883.00 " "$1,814.74 " $885.24 "$1,453.06 " "$4,801.74 " "$1,961.63 " "$1,961.63 " "$1,961.63 " "$1,961.63 " "$4,838.00 " "$1,874.28 " "$1,785.03 " "$5,150.00 " $885.24 $885.24 "$1,517.28 " $991.47 "$1,785.03 " $885.24 "$7,492.00 " 330104 36620 423 361 HC INSERTION CATHETER ARTERY;PERCUT O $561.75 N/A N/A $205.12 $482.00 "$1,717.00 " "$1,565.00 " $51.71 $205.12 N/A $205.12 N/A $421.31 N/A $365.14 $373.56 $246.15 $205.12 $337.05 "$7,492.00 " N/A "$4,407.00 " $205.12 N/A $365.14 $287.17 $449.40 $205.12 $205.12 $246.15 N/A $205.12 N/A N/A N/A $449.40 $477.49 $276.91 $421.31 $420.50 $276.91 $280.88 $365.14 $379.18 $379.18 $379.18 $379.18 "$2,688.00 " N/A N/A "$2,954.00 " $205.12 $205.12 N/A $229.74 N/A $51.71 "$7,492.00 " 330104 37191 5184 77 361 HC INS ENDOVAS VENA CAVA FILTR O "$21,176.37 " "$6,166.38 " "$6,166.38 " "$2,386.19 " "$4,069.00 " "$2,949.00 " "$2,686.00 " "$6,104.71 " "$2,386.19 " "$11,716.11 " "$2,386.19 " "$6,166.38 " "$15,882.28 " "$6,783.01 " "$13,764.64 " "$14,082.29 " "$2,863.42 " "$2,386.19 " "$12,705.82 " "$7,492.00 " "$20,965.68 " "$4,407.00 " "$2,386.19 " "$6,166.38 " "$7,399.65 " "$3,340.66 " "$16,941.10 " "$2,386.19 " "$2,386.19 " "$2,863.42 " "$8,632.93 " "$2,386.19 " "$6,166.38 " "$6,166.38 " "$6,721.35 " "$16,941.10 " "$17,999.91 " "$2,386.19 " "$3,883.00 " "$4,891.68 " "$2,386.19 " "$10,588.18 " "$16,587.55 " "$14,294.05 " "$14,294.05 " "$14,294.05 " "$14,294.05 " "$8,611.00 " "$6,474.69 " "$6,166.38 " "$9,057.00 " "$2,386.19 " "$2,386.19 " "$5,241.42 " "$2,672.53 " "$6,166.38 " "$2,386.19 " "$20,965.68 " 330104 37200 5184 77 361 HC TRANSCATHETER BIOPSY O "$5,350.00 " "$6,166.38 " "$6,166.38 " "$2,386.19 " "$2,523.00 " "$2,973.00 " "$2,708.00 " "$6,104.71 " "$2,386.19 " "$11,716.11 " "$2,386.19 " "$6,166.38 " "$4,012.50 " "$6,783.01 " "$3,477.50 " "$3,557.75 " "$2,863.42 " "$2,386.19 " "$3,210.00 " "$7,492.00 " "$20,965.68 " "$4,407.00 " "$2,386.19 " "$6,166.38 " "$7,399.65 " "$3,340.66 " "$4,280.00 " "$2,386.19 " "$2,386.19 " "$2,863.42 " "$8,632.93 " "$2,386.19 " "$6,166.38 " "$6,166.38 " "$6,721.35 " "$4,280.00 " "$4,547.50 " "$2,386.19 " "$3,883.00 " "$4,891.68 " "$2,386.19 " "$2,675.00 " "$16,587.55 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$8,611.00 " "$6,474.69 " "$6,166.38 " "$9,057.00 " "$2,386.19 " "$2,386.19 " "$5,241.42 " "$2,672.53 " "$6,166.38 " "$2,386.19 " "$20,965.68 " 330104 36581 5183 83 361 HC REPLACE COMPLETE TUNNELED CV CATH; W/O PORT / PUMP O "$12,768.31 " "$3,573.99 " "$3,573.99 " "$1,495.25 " "$2,523.00 " "$2,802.00 " "$2,551.00 " "$3,538.25 " "$1,495.25 " "$6,790.58 " "$1,495.25 " "$3,573.99 " "$9,576.23 " "$3,931.39 " "$8,299.40 " "$8,490.93 " "$1,794.30 " "$1,495.25 " "$7,660.99 " "$7,492.00 " "$12,151.56 " "$4,407.00 " "$1,495.25 " "$3,573.99 " "$4,288.79 " "$2,093.35 " "$10,214.65 " "$1,495.25 " "$1,495.25 " "$1,794.30 " "$5,003.59 " "$1,495.25 " "$3,573.99 " "$3,573.99 " "$3,895.65 " "$10,214.65 " "$10,853.06 " "$1,495.25 " "$3,883.00 " "$3,065.26 " "$1,495.25 " "$6,384.15 " "$9,614.03 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$8,618.61 " "$6,665.00 " "$3,752.69 " "$3,573.99 " "$7,069.00 " "$1,495.25 " "$1,495.25 " "$3,037.89 " "$1,674.68 " "$3,573.99 " "$1,495.25 " "$12,151.56 " 330104 37225 5193 85 361 HC FEM/POPL REVAS W/ATHER O "$45,866.62 " "$12,735.61 " "$12,735.61 " "$2,877.70 " "$5,623.00 " "$2,973.00 " "$2,708.00 " "$12,608.26 " "$2,877.70 " "$24,197.66 " "$2,877.70 " "$12,735.61 " "$34,399.97 " "$14,009.17 " "$29,813.30 " "$30,501.30 " "$3,453.24 " "$2,877.70 " "$27,519.97 " "$7,492.00 " "$43,301.08 " "$4,407.00 " "$2,877.70 " "$12,735.61 " "$15,282.73 " "$4,028.78 " "$36,693.30 " "$2,877.70 " "$2,877.70 " "$3,453.24 " "$17,829.86 " "$2,877.70 " "$12,735.61 " "$12,735.61 " "$13,881.82 " "$36,693.30 " "$38,986.63 " "$2,877.70 " "$4,965.00 " "$5,899.28 " "$2,877.70 " "$22,933.31 " "$34,258.80 " "$30,959.97 " "$30,959.97 " "$30,959.97 " "$30,959.97 " "$11,327.00 " "$13,372.39 " "$12,735.61 " "$11,677.00 " "$2,877.70 " "$2,877.70 " "$10,825.27 " "$3,223.02 " "$12,735.61 " "$2,708.00 " "$43,301.08 " 330104 37236 5193 85 361 HC OPEN/PERQ PLACE STENT 1ST O "$53,644.45 " "$12,735.61 " "$12,735.61 " "$2,877.70 " "$7,500.00 " "$2,949.00 " "$2,686.00 " "$12,608.26 " "$2,877.70 " "$24,197.66 " "$2,877.70 " "$12,735.61 " "$40,233.34 " "$14,009.17 " "$34,868.89 " "$35,673.56 " "$3,453.24 " "$2,877.70 " "$32,186.67 " "$7,492.00 " "$43,301.08 " "$4,407.00 " "$2,877.70 " "$12,735.61 " "$15,282.73 " "$4,028.78 " "$42,915.56 " "$2,877.70 " "$2,877.70 " "$3,453.24 " "$17,829.86 " "$2,877.70 " "$12,735.61 " "$12,735.61 " "$13,881.82 " "$42,915.56 " "$45,597.78 " "$2,877.70 " "$40,233.34 " "$5,899.28 " "$2,877.70 " "$26,822.22 " "$34,258.80 " "$36,210.00 " "$36,210.00 " "$36,210.00 " "$36,210.00 " "$11,327.00 " "$13,372.39 " "$12,735.61 " "$11,677.00 " "$2,877.70 " "$2,877.70 " "$10,825.27 " "$3,223.02 " "$12,735.61 " "$2,686.00 " "$45,597.78 " 330104 37237 85 361 HC OPEN/PERQ PLACE STENT EA ADDL ARTERY O "$28,020.09 " N/A N/A "$2,877.70 " "$7,500.00 " "$1,717.00 " "$1,565.00 " $259.62 "$2,877.70 " N/A "$2,877.70 " N/A "$21,015.07 " N/A "$18,213.06 " "$18,633.36 " "$3,453.24 " "$2,877.70 " "$16,812.05 " "$7,492.00 " N/A "$4,407.00 " "$2,877.70 " N/A "$18,213.06 " "$4,028.78 " "$22,416.07 " "$2,877.70 " "$2,877.70 " "$3,453.24 " N/A "$2,877.70 " N/A N/A N/A "$22,416.07 " "$23,817.08 " "$3,884.89 " "$21,015.07 " "$5,899.28 " "$3,884.89 " "$14,010.05 " "$18,213.06 " "$18,913.56 " "$18,913.56 " "$18,913.56 " "$18,913.56 " "$8,611.00 " N/A N/A "$9,057.00 " "$2,877.70 " "$2,877.70 " N/A "$3,223.02 " N/A $259.62 "$23,817.08 " 330104 38792 5591 331 361 HC RA TRACER ID OF SENTINL NODE O "$3,460.38 " $466.31 $466.31 N/A $482.00 "$1,717.00 " "$1,565.00 " $461.65 N/A $886.00 N/A $466.31 "$2,595.28 " $512.95 "$2,249.25 " "$2,301.15 " N/A N/A "$2,076.23 " "$7,492.00 " "$1,585.47 " "$4,407.00 " N/A $466.31 $559.58 N/A "$2,768.30 " N/A N/A N/A $652.84 N/A $466.31 $466.31 $508.28 "$2,768.30 " "$2,941.32 " N/A "$2,595.28 " N/A N/A "$1,730.19 " "$1,254.39 " "$2,335.76 " "$2,335.76 " "$2,335.76 " "$2,335.76 " "$2,688.00 " $489.63 $466.31 "$2,954.00 " N/A N/A $396.37 N/A $466.31 $396.37 "$7,492.00 " 330104 43761 5371 130 361 HC REPOSITION GASTROSTOMY TUBE O "$2,295.15 " $257.79 $257.79 $541.26 "$1,878.00 " "$1,717.00 " "$1,565.00 " $255.21 $541.26 $489.80 $541.26 $257.79 "$1,721.36 " $283.57 "$1,491.85 " "$1,526.27 " $649.51 $541.26 "$1,377.09 " "$7,492.00 " $876.48 "$4,407.00 " $541.26 $257.79 $309.35 $757.76 "$1,836.12 " $541.26 $541.26 $649.51 $360.90 $541.26 $257.79 $257.79 $280.99 "$1,836.12 " "$1,950.88 " $541.26 "$3,883.00 " "$1,109.58 " $541.26 "$1,147.58 " $693.45 "$1,549.23 " "$1,549.23 " "$1,549.23 " "$1,549.23 " "$2,688.00 " $270.68 $257.79 "$2,954.00 " $541.26 $541.26 $219.12 $606.21 $257.79 $219.12 "$7,492.00 " 330104 46320 5312 141 361 HC REMOVAL OF HEMORRHOID CLOT O "$2,493.10 " "$1,299.21 " "$1,299.21 " "$1,175.03 " "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,286.22 " "$1,175.03 " "$2,468.50 " "$1,175.03 " "$1,299.21 " "$1,869.82 " "$1,429.13 " "$1,620.52 " "$1,657.91 " "$1,410.04 " "$1,175.03 " "$1,495.86 " "$7,492.00 " "$4,417.32 " "$4,407.00 " "$1,175.03 " "$1,299.21 " "$1,559.05 " "$1,645.05 " "$1,994.48 " "$1,175.03 " "$1,175.03 " "$1,410.04 " "$1,818.89 " "$1,175.03 " "$1,299.21 " "$1,299.21 " "$1,416.14 " "$1,994.48 " "$2,119.13 " "$1,175.03 " "$1,869.82 " "$2,408.82 " "$1,175.03 " "$1,246.55 " "$3,494.88 " "$1,682.84 " "$1,682.84 " "$1,682.84 " "$1,682.84 " "$4,838.00 " "$1,364.17 " "$1,299.21 " "$5,150.00 " "$1,175.03 " "$1,175.03 " "$1,104.33 " "$1,316.04 " "$1,299.21 " "$1,104.33 " "$7,492.00 " 330104 47000 5072 150 361 HC NEEDLE BIOPSY OF LIVER O "$6,324.77 " "$1,799.07 " "$1,799.07 " $649.92 "$1,878.00 " "$1,717.00 " "$1,565.00 " "$1,781.08 " $649.92 "$3,418.23 " $649.92 "$1,799.07 " "$4,743.58 " "$1,978.98 " "$4,111.10 " "$4,205.97 " $779.90 $649.92 "$3,794.86 " "$7,492.00 " "$6,116.84 " "$4,407.00 " $649.92 "$1,799.07 " "$2,158.88 " $909.89 "$5,059.82 " $649.92 $649.92 $779.90 "$2,518.70 " $649.92 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " $649.92 "$3,883.00 " "$1,332.34 " $649.92 "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,838.00 " "$1,889.02 " "$1,799.07 " "$5,150.00 " $649.92 $649.92 "$1,529.21 " $727.91 "$1,799.07 " $649.92 "$7,492.00 " 330104 37220 5192 79 361 HC ILIAC REVASC O "$22,823.10 " "$6,257.12 " "$6,257.12 " "$2,877.69 " "$5,623.00 " "$2,973.00 " "$2,708.00 " "$6,194.55 " "$2,877.69 " "$11,888.54 " "$2,877.69 " "$6,257.12 " "$17,117.32 " "$6,882.84 " "$14,835.01 " "$15,177.36 " "$3,453.23 " "$2,877.69 " "$13,693.86 " "$7,492.00 " "$21,274.22 " "$4,407.00 " "$2,877.69 " "$6,257.12 " "$7,508.55 " "$4,028.77 " "$18,258.48 " "$2,877.69 " "$2,877.69 " "$3,453.23 " "$8,759.97 " "$2,877.69 " "$6,257.12 " "$6,257.12 " "$6,820.27 " "$18,258.48 " "$19,399.63 " "$2,877.69 " "$4,965.00 " "$5,899.27 " "$2,877.69 " "$11,411.55 " "$16,831.66 " "$15,405.59 " "$15,405.59 " "$15,405.59 " "$15,405.59 " "$8,611.00 " "$6,569.98 " "$6,257.12 " "$9,057.00 " "$2,877.69 " "$2,877.69 " "$5,318.56 " "$3,223.01 " "$6,257.12 " "$2,708.00 " "$21,274.22 " 330104 369 HC TISSUE RECOVERY O "$4,477.95 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$2,928.58 " N/A N/A N/A N/A "$3,358.46 " "$3,134.56 " "$2,910.67 " "$2,977.84 " "$1,567.28 " "$1,567.28 " "$2,686.77 " "$14,074.00 " N/A "$9,788.00 " "$1,567.28 " N/A N/A N/A "$3,582.36 " N/A "$3,582.36 " N/A N/A "$3,582.36 " N/A N/A N/A "$3,582.36 " "$3,806.26 " "$2,238.97 " "$3,358.46 " "$2,238.97 " "$2,238.97 " N/A "$2,910.67 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$2,238.97 " N/A N/A N/A N/A "$1,567.28 " "$14,074.00 " 330104 369 HC ORGAN RECOVERY - DECEASED O "$20,155.59 " N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " "$13,181.76 " N/A N/A N/A N/A "$15,116.69 " "$14,108.91 " "$13,101.13 " "$13,403.47 " "$7,054.46 " "$7,054.46 " "$12,093.35 " "$14,074.00 " N/A "$9,788.00 " "$7,054.46 " N/A N/A N/A "$16,124.47 " N/A "$16,124.47 " N/A N/A "$16,124.47 " N/A N/A N/A "$16,124.47 " "$17,132.25 " "$10,077.80 " "$15,116.69 " "$10,077.80 " "$10,077.80 " N/A "$13,101.13 " "$7,276.00 " "$7,276.00 " "$7,276.00 " "$7,276.00 " N/A N/A N/A "$3,372.00 " "$10,077.80 " N/A N/A N/A N/A "$2,215.00 " "$17,132.25 " 330104 370 HC ANESTHESIA-LOCAL O "$1,458.41 " N/A N/A N/A $729.21 $904.21 $904.21 $953.80 N/A N/A N/A N/A "$1,093.81 " "$1,020.89 " $947.97 "$1,066.10 " $510.44 $510.44 $875.05 "$7,492.00 " N/A "$4,407.00 " $510.44 N/A N/A N/A "$1,166.73 " N/A "$1,166.73 " N/A N/A "$1,166.73 " N/A N/A N/A "$1,166.73 " "$1,239.65 " $729.21 "$1,093.81 " $729.21 $729.21 N/A $947.97 $984.43 $984.43 $984.43 $984.43 N/A N/A N/A $972.76 $729.21 N/A N/A N/A N/A $510.44 "$7,492.00 " 330104 370 HC ANESTHESIA-REG/BLOCK O "$1,937.77 " N/A N/A N/A $968.88 "$1,201.42 " "$1,201.42 " "$1,267.30 " N/A N/A N/A N/A "$1,453.33 " "$1,356.44 " "$1,259.55 " "$1,416.51 " $678.22 $678.22 "$1,162.66 " "$7,492.00 " N/A "$4,407.00 " $678.22 N/A N/A N/A "$1,550.22 " N/A "$1,550.22 " N/A N/A "$1,550.22 " N/A N/A N/A "$1,550.22 " "$1,647.10 " $968.88 "$1,453.33 " $968.88 $968.88 N/A "$1,259.55 " "$1,307.99 " "$1,307.99 " "$1,307.99 " "$1,307.99 " N/A N/A N/A "$1,292.49 " $968.88 N/A N/A N/A N/A $678.22 "$7,492.00 " 330104 99151 380 370 HC MOD SED SAME PHYS/QHP <5 YRS O $268.57 N/A N/A N/A $134.28 $166.51 $166.51 $28.13 N/A N/A N/A N/A $201.43 N/A $174.57 $196.32 N/A N/A $161.14 "$7,492.00 " N/A "$4,407.00 " N/A N/A $174.57 N/A $214.86 N/A N/A N/A N/A N/A N/A N/A N/A $214.86 $228.28 N/A $201.43 N/A N/A $134.28 $174.57 $181.28 $181.28 $181.28 $181.28 N/A N/A N/A $179.14 N/A N/A N/A N/A N/A $28.13 "$7,492.00 " 330104 99152 380 370 HC MOD SED SAME PHYS/QHP 5/>YRS O $268.57 N/A N/A N/A $134.28 $166.51 $166.51 $15.21 N/A N/A N/A N/A $201.43 N/A $174.57 $196.32 N/A N/A $161.14 "$7,492.00 " N/A "$4,407.00 " N/A N/A $174.57 N/A $214.86 N/A N/A N/A N/A N/A N/A N/A N/A $214.86 $228.28 N/A $201.43 N/A N/A $134.28 $174.57 $181.28 $181.28 $181.28 $181.28 N/A N/A N/A $179.14 N/A N/A N/A N/A N/A $15.21 "$7,492.00 " 330104 99153 380 370 HC MOD SED SAME PHYS/QHP EA O $166.92 N/A N/A N/A $83.46 $103.49 $103.49 $14.15 N/A N/A N/A N/A $125.19 N/A $108.50 $122.02 N/A N/A $100.15 "$7,492.00 " N/A "$4,407.00 " N/A N/A $108.50 N/A $133.54 N/A N/A N/A N/A N/A N/A N/A N/A $133.54 $141.88 N/A $125.19 N/A N/A $83.46 $108.50 $112.67 $112.67 $112.67 $112.67 N/A N/A N/A $111.34 N/A N/A N/A N/A N/A $14.15 "$7,492.00 " 330104 99156 380 370 HC MOD SED OTH PHYS/QHP 5/>YRS O $656.98 N/A N/A N/A $328.49 $407.33 $407.33 $89.06 N/A N/A N/A N/A $492.74 N/A $427.04 $480.25 N/A N/A $394.19 "$7,492.00 " N/A "$4,407.00 " N/A N/A $427.04 N/A $525.58 N/A N/A N/A N/A N/A N/A N/A N/A $525.58 $558.43 N/A $492.74 N/A N/A $328.49 $427.04 $443.46 $443.46 $443.46 $443.46 N/A N/A N/A $438.21 N/A N/A N/A N/A N/A $89.06 "$7,492.00 " 330104 370 HC ANESTHESIS-MAC O "$2,175.31 " N/A N/A N/A "$1,087.65 " "$1,348.69 " "$1,348.69 " "$1,422.65 " N/A N/A N/A N/A "$1,631.48 " "$1,522.72 " "$1,413.95 " "$1,590.15 " $761.36 $761.36 "$1,305.19 " "$7,492.00 " N/A "$4,407.00 " $761.36 N/A N/A N/A "$1,740.25 " N/A "$1,740.25 " N/A N/A "$1,740.25 " N/A N/A N/A "$1,740.25 " "$1,849.01 " "$1,087.65 " "$1,631.48 " "$1,087.65 " "$1,087.65 " N/A "$1,413.95 " "$1,468.33 " "$1,468.33 " "$1,468.33 " "$1,468.33 " N/A N/A N/A "$1,450.93 " "$1,087.65 " N/A N/A N/A N/A $761.36 "$7,492.00 " 330104 P9011 9520 2061 390 HC BLOOD SPLIT UNIT O $675.00 $166.82 $166.82 $548.66 $337.50 $418.50 $418.50 $165.16 $548.66 $316.97 $548.66 $166.82 $506.25 $183.51 $438.75 $493.43 $658.39 $548.66 $405.00 "$7,492.00 " $567.20 "$4,407.00 " $548.66 $166.82 $200.19 $768.12 $540.00 $548.66 $548.66 $658.39 $233.55 $548.66 $166.82 $166.82 $181.84 $540.00 $573.75 $548.66 $506.25 "$1,124.75 " $548.66 $337.50 $275.26 $455.63 $455.63 $455.63 $455.63 $337.50 $175.17 $166.82 $337.50 $675.00 $548.66 $141.80 $141.80 $166.82 $141.80 "$7,492.00 " 330104 P9054 9527 2061 390 HC WSH LR FROZ DW WB/RBC EA UNIT O "$2,361.00 " $356.18 $356.18 $548.66 "$1,180.50 " "$1,463.82 " "$1,463.82 " $352.62 $548.66 $676.74 $548.66 $356.18 "$1,770.75 " $391.80 "$1,534.65 " "$1,725.89 " $658.39 $548.66 "$1,416.60 " "$7,492.00 " "$1,211.01 " "$4,407.00 " $548.66 $356.18 $427.41 $768.12 "$1,888.80 " $548.66 $548.66 $658.39 $498.65 $548.66 $356.18 $356.18 $388.23 "$1,888.80 " "$2,006.85 " $548.66 "$1,770.75 " "$1,124.75 " $548.66 "$1,180.50 " $587.70 "$1,593.68 " "$1,593.68 " "$1,593.68 " "$1,593.68 " "$1,180.50 " $373.99 $356.18 "$1,180.50 " "$2,361.00 " $548.66 $302.75 $302.75 $356.18 $302.75 "$7,492.00 " 330104 P9021 9517 2061 390 HC RED BLOOD CELLS UNIT O $690.00 $162.59 $162.59 $548.66 $345.00 $427.80 $427.80 $160.96 $548.66 $308.92 $548.66 $162.59 $517.50 $178.85 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " $552.80 "$4,407.00 " $548.66 $162.59 $195.11 $768.12 $552.00 $548.66 $548.66 $658.39 $227.62 $548.66 $162.59 $162.59 $177.22 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $268.27 $465.75 $465.75 $465.75 $465.75 $345.00 $170.72 $162.59 $345.00 $690.00 $548.66 $138.20 $138.20 $162.59 $138.20 "$7,492.00 " 330104 P9022 9518 2062 390 HC WASHED RED BLOOD CELLS UNIT O $975.00 $474.83 $474.83 $675.23 $487.50 $604.50 $604.50 $470.08 $675.23 $902.18 $675.23 $474.83 $731.25 $522.32 $633.75 $712.73 $810.27 $675.23 $585.00 "$7,492.00 " "$1,614.43 " "$4,407.00 " $675.23 $474.83 $569.80 $945.32 $780.00 $675.23 $675.23 $810.27 $664.77 $675.23 $474.83 $474.83 $517.57 $780.00 $828.75 $675.23 $731.25 "$1,384.22 " $675.23 $487.50 $783.47 $658.12 $658.12 $658.12 $658.12 $487.50 $498.57 $474.83 $487.50 $975.00 $675.23 $403.61 $403.61 $474.83 $403.61 "$7,492.00 " 330104 P9031 9526 2062 390 HC PLATELETS LEUKOCYTES REDUCED O "$1,605.00 " $157.03 $157.03 $675.23 $802.50 $995.10 $995.10 $155.46 $675.23 $298.36 $675.23 $157.03 "$1,203.75 " $172.74 "$1,043.25 " "$1,173.25 " $810.27 $675.23 $963.00 "$7,492.00 " $533.92 "$4,407.00 " $675.23 $157.03 $188.44 $945.32 "$1,284.00 " $675.23 $675.23 $810.27 $219.85 $675.23 $157.03 $157.03 $171.17 "$1,284.00 " "$1,364.25 " $675.23 "$1,203.75 " "$1,384.22 " $675.23 $802.50 $259.11 "$1,083.38 " "$1,083.38 " "$1,083.38 " "$1,083.38 " $802.50 $164.89 $157.03 $802.50 "$1,605.00 " $675.23 $133.48 $133.48 $157.03 $133.48 "$7,492.00 " 330104 P9032 9500 2062 390 HC PLATELETS IRRADIATED O "$1,605.00 " $172.52 $172.52 $675.23 $802.50 $995.10 $995.10 $170.80 $675.23 $327.79 $675.23 $172.52 "$1,203.75 " $189.77 "$1,043.25 " "$1,173.25 " $810.27 $675.23 $963.00 "$7,492.00 " $586.58 "$4,407.00 " $675.23 $172.52 $207.03 $945.32 "$1,284.00 " $675.23 $675.23 $810.27 $241.53 $675.23 $172.52 $172.52 $188.05 "$1,284.00 " "$1,364.25 " $675.23 "$1,203.75 " "$1,384.22 " $675.23 $802.50 $284.66 "$1,083.38 " "$1,083.38 " "$1,083.38 " "$1,083.38 " $802.50 $181.15 $172.52 $802.50 "$1,605.00 " $675.23 $146.64 $146.64 $172.52 $146.64 "$7,492.00 " 330104 P9035 9501 2062 390 HC PLATELET PHERES LEUKOREDUCED O "$1,605.00 " $582.67 $582.67 $675.23 $802.50 $995.10 $995.10 $576.84 $675.23 "$1,107.06 " $675.23 $582.67 "$1,203.75 " $640.93 "$1,043.25 " "$1,173.25 " $810.27 $675.23 $963.00 "$7,492.00 " "$1,981.06 " "$4,407.00 " $675.23 $582.67 $699.20 $945.32 "$1,284.00 " $675.23 $675.23 $810.27 $815.73 $675.23 $582.67 $582.67 $635.11 "$1,284.00 " "$1,364.25 " $675.23 "$1,203.75 " "$1,384.22 " $675.23 $802.50 $961.40 "$1,083.38 " "$1,083.38 " "$1,083.38 " "$1,083.38 " $802.50 $611.80 $582.67 $802.50 "$1,605.00 " $675.23 $495.27 $495.27 $582.67 $495.27 "$7,492.00 " 330104 P9010 9510 2061 390 HC WHOLE BLOOD FOR TRANSFUSION O $879.00 $273.07 $273.07 $548.66 $439.50 $544.98 $544.98 $270.34 $548.66 $518.84 $548.66 $273.07 $659.25 $300.38 $571.35 $642.55 $658.39 $548.66 $527.40 "$7,492.00 " $928.45 "$4,407.00 " $548.66 $273.07 $327.69 $768.12 $703.20 $548.66 $548.66 $658.39 $382.30 $548.66 $273.07 $273.07 $297.65 $703.20 $747.15 $548.66 $659.25 "$1,124.75 " $548.66 $439.50 $450.57 $593.33 $593.33 $593.33 $593.33 $439.50 $286.73 $273.07 $439.50 $879.00 $548.66 $232.11 $232.11 $273.07 $232.11 "$7,492.00 " 330104 P9019 9515 2061 390 HC PLATELETS EACH UNIT O $455.00 $92.66 $92.66 $548.66 $227.50 $282.10 $282.10 $91.73 $548.66 $176.05 $548.66 $92.66 $341.25 $101.92 $295.75 $332.61 $658.39 $548.66 $273.00 "$7,492.00 " $315.03 "$4,407.00 " $548.66 $92.66 $111.19 $768.12 $364.00 $548.66 $548.66 $658.39 $129.72 $548.66 $92.66 $92.66 $100.99 $364.00 $386.75 $548.66 $341.25 "$1,124.75 " $548.66 $227.50 $152.88 $307.12 $307.12 $307.12 $307.12 $227.50 $97.29 $92.66 $227.50 $455.00 $548.66 $78.76 $78.76 $92.66 $78.76 "$7,492.00 " 330104 P9054 9527 2061 390 HC WASHED LEUKO RED RBC O "$2,227.00 " $356.18 $356.18 $548.66 "$1,113.50 " "$1,380.74 " "$1,380.74 " $352.62 $548.66 $676.74 $548.66 $356.18 "$1,670.25 " $391.80 "$1,447.55 " "$1,627.94 " $658.39 $548.66 "$1,336.20 " "$7,492.00 " "$1,211.01 " "$4,407.00 " $548.66 $356.18 $427.41 $768.12 "$1,781.60 " $548.66 $548.66 $658.39 $498.65 $548.66 $356.18 $356.18 $388.23 "$1,781.60 " "$1,892.95 " $548.66 "$1,670.25 " "$1,124.75 " $548.66 "$1,113.50 " $587.70 "$1,503.23 " "$1,503.23 " "$1,503.23 " "$1,503.23 " "$1,113.50 " $373.99 $356.18 "$1,113.50 " "$2,227.00 " $548.66 $302.75 $302.75 $356.18 $302.75 "$7,492.00 " 330104 P9059 9513 2061 390 HC FFP 8-24 HRS OF COLLECT EA UNIT O $128.00 $91.42 $91.42 $548.66 $64.00 $79.36 $79.36 $90.51 $548.66 $173.70 $548.66 $91.42 $96.00 $100.56 $83.20 $93.57 $658.39 $548.66 $76.80 "$7,492.00 " $310.83 "$4,407.00 " $548.66 $91.42 $109.70 $768.12 $102.40 $548.66 $548.66 $658.39 $127.99 $548.66 $91.42 $91.42 $99.65 $102.40 $108.80 $548.66 $96.00 "$1,124.75 " $548.66 $64.00 $150.84 $86.40 $86.40 $86.40 $86.40 $64.00 $95.99 $91.42 $64.00 $128.00 $548.66 $77.71 $77.71 $91.42 $64.00 "$7,492.00 " 330104 P9058 9533 2061 390 HC CMV NEG LR IRR RBC EA UNIT O $690.00 $301.12 $301.12 $548.66 $345.00 $427.80 $427.80 $298.11 $548.66 $572.13 $548.66 $301.12 $517.50 $331.24 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " "$1,023.82 " "$4,407.00 " $548.66 $301.12 $361.35 $768.12 $552.00 $548.66 $548.66 $658.39 $421.57 $548.66 $301.12 $301.12 $328.22 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $496.85 $465.75 $465.75 $465.75 $465.75 $345.00 $316.18 $301.12 $345.00 $690.00 $548.66 $255.95 $255.95 $301.12 $255.95 "$7,492.00 " 330104 P9057 9532 2061 390 HC RBC FROZ LEUK REDUC IR EA O "$2,361.00 " $472.51 $472.51 $548.66 "$1,180.50 " "$1,463.82 " "$1,463.82 " $467.78 $548.66 $897.76 $548.66 $472.51 "$1,770.75 " $519.76 "$1,534.65 " "$1,725.89 " $658.39 $548.66 "$1,416.60 " "$7,492.00 " "$1,606.52 " "$4,407.00 " $548.66 $472.51 $567.01 $768.12 "$1,888.80 " $548.66 $548.66 $658.39 $661.51 $548.66 $472.51 $472.51 $515.03 "$1,888.80 " "$2,006.85 " $548.66 "$1,770.75 " "$1,124.75 " $548.66 "$1,180.50 " $779.63 "$1,593.68 " "$1,593.68 " "$1,593.68 " "$1,593.68 " "$1,180.50 " $496.13 $472.51 "$1,180.50 " "$2,361.00 " $548.66 $401.63 $401.63 $472.51 $401.63 "$7,492.00 " 330104 P9037 9530 2062 390 HC PLATE PHERES LEUKOREDU IRRAD O "$1,605.00 " $765.66 $765.66 $675.23 $802.50 $995.10 $995.10 $758.01 $675.23 "$1,454.76 " $675.23 $765.66 "$1,203.75 " $842.23 "$1,043.25 " "$1,173.25 " $810.27 $675.23 $963.00 "$7,492.00 " "$2,603.25 " "$4,407.00 " $675.23 $765.66 $918.79 $945.32 "$1,284.00 " $675.23 $675.23 $810.27 "$1,071.93 " $675.23 $765.66 $765.66 $834.57 "$1,284.00 " "$1,364.25 " $675.23 "$1,203.75 " "$1,384.22 " $675.23 $802.50 "$1,263.34 " "$1,083.38 " "$1,083.38 " "$1,083.38 " "$1,083.38 " $802.50 $803.95 $765.66 $802.50 "$1,605.00 " $675.23 $650.81 $650.81 $765.66 $650.81 "$7,492.00 " 330104 P9052 9525 2062 390 HC PLATELETS HLA-M L/R UNIT O "$7,728.00 " $994.06 $994.06 $675.23 "$3,864.00 " "$4,791.36 " "$4,791.36 " $984.12 $675.23 "$1,888.71 " $675.23 $994.06 "$5,796.00 " "$1,093.46 " "$5,023.20 " "$5,649.17 " $810.27 $675.23 "$4,636.80 " "$7,492.00 " "$3,379.79 " "$4,407.00 " $675.23 $994.06 "$1,192.87 " $945.32 "$6,182.40 " $675.23 $675.23 $810.27 "$1,391.68 " $675.23 $994.06 $994.06 "$1,083.52 " "$6,182.40 " "$6,568.80 " $675.23 "$5,796.00 " "$1,384.22 " $675.23 "$3,864.00 " "$1,640.19 " "$5,216.40 " "$5,216.40 " "$5,216.40 " "$5,216.40 " "$3,864.00 " "$1,043.76 " $994.06 "$3,864.00 " "$7,728.00 " $675.23 $844.95 $844.95 $994.06 $675.23 "$7,728.00 " 330104 P9051 9524 2061 390 HC CMV NEGATIVE UNITS O $916.00 $235.66 $235.66 $548.66 $458.00 $567.92 $567.92 $233.31 $548.66 $447.76 $548.66 $235.66 $687.00 $259.23 $595.40 $669.60 $658.39 $548.66 $549.60 "$7,492.00 " $801.26 "$4,407.00 " $548.66 $235.66 $282.80 $768.12 $732.80 $548.66 $548.66 $658.39 $329.93 $548.66 $235.66 $235.66 $256.87 $732.80 $778.60 $548.66 $687.00 "$1,124.75 " $548.66 $458.00 $388.85 $618.30 $618.30 $618.30 $618.30 $458.00 $247.45 $235.66 $458.00 $916.00 $548.66 $200.32 $200.32 $235.66 $200.32 "$7,492.00 " 330104 P9021 9517 2061 390 HC DIRECTED RBC O "$1,208.00 " $162.59 $162.59 $548.66 $604.00 $748.96 $748.96 $160.96 $548.66 $308.92 $548.66 $162.59 $906.00 $178.85 $785.20 $883.05 $658.39 $548.66 $724.80 "$7,492.00 " $552.80 "$4,407.00 " $548.66 $162.59 $195.11 $768.12 $966.40 $548.66 $548.66 $658.39 $227.62 $548.66 $162.59 $162.59 $177.22 $966.40 "$1,026.80 " $548.66 $906.00 "$1,124.75 " $548.66 $604.00 $268.27 $815.40 $815.40 $815.40 $815.40 $604.00 $170.72 $162.59 $604.00 "$1,208.00 " $548.66 $138.20 $138.20 $162.59 $138.20 "$7,492.00 " 330104 P9040 9522 2061 390 HC RBC LEUKOREDUCED IRRADIATED O $690.00 $310.88 $310.88 $548.66 $345.00 $427.80 $427.80 $307.77 $548.66 $590.67 $548.66 $310.88 $517.50 $341.96 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " "$1,056.98 " "$4,407.00 " $548.66 $310.88 $373.05 $768.12 $552.00 $548.66 $548.66 $658.39 $435.23 $548.66 $310.88 $310.88 $338.86 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $512.95 $465.75 $465.75 $465.75 $465.75 $345.00 $326.42 $310.88 $345.00 $690.00 $548.66 $264.25 $264.25 $310.88 $264.25 "$7,492.00 " 330104 P9017 9508 2061 390 HC PLASMA 1 DONOR FRZ W/IN 8 HR O $128.00 $102.54 $102.54 $548.66 $64.00 $79.36 $79.36 $101.52 $548.66 $194.83 $548.66 $102.54 $96.00 $112.80 $83.20 $93.57 $658.39 $548.66 $76.80 "$7,492.00 " $348.64 "$4,407.00 " $548.66 $102.54 $123.05 $768.12 $102.40 $548.66 $548.66 $658.39 $143.56 $548.66 $102.54 $102.54 $111.77 $102.40 $108.80 $548.66 $96.00 "$1,124.75 " $548.66 $64.00 $169.19 $86.40 $86.40 $86.40 $86.40 $64.00 $107.67 $102.54 $64.00 $128.00 $548.66 $87.16 $87.16 $102.54 $64.00 "$7,492.00 " 330104 P9012 9511 2062 390 HC CRYOPRECIPITATE EACH UNIT O $96.00 $89.25 $89.25 $675.23 $48.00 $59.52 $59.52 $88.36 $675.23 $169.57 $675.23 $89.25 $72.00 $98.17 $62.40 $70.18 $810.27 $675.23 $57.60 "$7,492.00 " $303.45 "$4,407.00 " $675.23 $89.25 $107.10 $945.32 $76.80 $675.23 $675.23 $810.27 $124.95 $675.23 $89.25 $89.25 $97.28 $76.80 $81.60 $675.23 $72.00 "$1,384.22 " $675.23 $48.00 $147.26 $64.80 $64.80 $64.80 $64.80 $48.00 $93.71 $89.25 $48.00 $96.00 $675.23 $75.86 $75.86 $89.25 $48.00 "$7,492.00 " 330104 P9016 9512 2061 390 HC RBC LEUKOCYTES REDUCED O $690.00 $227.00 $227.00 $548.66 $345.00 $427.80 $427.80 $224.73 $548.66 $431.31 $548.66 $227.00 $517.50 $249.70 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " $771.81 "$4,407.00 " $548.66 $227.00 $272.40 $768.12 $552.00 $548.66 $548.66 $658.39 $317.80 $548.66 $227.00 $227.00 $247.43 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $374.55 $465.75 $465.75 $465.75 $465.75 $345.00 $238.35 $227.00 $345.00 $690.00 $548.66 $192.95 $192.95 $227.00 $192.95 "$7,492.00 " 330104 P9038 9505 2061 390 HC RBC IRRADIATED O $690.00 $235.39 $235.39 $548.66 $345.00 $427.80 $427.80 $233.04 $548.66 $447.24 $548.66 $235.39 $517.50 $258.93 $448.50 $504.39 $658.39 $548.66 $414.00 "$7,492.00 " $800.32 "$4,407.00 " $548.66 $235.39 $282.47 $768.12 $552.00 $548.66 $548.66 $658.39 $329.54 $548.66 $235.39 $235.39 $256.57 $552.00 $586.50 $548.66 $517.50 "$1,124.75 " $548.66 $345.00 $388.39 $465.75 $465.75 $465.75 $465.75 $345.00 $247.16 $235.39 $345.00 $690.00 $548.66 $200.08 $200.08 $235.39 $200.08 "$7,492.00 " 330104 36430 5241 113 391 HC BLOOD TRANSFUSION SERVICE O "$4,136.62 " $489.19 $489.19 $8.00 "$2,068.31 " "$2,564.70 " "$2,564.70 " $484.30 $8.00 $929.47 $8.00 $489.19 "$3,102.47 " $538.11 "$2,688.80 " "$3,023.87 " $9.60 $8.00 "$2,481.97 " "$7,492.00 " "$1,663.26 " "$4,407.00 " $8.00 $489.19 $587.03 $11.20 "$3,309.30 " $8.00 $8.00 $9.60 $684.87 $8.00 $489.19 $489.19 $533.22 "$3,309.30 " "$3,516.13 " $8.00 "$3,102.47 " $16.40 $8.00 "$2,068.31 " $807.17 "$2,792.22 " "$2,792.22 " "$2,792.22 " "$2,792.22 " "$2,068.31 " $513.65 $489.19 "$2,068.31 " $8.00 $8.00 $415.81 $415.81 $489.19 $8.00 "$7,492.00 " 330104 77053 5523 389 401 HC X-RAY OF MAMMARY DUCT O "$2,545.53 " $280.16 $280.16 $30.00 "$1,272.77 " $92.84 $84.40 $277.36 $30.00 $532.31 $30.00 $280.16 "$1,909.15 " $308.18 "$1,603.68 " "$1,860.78 " $36.00 $30.00 "$1,527.32 " "$7,492.00 " $952.56 "$1,596.93 " $30.00 $280.16 $336.20 $42.00 "$2,036.42 " $30.00 $30.00 $36.00 $392.23 $30.00 $280.16 $280.16 $305.38 "$2,036.42 " "$2,163.70 " $30.00 "$1,909.15 " $61.50 $30.00 "$1,272.77 " $753.64 $441.26 $441.26 $441.26 $441.26 $367.94 $294.17 $280.16 $367.94 $30.00 $30.00 $238.14 $238.14 $280.16 $30.00 "$7,492.00 " 330104 77054 5523 389 401 HC X-RAY OF MAMMARY DUCTS O "$3,203.58 " $280.16 $280.16 $40.00 "$1,601.79 " $119.77 $108.88 $277.36 $40.00 $532.31 $40.00 $280.16 "$2,402.68 " $308.18 "$2,018.26 " "$2,341.82 " $48.00 $40.00 "$1,922.15 " "$7,492.00 " $952.56 "$1,596.93 " $40.00 $280.16 $336.20 $56.00 "$2,562.86 " $40.00 $40.00 $48.00 $392.23 $40.00 $280.16 $280.16 $305.38 "$2,562.86 " "$2,723.04 " $40.00 "$2,402.68 " $82.00 $40.00 "$1,601.79 " $753.64 $441.26 $441.26 $441.26 $441.26 $367.94 $294.17 $280.16 $367.94 $40.00 $40.00 $238.14 $238.14 $280.16 $40.00 "$7,492.00 " 330104 77061 286 401 HC BREAST TOMOSYNTHESIS UNILATERAL O $43.87 N/A N/A N/A $21.93 N/A N/A N/A N/A N/A N/A N/A $32.90 N/A $27.64 $32.07 N/A N/A $26.32 "$7,492.00 " N/A N/A N/A N/A $28.52 N/A $35.10 N/A N/A N/A N/A N/A N/A N/A N/A $35.10 $37.29 N/A $32.90 N/A N/A $21.93 $28.52 N/A N/A N/A N/A $192.46 N/A N/A $192.46 N/A N/A N/A N/A N/A $21.93 "$7,492.00 " 330104 77062 286 401 HC BREAST TOMOSYNTHESIS BILATERAL O $57.78 N/A N/A N/A $28.89 N/A N/A N/A N/A N/A N/A N/A $43.34 N/A $36.40 $42.24 N/A N/A $34.67 "$7,492.00 " N/A N/A N/A N/A $37.56 N/A $46.22 N/A N/A N/A N/A N/A N/A N/A N/A $46.22 $49.11 N/A $43.34 N/A N/A $28.89 $37.56 N/A N/A N/A N/A $150.66 N/A N/A $150.66 N/A N/A N/A N/A N/A $28.89 "$7,492.00 " 330104 77065 286 401 HC DX MAMMO INCL CAD UNI O "$1,104.24 " $152.00 $152.00 $97.00 $552.12 $217.36 $197.60 $150.48 $97.00 $288.80 $97.00 $152.00 $828.18 $167.20 $695.67 $807.20 $116.40 $97.00 $662.54 "$7,492.00 " $516.80 $866.41 $97.00 $152.00 $717.76 $135.80 $883.39 $97.00 $97.00 $116.40 $212.80 $97.00 $152.00 $152.00 $165.68 $883.39 $938.60 $130.95 $828.18 $198.85 $130.95 $552.12 $717.76 $239.40 $239.40 $239.40 $239.40 $157.65 $159.60 $152.00 $157.65 $97.00 $97.00 $129.20 $129.20 $152.00 $97.00 "$7,492.00 " 330104 77066 286 401 HC DX MAMMO INCL CAD BI O "$1,370.67 " $191.25 $191.25 $97.00 $685.34 $273.48 $248.62 $189.33 $97.00 $363.37 $97.00 $191.25 "$1,028.00 " $210.37 $863.52 "$1,001.96 " $116.40 $97.00 $822.40 "$7,492.00 " $650.24 "$1,090.11 " $97.00 $191.25 $890.94 $135.80 "$1,096.54 " $97.00 $97.00 $116.40 $267.75 $97.00 $191.25 $191.25 $208.46 "$1,096.54 " "$1,165.07 " $130.95 "$1,028.00 " $198.85 $130.95 $685.34 $890.94 $301.21 $301.21 $301.21 $301.21 $201.14 $200.81 $191.25 $201.14 $97.00 $97.00 $162.56 $162.56 $191.25 $97.00 "$7,492.00 " 330104 76812 470 402 HC OB US DETAILED ADDL FETUS O $659.12 N/A N/A $36.00 $329.56 $327.44 $297.67 $226.69 $36.00 N/A $36.00 N/A $494.34 N/A $415.25 $481.82 $43.20 $36.00 $395.47 "$7,492.00 " N/A N/A $36.00 N/A $428.43 $50.40 $527.30 $36.00 $36.00 $43.20 N/A $36.00 N/A N/A N/A $527.30 $560.25 $48.60 $494.34 $73.80 $48.60 $329.56 $428.43 N/A N/A N/A N/A $99.60 N/A N/A $99.60 $36.00 $36.00 N/A N/A N/A $36.00 "$7,492.00 " 330104 76811 5523 470 402 HC OB US DETAILED SNGL FETUS O "$2,312.27 " $280.16 $280.16 $72.00 "$1,156.13 " $299.40 $272.18 $277.36 $72.00 $532.31 $72.00 $280.16 "$1,734.20 " $308.18 "$1,456.73 " "$1,690.27 " $86.40 $72.00 "$1,387.36 " "$7,492.00 " $952.56 "$1,596.93 " $72.00 $280.16 $336.20 $100.80 "$1,849.82 " $72.00 $72.00 $86.40 $392.23 $72.00 $280.16 $280.16 $305.38 "$1,849.82 " "$1,965.43 " $72.00 "$1,734.20 " $147.60 $72.00 "$1,156.13 " $753.64 $441.26 $441.26 $441.26 $441.26 $244.78 $294.17 $280.16 $244.78 $72.00 $72.00 $238.14 $238.14 $280.16 $72.00 "$7,492.00 " 330104 76810 470 402 HC OB US >/= 14 WKS ADDL FETUS O "$1,035.76 " N/A N/A $41.00 $517.88 $150.88 $137.17 $104.46 $41.00 N/A $41.00 N/A $776.82 N/A $652.53 $757.14 $49.20 $41.00 $621.46 "$7,492.00 " N/A N/A $41.00 N/A $673.24 $57.40 $828.61 $41.00 $41.00 $49.20 N/A $41.00 N/A N/A N/A $828.61 $880.40 $55.35 $776.82 $84.05 $55.35 $517.88 $673.24 N/A N/A N/A N/A $154.05 N/A N/A $154.05 $41.00 $41.00 N/A N/A N/A $41.00 "$7,492.00 " 330104 76805 5522 470 402 HC OB US >/= 14 WKS SNGL FETUS O "$1,035.76 " $128.23 $128.23 $55.00 $517.88 $235.33 $213.93 $126.95 $55.00 $243.63 $55.00 $128.23 $776.82 $141.05 $652.53 $757.14 $66.00 $55.00 $621.46 "$7,492.00 " $435.98 $730.90 $55.00 $128.23 $153.87 $77.00 $828.61 $55.00 $55.00 $66.00 $179.52 $55.00 $128.23 $128.23 $139.77 $828.61 $880.40 $55.00 $776.82 $112.75 $55.00 $517.88 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $55.00 $55.00 $108.99 $108.99 $128.23 $55.00 "$7,492.00 " 330104 76802 470 402 HC OB US < 14 WKS ADDL FETUS O $659.12 N/A N/A $41.00 $329.56 $103.33 $93.93 $71.53 $41.00 N/A $41.00 N/A $494.34 N/A $415.25 $481.82 $49.20 $41.00 $395.47 "$7,492.00 " N/A N/A $41.00 N/A $428.43 $57.40 $527.30 $41.00 $41.00 $49.20 N/A $41.00 N/A N/A N/A $527.30 $560.25 $55.35 $494.34 $84.05 $55.35 $329.56 $428.43 N/A N/A N/A N/A $99.60 N/A N/A $99.60 $41.00 $41.00 N/A N/A N/A $41.00 "$7,492.00 " 330104 76801 5522 470 402 HC OB US < 14 WKS SINGLE FETUS O "$1,148.11 " $128.23 $128.23 $55.00 $574.05 $203.08 $184.62 $126.95 $55.00 $243.63 $55.00 $128.23 $861.08 $141.05 $723.31 $839.27 $66.00 $55.00 $688.87 "$7,492.00 " $435.98 $730.90 $55.00 $128.23 $153.87 $77.00 $918.49 $55.00 $55.00 $66.00 $179.52 $55.00 $128.23 $128.23 $139.77 $918.49 $975.89 $55.00 $861.08 $112.75 $55.00 $574.05 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $55.00 $55.00 $108.99 $108.99 $128.23 $55.00 "$7,492.00 " 330104 76800 5522 288 402 HC US EXAM SPINAL CANAL O "$1,170.58 " $128.23 $128.23 $60.00 $585.29 $277.58 $252.35 $126.95 $60.00 $243.63 $60.00 $128.23 $877.93 $141.05 $737.47 $855.69 $72.00 $60.00 $702.35 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 $936.46 $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 $936.46 $994.99 $60.00 $877.93 $123.00 $60.00 $585.29 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76815 5522 470 402 HC OB US LIMITED FETUS(S) O "$1,031.48 " $128.23 $128.23 $25.00 $515.74 $141.63 $128.76 $126.95 $25.00 $243.63 $25.00 $128.23 $773.61 $141.05 $649.83 $754.01 $30.00 $25.00 $618.89 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $825.18 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $825.18 $876.76 $25.00 $773.61 $51.25 $25.00 $515.74 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 76814 470 402 HC OB US NUCHAL MEAS ADD-ON O "$1,035.76 " N/A N/A $25.00 $517.88 $125.67 $114.24 $87.00 $25.00 N/A $25.00 N/A $776.82 N/A $652.53 $757.14 $30.00 $25.00 $621.46 "$7,492.00 " N/A N/A $25.00 N/A $673.24 $35.00 $828.61 $25.00 $25.00 $30.00 N/A $25.00 N/A N/A N/A $828.61 $880.40 $33.75 $776.82 $51.25 $33.75 $517.88 $673.24 N/A N/A N/A N/A $99.60 N/A N/A $99.60 $25.00 $25.00 N/A N/A N/A $25.00 "$7,492.00 " 330104 76857 5522 288 402 HC US EXAM PELVIC LIMITED O $702.99 $128.23 $128.23 $40.00 $351.50 $83.56 $75.96 $126.95 $40.00 $243.63 $40.00 $128.23 $527.24 $141.05 $442.88 $513.89 $48.00 $40.00 $421.79 "$7,492.00 " $435.98 $730.90 $40.00 $128.23 $153.87 $56.00 $562.39 $40.00 $40.00 $48.00 $179.52 $40.00 $128.23 $128.23 $139.77 $562.39 $597.54 $40.00 $527.24 $82.00 $40.00 $351.50 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $40.00 $40.00 $108.99 $108.99 $128.23 $40.00 "$7,492.00 " 330104 76816 5522 470 402 HC OB US FOLLOW-UP PER FETUS O "$1,203.75 " $128.23 $128.23 $25.00 $601.88 $188.39 $171.27 $126.95 $25.00 $243.63 $25.00 $128.23 $902.81 $141.05 $758.36 $879.94 $30.00 $25.00 $722.25 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $963.00 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $963.00 "$1,023.19 " $25.00 $902.81 $51.25 $25.00 $601.88 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 76999 5521 288 402 HC ECHO EXAMINATION PROCEDURE O $439.77 $104.23 $104.23 N/A $219.88 N/A N/A $103.19 N/A $198.04 N/A $104.23 $329.83 $114.66 $277.06 $321.47 N/A N/A $263.86 "$7,492.00 " $354.39 $594.13 N/A $104.23 $125.08 N/A $351.82 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $351.82 $373.80 N/A $329.83 N/A N/A $219.88 $280.39 $164.17 $164.17 $164.17 $164.17 $99.60 $109.45 $104.23 $99.60 N/A N/A $88.60 $88.60 $104.23 $88.60 "$7,492.00 " 330104 76998 472 402 HC US GUIDE INTRAOP O "$2,059.75 " N/A N/A N/A "$1,029.88 " N/A N/A N/A N/A N/A N/A N/A "$1,544.81 " N/A "$1,297.64 " "$1,505.68 " N/A N/A "$1,235.85 " "$7,492.00 " N/A N/A N/A N/A "$1,338.84 " N/A "$1,647.80 " N/A N/A N/A N/A N/A N/A N/A N/A "$1,647.80 " "$1,750.79 " N/A "$1,544.81 " N/A N/A "$1,029.88 " "$1,338.84 " N/A N/A N/A N/A N/A N/A N/A "$1,373.85 " N/A N/A N/A N/A N/A "$1,029.88 " "$7,492.00 " 330104 76981 5522 288 402 HC ULTRASOUND ELASTOGRAPHY; PARENCHYMA (EG ORGAN) O "$1,317.17 " $128.23 $128.23 N/A $658.59 $182.02 $165.48 $126.95 N/A $243.63 N/A $128.23 $987.88 $141.05 $829.82 $962.85 N/A N/A $790.30 "$7,492.00 " $435.98 $730.90 N/A $128.23 $153.87 N/A "$1,053.74 " N/A N/A N/A $179.52 N/A $128.23 $128.23 $139.77 "$1,053.74 " "$1,119.59 " N/A $987.88 N/A N/A $658.59 $344.93 $201.96 $201.96 $201.96 $201.96 $180.02 $134.64 $128.23 $180.02 N/A N/A $108.99 $108.99 $128.23 $108.99 "$7,492.00 " 330104 76946 472 402 HC ECHO GUIDE FOR AMNIOCENTESIS O "$2,059.75 " N/A N/A $20.00 "$1,029.88 " $55.75 $50.68 $38.59 $20.00 N/A $20.00 N/A "$1,544.81 " N/A "$1,297.64 " "$1,505.68 " $24.00 $20.00 "$1,235.85 " "$7,492.00 " N/A N/A $20.00 N/A "$1,338.84 " $28.00 "$1,647.80 " $20.00 $20.00 $24.00 N/A $20.00 N/A N/A N/A "$1,647.80 " "$1,750.79 " $27.00 "$1,544.81 " $41.00 $27.00 "$1,029.88 " "$1,338.84 " N/A N/A N/A N/A N/A N/A N/A "$1,373.85 " $20.00 $20.00 N/A N/A N/A $20.00 "$7,492.00 " 330104 76942 472 402 HC ECHO GUIDE FOR BIOPSY O "$1,365.32 " N/A N/A $55.00 $682.66 $99.78 $90.71 $69.08 $55.00 N/A $55.00 N/A "$1,023.99 " N/A $860.15 $998.05 $66.00 $55.00 $819.19 "$7,492.00 " N/A N/A $55.00 N/A $887.46 $77.00 "$1,092.26 " $55.00 $55.00 $66.00 N/A $55.00 N/A N/A N/A "$1,092.26 " "$1,160.52 " $74.25 "$1,023.99 " $112.75 $74.25 $682.66 $887.46 N/A N/A N/A N/A N/A N/A N/A $910.67 $55.00 $55.00 N/A N/A N/A $55.00 "$7,492.00 " 330104 76937 472 402 HC US GUIDE VASCULAR ACCESS O $667.68 N/A N/A $55.00 $333.84 $69.16 $62.87 $47.88 $55.00 N/A $55.00 N/A $500.76 N/A $420.64 $488.07 $66.00 $55.00 $400.61 "$7,492.00 " N/A N/A $55.00 N/A $433.99 $77.00 $534.14 $55.00 $55.00 $66.00 N/A $55.00 N/A N/A N/A $534.14 $567.53 $74.25 $500.76 $112.75 $74.25 $333.84 $433.99 N/A N/A N/A N/A N/A N/A N/A $445.34 $55.00 $55.00 N/A N/A N/A $47.88 "$7,492.00 " 330104 76936 5722 474 402 HC ECHO GUIDE FOR ARTERY REPAIR O "$1,332.15 " $336.00 $336.00 $358.61 $666.08 $454.51 $413.19 $332.64 $358.61 $638.40 $358.61 $336.00 $999.11 $369.60 $839.25 $973.80 $430.34 $358.61 $799.29 "$7,492.00 " "$1,142.40 " "$1,915.20 " $358.61 $336.00 $403.20 $502.06 "$1,065.72 " $358.61 $358.61 $430.34 $470.40 $358.61 $336.00 $336.00 $366.24 "$1,065.72 " "$1,132.33 " $358.61 $999.11 $735.16 $358.61 $666.08 $903.84 $529.20 $529.20 $529.20 $529.20 $170.37 $352.80 $336.00 $170.37 $358.61 $358.61 $285.60 $285.60 $336.00 $170.37 "$7,492.00 " 330104 76886 5521 288 402 HC US EXAM INFANT HIPS STATIC O $342.40 $104.23 $104.23 $25.00 $171.20 $176.51 $160.46 $103.19 $25.00 $198.04 $25.00 $104.23 $256.80 $114.66 $215.71 $250.29 $30.00 $25.00 $205.44 "$7,492.00 " $354.39 $594.13 $25.00 $104.23 $125.08 $35.00 $273.92 $25.00 $25.00 $30.00 $145.93 $25.00 $104.23 $104.23 $113.61 $273.92 $291.04 $25.00 $256.80 $51.25 $25.00 $171.20 $280.39 $164.17 $164.17 $164.17 $164.17 $99.60 $109.45 $104.23 $99.60 $25.00 $25.00 $88.60 $88.60 $104.23 $25.00 "$7,492.00 " 330104 76882 5522 288 402 HC US XTR NON-VASC LMTD O "$1,250.83 " $128.23 $128.23 $9.87 $625.41 $71.44 $64.94 $126.95 $9.87 $243.63 $9.87 $128.23 $938.12 $141.05 $788.02 $914.36 $11.84 $9.87 $750.50 "$7,492.00 " $435.98 $730.90 $9.87 $128.23 $153.87 $13.82 "$1,000.66 " $9.87 $9.87 $11.84 $179.52 $9.87 $128.23 $128.23 $139.77 "$1,000.66 " "$1,063.21 " $9.87 $938.12 $20.23 $9.87 $625.41 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $9.87 $9.87 $108.99 $108.99 $128.23 $9.87 "$7,492.00 " 330104 76881 5522 288 402 HC US XTR NON-VASC COMPLETE O "$1,250.83 " $128.23 $128.23 $36.55 $625.41 $90.41 $82.19 $126.95 $36.55 $243.63 $36.55 $128.23 $938.12 $141.05 $788.02 $914.36 $43.86 $36.55 $750.50 "$7,492.00 " $435.98 $730.90 $36.55 $128.23 $153.87 $51.17 "$1,000.66 " $36.55 $36.55 $43.86 $179.52 $36.55 $128.23 $128.23 $139.77 "$1,000.66 " "$1,063.21 " $36.55 $938.12 $74.93 $36.55 $625.41 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $36.55 $36.55 $108.99 $108.99 $128.23 $36.55 "$7,492.00 " 330104 76873 5522 289 402 HC ECHOGRAP TRANS R PROS STUDY O "$1,907.81 " $128.23 $128.23 $60.00 $953.90 $299.70 $272.45 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,430.86 " $141.05 "$1,201.92 " "$1,394.61 " $72.00 $60.00 "$1,144.69 " "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$1,526.25 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$1,526.25 " "$1,621.64 " $60.00 "$1,430.86 " $123.00 $60.00 $953.90 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76776 5522 288 402 HC US EXAM K TRANSPL W/DOPPLER O "$1,365.32 " $128.23 $128.23 $60.00 $682.66 $259.38 $235.80 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,023.99 " $141.05 $860.15 $998.05 $72.00 $60.00 $819.19 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$1,092.26 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$1,092.26 " "$1,160.52 " $60.00 "$1,023.99 " $123.00 $60.00 $682.66 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76872 5522 288 402 HC US TRANSRECTAL O "$2,571.21 " $128.23 $128.23 $60.00 "$1,285.61 " $351.06 $319.15 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,928.41 " $141.05 "$1,619.86 " "$1,879.55 " $72.00 $60.00 "$1,542.73 " "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$2,056.97 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$2,056.97 " "$2,185.53 " $60.00 "$1,928.41 " $123.00 $60.00 "$1,285.61 " $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76856 5522 289 402 HC US EXAM PELVIC COMPLETE O "$1,501.21 " $128.23 $128.23 $55.00 $750.61 $184.20 $167.46 $126.95 $55.00 $243.63 $55.00 $128.23 "$1,125.91 " $141.05 $945.76 "$1,097.38 " $66.00 $55.00 $900.73 "$7,492.00 " $435.98 $730.90 $55.00 $128.23 $153.87 $77.00 "$1,200.97 " $55.00 $55.00 $66.00 $179.52 $55.00 $128.23 $128.23 $139.77 "$1,200.97 " "$1,276.03 " $55.00 "$1,125.91 " $112.75 $55.00 $750.61 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $55.00 $55.00 $108.99 $108.99 $128.23 $55.00 "$7,492.00 " 330104 76831 5523 289 402 HC ECHO EXAM UTERUS O "$2,451.37 " $280.16 $280.16 $28.00 "$1,225.68 " $201.71 $183.37 $277.36 $28.00 $532.31 $28.00 $280.16 "$1,838.53 " $308.18 "$1,544.36 " "$1,791.95 " $33.60 $28.00 "$1,470.82 " "$7,492.00 " $952.56 "$1,596.93 " $28.00 $280.16 $336.20 $39.20 "$1,961.10 " $28.00 $28.00 $33.60 $392.23 $28.00 $280.16 $280.16 $305.38 "$1,961.10 " "$2,083.66 " $28.00 "$1,838.53 " $57.40 $28.00 "$1,225.68 " $753.64 $441.26 $441.26 $441.26 $441.26 $244.78 $294.17 $280.16 $244.78 $28.00 $28.00 $238.14 $238.14 $280.16 $28.00 "$7,492.00 " 330104 76830 5522 288 402 HC TRANSVAGINAL US NON-OB O "$2,571.21 " $128.23 $128.23 $60.00 "$1,285.61 " $209.46 $190.42 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,928.41 " $141.05 "$1,619.86 " "$1,879.55 " $72.00 $60.00 "$1,542.73 " "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$2,056.97 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$2,056.97 " "$2,185.53 " $60.00 "$1,928.41 " $123.00 $60.00 "$1,285.61 " $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76828 5522 470 402 HC DOPPLER ECHO EXAM OF FETAL HEART; F/U/REPEAT STUDY O "$1,035.76 " $128.23 $128.23 $25.00 $517.88 $83.16 $75.60 $126.95 $25.00 $243.63 $25.00 $128.23 $776.82 $141.05 $652.53 $757.14 $30.00 $25.00 $621.46 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $828.61 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $828.61 $880.40 $25.00 $776.82 $51.25 $25.00 $517.88 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 76827 5522 470 402 HC DOPPLER ECHO EXAM OF FETAL HEART;COMPLETE O "$1,599.65 " $128.23 $128.23 $25.00 $799.83 $119.96 $109.05 $126.95 $25.00 $243.63 $25.00 $128.23 "$1,199.74 " $141.05 "$1,007.78 " "$1,169.34 " $30.00 $25.00 $959.79 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 "$1,279.72 " $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 "$1,279.72 " "$1,359.70 " $25.00 "$1,199.74 " $51.25 $25.00 $799.83 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 76825 5524 470 402 HC ECHO EXAM OF FETAL HEART O "$2,220.25 " $603.63 $603.63 $25.00 "$1,110.12 " $453.84 $412.58 $597.59 $25.00 "$1,146.89 " $25.00 $603.63 "$1,665.19 " $663.99 "$1,398.76 " "$1,623.00 " $30.00 $25.00 "$1,332.15 " "$7,492.00 " "$2,052.33 " "$3,440.66 " $25.00 $603.63 $724.35 $35.00 "$1,776.20 " $25.00 $25.00 $30.00 $845.08 $25.00 $603.63 $603.63 $657.95 "$1,776.20 " "$1,887.21 " $25.00 "$1,665.19 " $51.25 $25.00 "$1,110.12 " "$1,623.75 " $950.71 $950.71 $950.71 $950.71 $899.44 $633.81 $603.63 $899.44 $25.00 $25.00 $513.08 $513.08 $603.63 $25.00 "$7,492.00 " 330104 76821 5522 470 402 HC MIDDLE CEREBRAL ARTERY ECHO O $836.74 $128.23 $128.23 $29.78 $418.37 $152.53 $138.66 $126.95 $29.78 $243.63 $29.78 $128.23 $627.56 $141.05 $527.15 $611.66 $35.74 $29.78 $502.04 "$7,492.00 " $435.98 $730.90 $29.78 $128.23 $153.87 $41.69 $669.39 $29.78 $29.78 $35.74 $179.52 $29.78 $128.23 $128.23 $139.77 $669.39 $711.23 $29.78 $627.56 $61.05 $29.78 $418.37 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $29.78 $29.78 $108.99 $108.99 $128.23 $29.78 "$7,492.00 " 330104 76820 5522 470 402 HC UMBILICAL ARTERY ECHO O $836.74 $128.23 $128.23 $12.79 $418.37 $75.98 $69.07 $126.95 $12.79 $243.63 $12.79 $128.23 $627.56 $141.05 $527.15 $611.66 $15.35 $12.79 $502.04 "$7,492.00 " $435.98 $730.90 $12.79 $128.23 $153.87 $17.91 $669.39 $12.79 $12.79 $15.35 $179.52 $12.79 $128.23 $128.23 $139.77 $669.39 $711.23 $12.79 $627.56 $26.22 $12.79 $418.37 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $12.79 $12.79 $108.99 $108.99 $128.23 $12.79 "$7,492.00 " 330104 76819 5522 470 402 HC FETAL BIOPHYS PROFIL W/O NST O "$2,224.53 " $128.23 $128.23 $35.00 "$1,112.27 " $143.78 $130.70 $126.95 $35.00 $243.63 $35.00 $128.23 "$1,668.40 " $141.05 "$1,401.45 " "$1,626.13 " $42.00 $35.00 "$1,334.72 " "$7,492.00 " $435.98 $730.90 $35.00 $128.23 $153.87 $49.00 "$1,779.62 " $35.00 $35.00 $42.00 $179.52 $35.00 $128.23 $128.23 $139.77 "$1,779.62 " "$1,890.85 " $35.00 "$1,668.40 " $71.75 $35.00 "$1,112.27 " $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $35.00 $35.00 $108.99 $108.99 $128.23 $35.00 "$7,492.00 " 330104 76818 5522 470 402 HC FETAL BIOPHYS PROFILE W/NST O "$1,516.19 " $128.23 $128.23 $35.00 $758.10 $200.81 $182.55 $126.95 $35.00 $243.63 $35.00 $128.23 "$1,137.14 " $141.05 $955.20 "$1,108.33 " $42.00 $35.00 $909.71 "$7,492.00 " $435.98 $730.90 $35.00 $128.23 $153.87 $49.00 "$1,212.95 " $35.00 $35.00 $42.00 $179.52 $35.00 $128.23 $128.23 $139.77 "$1,212.95 " "$1,288.76 " $35.00 "$1,137.14 " $71.75 $35.00 $758.10 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $35.00 $35.00 $108.99 $108.99 $128.23 $35.00 "$7,492.00 " 330104 76817 5522 470 402 HC TRANSVAGINAL US OBSTETRIC O $659.12 $128.23 $128.23 $60.00 $329.56 $160.85 $146.22 $126.95 $60.00 $243.63 $60.00 $128.23 $494.34 $141.05 $415.25 $481.82 $72.00 $60.00 $395.47 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 $527.30 $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 $527.30 $560.25 $60.00 $494.34 $123.00 $60.00 $329.56 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76870 5522 288 402 HC US EXAM SCROTUM O "$1,346.06 " $128.23 $128.23 $30.00 $673.03 $176.36 $160.33 $126.95 $30.00 $243.63 $30.00 $128.23 "$1,009.54 " $141.05 $848.02 $983.97 $36.00 $30.00 $807.64 "$7,492.00 " $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 "$1,076.85 " $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 "$1,076.85 " "$1,144.15 " $30.00 "$1,009.54 " $61.50 $30.00 $673.03 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 "$7,492.00 " 330104 76775 5522 288 402 HC US EXAM ABDO BACK WALL LIM O "$1,545.08 " $128.23 $128.23 $60.00 $772.54 $102.22 $92.93 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,158.81 " $141.05 $973.40 "$1,129.45 " $72.00 $60.00 $927.05 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$1,236.06 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$1,236.06 " "$1,313.32 " $60.00 "$1,158.81 " $123.00 $60.00 $772.54 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76813 5522 470 402 HC OB US NUCHAL MEAS 1 GEST O "$1,035.76 " $128.23 $128.23 $39.00 $517.88 $200.47 $182.24 $126.95 $39.00 $243.63 $39.00 $128.23 $776.82 $141.05 $652.53 $757.14 $46.80 $39.00 $621.46 "$7,492.00 " $435.98 $730.90 $39.00 $128.23 $153.87 $54.60 $828.61 $39.00 $39.00 $46.80 $179.52 $39.00 $128.23 $128.23 $139.77 $828.61 $880.40 $39.00 $776.82 $79.95 $39.00 $517.88 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $39.00 $39.00 $108.99 $108.99 $128.23 $39.00 "$7,492.00 " 330104 76706 5522 288 402 HC US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA O $480.43 $128.23 $128.23 $22.25 $240.22 $187.02 $170.02 $126.95 $22.25 $243.63 $22.25 $128.23 $360.32 $141.05 $302.67 $351.19 $26.70 $22.25 $288.26 "$7,492.00 " $435.98 $730.90 $22.25 $128.23 $153.87 $31.15 $384.34 $22.25 $22.25 $26.70 $179.52 $22.25 $128.23 $128.23 $139.77 $384.34 $408.37 $22.25 $360.32 $45.61 $22.25 $240.22 $344.93 $201.96 $201.96 $201.96 $201.96 $180.30 $134.64 $128.23 $180.30 $22.25 $22.25 $108.99 $108.99 $128.23 $22.25 "$7,492.00 " 330104 76770 5522 289 402 HC US EXAM ABDO BACK WALL COMP O "$1,170.58 " $128.23 $128.23 $60.00 $585.29 $189.11 $171.92 $126.95 $60.00 $243.63 $60.00 $128.23 $877.93 $141.05 $737.47 $855.69 $72.00 $60.00 $702.35 "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 $936.46 $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 $936.46 $994.99 $60.00 $877.93 $123.00 $60.00 $585.29 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 0690T 288 402 HC QUANTITATIVE US TISS CHARAC I&R W/DX US SM ANAT O $267.50 N/A N/A N/A $133.75 N/A N/A N/A N/A N/A N/A N/A $200.62 N/A $168.53 $195.54 N/A N/A $160.50 "$7,492.00 " N/A N/A N/A N/A $173.88 N/A $214.00 N/A N/A N/A N/A N/A N/A N/A N/A $214.00 $227.38 N/A $200.62 N/A N/A $133.75 $173.88 N/A N/A N/A N/A N/A N/A N/A $178.42 N/A N/A N/A N/A N/A $133.75 "$7,492.00 " 330104 76506 5522 288 402 HC ECHO EXAM OF HEAD O "$1,432.73 " $128.23 $128.23 $30.00 $716.37 $198.17 $180.15 $126.95 $30.00 $243.63 $30.00 $128.23 "$1,074.55 " $141.05 $902.62 "$1,047.33 " $36.00 $30.00 $859.64 "$7,492.00 " $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 "$1,146.18 " $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 "$1,146.18 " "$1,217.82 " $30.00 "$1,074.55 " $61.50 $30.00 $716.37 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 "$7,492.00 " 330104 76536 5522 288 402 HC US EXAM OF HEAD AND NECK O "$1,687.39 " $128.23 $128.23 $30.00 $843.70 $195.17 $177.43 $126.95 $30.00 $243.63 $30.00 $128.23 "$1,265.54 " $141.05 "$1,063.06 " "$1,233.48 " $36.00 $30.00 "$1,012.43 " "$7,492.00 " $435.98 $730.90 $30.00 $128.23 $153.87 $42.00 "$1,349.91 " $30.00 $30.00 $36.00 $179.52 $30.00 $128.23 $128.23 $139.77 "$1,349.91 " "$1,434.28 " $30.00 "$1,265.54 " $61.50 $30.00 $843.70 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $30.00 $30.00 $108.99 $108.99 $128.23 $30.00 "$7,492.00 " 330104 0689T 5521 288 402 HC QUAN US TISS CHARAC I&R W/O DX US SAME ANAT O $214.00 $104.23 $104.23 N/A $107.00 N/A N/A $103.19 N/A $198.04 N/A $104.23 $160.50 $114.66 $134.82 $156.43 N/A N/A $128.40 "$7,492.00 " $354.39 $594.13 N/A $104.23 $125.08 N/A $171.20 N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 $171.20 $181.90 N/A $160.50 N/A N/A $107.00 $280.39 $164.17 $164.17 $164.17 $164.17 N/A $109.45 $104.23 $142.74 N/A N/A $88.60 $88.60 $104.23 $88.60 "$7,492.00 " 330104 76641 5522 288 402 HC US BREAST UNIL INCLUD.AXILLA COMPLETE O "$1,324.66 " $128.23 $128.23 $32.47 $662.33 $179.79 $163.45 $126.95 $32.47 $243.63 $32.47 $128.23 $993.50 $141.05 $834.54 $968.33 $38.96 $32.47 $794.80 "$7,492.00 " $435.98 $730.90 $32.47 $128.23 $153.87 $45.46 "$1,059.73 " $32.47 $32.47 $38.96 $179.52 $32.47 $128.23 $128.23 $139.77 "$1,059.73 " "$1,125.96 " $32.47 $993.50 $66.56 $32.47 $662.33 $344.93 $201.96 $201.96 $201.96 $201.96 $146.66 $134.64 $128.23 $146.66 $32.47 $32.47 $108.99 $108.99 $128.23 $32.47 "$7,492.00 " 330104 76642 5521 288 402 HC US BREAST UNIL INCLUD.AXILLA LIMITED O "$1,324.66 " $104.23 $104.23 $26.66 $662.33 $147.87 $134.42 $103.19 $26.66 $198.04 $26.66 $104.23 $993.50 $114.66 $834.54 $968.33 $31.99 $26.66 $794.80 "$7,492.00 " $354.39 $594.13 $26.66 $104.23 $125.08 $37.32 "$1,059.73 " $26.66 $26.66 $31.99 $145.93 $26.66 $104.23 $104.23 $113.61 "$1,059.73 " "$1,125.96 " $26.66 $993.50 $54.65 $26.66 $662.33 $280.39 $164.17 $164.17 $164.17 $164.17 $146.66 $109.45 $104.23 $146.66 $26.66 $26.66 $88.60 $88.60 $104.23 $26.66 "$7,492.00 " 330104 76700 5522 289 402 HC US EXAM ABDOM COMPLETE O "$1,756.94 " $128.23 $128.23 $60.00 $878.47 $202.68 $184.25 $126.95 $60.00 $243.63 $60.00 $128.23 "$1,317.70 " $141.05 "$1,106.87 " "$1,284.32 " $72.00 $60.00 "$1,054.16 " "$7,492.00 " $435.98 $730.90 $60.00 $128.23 $153.87 $84.00 "$1,405.55 " $60.00 $60.00 $72.00 $179.52 $60.00 $128.23 $128.23 $139.77 "$1,405.55 " "$1,493.40 " $60.00 "$1,317.70 " $123.00 $60.00 $878.47 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $60.00 $60.00 $108.99 $108.99 $128.23 $60.00 "$7,492.00 " 330104 76705 5522 288 402 HC US/ECHO OF ABDOMEN O $870.98 $128.23 $128.23 $40.00 $435.49 $153.83 $139.85 $126.95 $40.00 $243.63 $40.00 $128.23 $653.24 $141.05 $548.72 $636.69 $48.00 $40.00 $522.59 "$7,492.00 " $435.98 $730.90 $40.00 $128.23 $153.87 $56.00 $696.78 $40.00 $40.00 $48.00 $179.52 $40.00 $128.23 $128.23 $139.77 $696.78 $740.33 $40.00 $653.24 $82.00 $40.00 $435.49 $344.93 $201.96 $201.96 $201.96 $201.96 $154.05 $134.64 $128.23 $154.05 $40.00 $40.00 $108.99 $108.99 $128.23 $40.00 "$7,492.00 " 330104 76604 5522 288 402 HC US EXAM CHEST O $907.36 $128.23 $128.23 $25.00 $453.68 $98.04 $89.12 $126.95 $25.00 $243.63 $25.00 $128.23 $680.52 $141.05 $571.64 $663.28 $30.00 $25.00 $544.42 "$7,492.00 " $435.98 $730.90 $25.00 $128.23 $153.87 $35.00 $725.89 $25.00 $25.00 $30.00 $179.52 $25.00 $128.23 $128.23 $139.77 $725.89 $771.26 $25.00 $680.52 $51.25 $25.00 $453.68 $344.93 $201.96 $201.96 $201.96 $201.96 $99.60 $134.64 $128.23 $99.60 $25.00 $25.00 $108.99 $108.99 $128.23 $25.00 "$7,492.00 " 330104 77067 286 403 HC SCR MAMMO BI INCL CAD O "$1,269.02 " $155.96 $155.96 $97.00 $634.51 $223.03 $202.75 $154.40 $97.00 $296.33 $97.00 $155.96 $951.76 $171.56 $799.48 $927.65 $116.40 $97.00 $761.41 "$7,492.00 " $530.27 $888.98 $97.00 $155.96 $824.86 $135.80 "$1,015.22 " $97.00 $97.00 $116.40 $218.35 $97.00 $155.96 $155.96 $170.00 "$1,015.22 " "$1,078.67 " $130.95 $951.76 $198.85 $130.95 $634.51 $824.86 $245.64 $245.64 $245.64 $245.64 $166.35 $163.76 $155.96 $166.35 $97.00 $97.00 $132.57 $132.57 $155.96 $97.00 "$7,492.00 " 330104 77063 286 403 HC BREAST TOMOSYNTHESIS SCREENING BILAT O $57.78 $63.21 $63.21 $10.11 $28.89 $90.38 $82.17 $62.57 $10.11 $120.09 $10.11 $63.21 $43.34 $69.53 $36.40 $42.24 $12.13 $10.11 $34.67 "$7,492.00 " $214.90 $360.27 $10.11 $63.21 $37.56 $14.15 $46.22 $10.11 $10.11 $12.13 $88.49 $10.11 $63.21 $63.21 $68.89 $46.22 $49.11 $13.65 $43.34 $20.73 $13.65 $28.89 $37.56 $99.55 $99.55 $99.55 $99.55 $41.25 $66.37 $63.21 $41.25 $10.11 $10.11 $53.72 $53.72 $63.21 $10.11 "$7,492.00 " 330104 78816 5594 290 404 HC PET IMAGE W/CT FULL BODY O "$6,156.78 " "$1,786.83 " "$1,786.83 " $870.00 "$3,078.39 " N/A N/A "$1,768.96 " $870.00 "$3,394.98 " $870.00 "$1,786.83 " "$4,617.59 " "$1,965.52 " "$3,878.77 " "$4,500.61 " "$1,044.00 " $870.00 "$3,694.07 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $870.00 "$1,786.83 " "$2,144.20 " "$1,218.00 " "$4,925.42 " $870.00 $870.00 "$1,044.00 " "$2,501.57 " $870.00 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,925.42 " "$5,233.26 " $870.00 "$4,617.59 " "$1,783.50 " $870.00 "$3,078.39 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$1,667.18 " "$1,876.17 " "$1,786.83 " "$1,667.18 " $870.00 $870.00 "$1,518.81 " "$1,518.81 " "$1,786.83 " $870.00 "$10,184.95 " 330104 78815 5594 290 404 HC PET IMAGE W/CT SKULL-THIGH O "$6,156.78 " "$1,786.83 " "$1,786.83 " $676.00 "$3,078.39 " N/A N/A "$1,768.96 " $676.00 "$3,394.98 " $676.00 "$1,786.83 " "$4,617.59 " "$1,965.52 " "$3,878.77 " "$4,500.61 " $811.20 $676.00 "$3,694.07 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $676.00 "$1,786.83 " "$2,144.20 " $946.40 "$4,925.42 " $676.00 $676.00 $811.20 "$2,501.57 " $676.00 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,925.42 " "$5,233.26 " $676.00 "$4,617.59 " "$1,385.80 " $676.00 "$3,078.39 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$1,667.18 " "$1,876.17 " "$1,786.83 " "$1,667.18 " $676.00 $676.00 "$1,518.81 " "$1,518.81 " "$1,786.83 " $676.00 "$10,184.95 " 330104 78814 5594 290 404 HC PET IMAGE W/CT LMTD O "$6,156.78 " "$1,786.83 " "$1,786.83 " $387.00 "$3,078.39 " N/A N/A "$1,768.96 " $387.00 "$3,394.98 " $387.00 "$1,786.83 " "$4,617.59 " "$1,965.52 " "$3,878.77 " "$4,500.61 " $464.40 $387.00 "$3,694.07 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $387.00 "$1,786.83 " "$2,144.20 " $541.80 "$4,925.42 " $387.00 $387.00 $464.40 "$2,501.57 " $387.00 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,925.42 " "$5,233.26 " $387.00 "$4,617.59 " $793.35 $387.00 "$3,078.39 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$1,667.18 " "$1,876.17 " "$1,786.83 " "$1,667.18 " $387.00 $387.00 "$1,518.81 " "$1,518.81 " "$1,786.83 " $387.00 "$10,184.95 " 330104 78608 5594 290 404 HC BRAIN IMAGING (PET) O "$6,156.78 " "$1,786.83 " "$1,786.83 " $742.00 "$3,078.39 " N/A N/A "$1,768.96 " $742.00 "$3,394.98 " $742.00 "$1,786.83 " "$4,617.59 " "$1,965.52 " "$3,878.77 " "$4,500.61 " $890.40 $742.00 "$3,694.07 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $742.00 "$1,786.83 " "$2,144.20 " "$1,038.80 " "$4,925.42 " $742.00 $742.00 $890.40 "$2,501.57 " $742.00 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,925.42 " "$5,233.26 " $742.00 "$4,617.59 " "$1,521.10 " $742.00 "$3,078.39 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$1,667.18 " "$1,876.17 " "$1,786.83 " "$1,667.18 " $742.00 $742.00 "$1,518.81 " "$1,518.81 " "$1,786.83 " $742.00 "$10,184.95 " 330104 78434 290 404 HC AQMBF PET REST AND PHARMACOLOGIC STRESS O $910.57 N/A N/A N/A $455.29 N/A N/A N/A N/A N/A N/A N/A $682.93 N/A $573.66 $665.63 N/A N/A $546.34 "$7,492.00 " N/A N/A N/A N/A $591.87 N/A $728.46 N/A N/A N/A N/A N/A N/A N/A N/A $728.46 $773.98 N/A $682.93 N/A N/A $455.29 $591.87 N/A N/A N/A N/A "$3,951.00 " N/A N/A "$4,300.00 " N/A N/A N/A N/A N/A $455.29 "$7,492.00 " 330104 78433 1521 290 404 HC MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT O "$11,735.76 " "$2,340.09 " "$2,340.09 " "$1,609.62 " "$5,867.88 " N/A N/A "$2,316.69 " "$1,609.62 " "$4,446.18 " "$1,609.62 " "$2,340.09 " "$8,801.82 " "$2,574.10 " "$7,393.53 " "$8,578.84 " "$1,931.54 " "$1,609.62 " "$7,041.46 " "$7,492.00 " "$7,956.32 " "$13,338.53 " "$1,609.62 " "$2,340.09 " "$2,808.11 " "$2,253.47 " "$9,388.61 " "$1,609.62 " "$1,609.62 " "$1,931.54 " "$3,276.13 " "$1,609.62 " "$2,340.09 " "$2,340.09 " "$2,550.70 " "$9,388.61 " "$9,975.40 " "$1,609.62 " "$8,801.82 " "$3,299.72 " "$1,609.62 " "$5,867.88 " "$6,294.85 " "$3,685.65 " "$3,685.65 " "$3,685.65 " "$3,685.65 " "$4,400.80 " "$2,457.10 " "$2,340.09 " "$4,400.80 " "$1,609.62 " "$1,609.62 " "$1,989.08 " "$1,989.08 " "$2,340.09 " "$1,609.62 " "$13,338.53 " 330104 78430 5594 290 404 HC MYOCRD IMG PET RST/STRS W/CT O "$6,158.92 " "$1,786.83 " "$1,786.83 " $60.62 "$3,079.46 " N/A N/A "$1,768.96 " $60.62 "$3,394.98 " $60.62 "$1,786.83 " "$4,619.19 " "$1,965.52 " "$3,880.12 " "$4,502.17 " $72.74 $60.62 "$3,695.35 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $60.62 "$1,786.83 " "$2,144.20 " $84.87 "$4,927.14 " $60.62 $60.62 $72.74 "$2,501.57 " $60.62 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,927.14 " "$5,235.08 " $60.62 "$4,619.19 " $124.27 $60.62 "$3,079.46 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,308.80 " "$1,876.17 " "$1,786.83 " "$2,308.80 " $60.62 $60.62 "$1,518.81 " "$1,518.81 " "$1,786.83 " $60.62 "$10,184.95 " 330104 78429 5594 290 404 HC MYOCRD IMG PET METAB EVAL SINGLE STUDY CNCRNT CT O "$6,158.92 " "$1,786.83 " "$1,786.83 " $63.32 "$3,079.46 " N/A N/A "$1,768.96 " $63.32 "$3,394.98 " $63.32 "$1,786.83 " "$4,619.19 " "$1,965.52 " "$3,880.12 " "$4,502.17 " $75.98 $63.32 "$3,695.35 " "$7,492.00 " "$6,075.23 " "$10,184.95 " $63.32 "$1,786.83 " "$2,144.20 " $88.65 "$4,927.14 " $63.32 $63.32 $75.98 "$2,501.57 " $63.32 "$1,786.83 " "$1,786.83 " "$1,947.65 " "$4,927.14 " "$5,235.08 " $63.32 "$4,619.19 " $129.81 $63.32 "$3,079.46 " "$4,806.58 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,814.26 " "$2,308.80 " "$1,876.17 " "$1,786.83 " "$2,308.80 " $63.32 $63.32 "$1,518.81 " "$1,518.81 " "$1,786.83 " $63.32 "$10,184.95 " 330104 78431 1523 290 404 HC MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT O "$9,616.09 " "$3,299.88 " "$3,299.88 " "$1,129.62 " "$4,808.05 " N/A N/A "$3,266.89 " "$1,129.62 " "$6,269.78 " "$1,129.62 " "$3,299.88 " "$7,212.07 " "$3,629.87 " "$6,058.14 " "$7,029.36 " "$1,355.54 " "$1,129.62 " "$5,769.65 " "$7,492.00 " "$11,219.61 " "$18,809.34 " "$1,129.62 " "$3,299.88 " "$3,959.86 " "$1,581.47 " "$7,692.87 " "$1,129.62 " "$1,129.62 " "$1,355.54 " "$4,619.84 " "$1,129.62 " "$3,299.88 " "$3,299.88 " "$3,596.87 " "$7,692.87 " "$8,173.68 " "$1,129.62 " "$7,212.07 " "$2,315.72 " "$1,129.62 " "$4,808.05 " "$8,876.69 " "$5,197.32 " "$5,197.32 " "$5,197.32 " "$5,197.32 " "$3,600.80 " "$3,464.88 " "$3,299.88 " "$3,600.80 " "$1,129.62 " "$1,129.62 " "$2,804.90 " "$2,804.90 " "$3,299.88 " "$1,129.62 " "$18,809.34 " 330104 94002 5801 67 410 HC VENT MGMT INPAT INIT DAY O "$2,142.14 " $667.92 $667.92 $190.31 N/A "$1,328.13 " "$1,328.13 " $661.24 $190.31 "$1,269.05 " $190.31 $667.92 "$1,606.61 " $734.71 "$1,392.39 " "$1,565.90 " $228.38 $190.31 "$1,285.28 " "$7,492.00 " "$2,270.93 " "$4,407.00 " $190.31 $667.92 $801.50 $266.44 "$1,713.71 " $190.31 $190.31 $228.38 $935.09 $190.31 $667.92 $667.92 $728.03 "$1,713.71 " "$1,820.82 " $190.31 "$1,606.61 " $390.14 $190.31 "$1,071.07 " "$1,102.07 " "$1,445.94 " "$1,445.94 " "$1,445.94 " "$1,445.94 " N/A $701.32 $667.92 "$1,428.81 " $190.31 $190.31 $567.73 $567.73 $667.92 $190.31 "$7,492.00 " 330104 94640 5791 412 410 HC AIRWAY INHALATION TREATMENT O $878.47 $229.75 $229.75 $3.00 N/A $544.65 $544.65 $227.45 $3.00 $436.53 $3.00 $229.75 $658.85 $252.73 $571.01 $642.16 $3.60 $3.00 $527.08 "$7,492.00 " $781.15 "$4,407.00 " $3.00 $229.75 $275.70 $4.20 $702.78 $3.00 $3.00 $3.60 $321.65 $3.00 $229.75 $229.75 $250.43 $702.78 $746.70 $3.00 $658.85 $6.15 $3.00 $439.24 $379.09 $592.97 $592.97 $592.97 $592.97 N/A $241.24 $229.75 $585.94 $3.00 $3.00 $195.29 $195.29 $229.75 $3.00 "$7,492.00 " 330104 94003 5801 67 410 HC VENT MGMT INPAT SUBQ DAY O "$2,142.14 " $667.92 $667.92 $190.31 N/A "$1,328.13 " "$1,328.13 " $661.24 $190.31 "$1,269.05 " $190.31 $667.92 "$1,606.61 " $734.71 "$1,392.39 " "$1,565.90 " $228.38 $190.31 "$1,285.28 " "$7,492.00 " "$2,270.93 " "$4,407.00 " $190.31 $667.92 $801.50 $266.44 "$1,713.71 " $190.31 $190.31 $228.38 $935.09 $190.31 $667.92 $667.92 $728.03 "$1,713.71 " "$1,820.82 " $190.31 "$1,606.61 " $390.14 $190.31 "$1,071.07 " "$1,102.07 " "$1,445.94 " "$1,445.94 " "$1,445.94 " "$1,445.94 " N/A $701.32 $667.92 "$1,428.81 " $190.31 $190.31 $567.73 $567.73 $667.92 $190.31 "$7,492.00 " 330104 94667 5734 412 410 HC CHEST WALL MANIPULATION INITIAL O $503.97 $139.30 $139.30 $74.80 N/A $312.46 $312.46 $137.91 $74.80 $264.67 $74.80 $139.30 $377.98 $153.23 $327.58 $368.40 $89.76 $74.80 $302.38 "$7,492.00 " $473.63 "$4,407.00 " $74.80 $139.30 $167.16 $104.72 $403.18 $74.80 $74.80 $89.76 $195.02 $74.80 $139.30 $139.30 $151.84 $403.18 $428.37 $74.80 $377.98 $153.34 $74.80 $251.99 $229.85 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $74.80 $74.80 $118.41 $118.41 $139.30 $74.80 "$7,492.00 " 330104 31720 5791 412 410 HC NASOTRACHEAL SUCTIONING O "$1,642.45 " $229.75 $229.75 $74.80 "$1,878.00 " "$1,018.32 " "$1,018.32 " $227.45 $74.80 $436.53 $74.80 $229.75 "$1,231.84 " $252.73 "$1,067.59 " "$1,200.63 " $89.76 $74.80 $985.47 "$7,492.00 " $781.15 "$4,407.00 " $74.80 $229.75 $275.70 $104.72 "$1,313.96 " $74.80 $74.80 $89.76 $321.65 $74.80 $229.75 $229.75 $250.43 "$1,313.96 " "$1,396.08 " $74.80 "$1,231.84 " $153.34 $74.80 $821.23 $379.09 "$1,108.65 " "$1,108.65 " "$1,108.65 " "$1,108.65 " N/A $241.24 $229.75 "$1,095.51 " $74.80 $74.80 $195.29 $195.29 $229.75 $74.80 "$7,492.00 " 330104 G0239 5732 66 410 HC PULMONARY REHAB GROUP O $182.97 $40.74 $40.74 N/A N/A $113.44 $113.44 $40.34 N/A $77.41 N/A $40.74 $137.23 $44.82 $118.93 $133.75 N/A N/A $109.78 "$7,492.00 " $138.53 "$4,407.00 " N/A $40.74 $48.89 N/A $146.38 N/A N/A N/A $57.04 N/A $40.74 $40.74 $44.41 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $67.23 $123.50 $123.50 $123.50 $123.50 N/A $42.78 $40.74 $122.04 N/A N/A $34.63 $34.63 $40.74 $34.63 "$7,492.00 " 330104 G0238 5731 66 410 HC OTH RESP PROC INDIV O $182.97 $29.95 $29.95 N/A N/A $113.44 $113.44 $29.65 N/A $56.90 N/A $29.95 $137.23 $32.94 $118.93 $133.75 N/A N/A $109.78 "$7,492.00 " $101.81 "$4,407.00 " N/A $29.95 $35.93 N/A $146.38 N/A N/A N/A $41.92 N/A $29.95 $29.95 $32.64 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $49.41 $123.50 $123.50 $123.50 $123.50 N/A $31.44 $29.95 $122.04 N/A N/A $25.45 $25.45 $29.95 $25.45 "$7,492.00 " 330104 G0237 5731 66 410 HC THERAPEUTIC PROCD STRG ENDUR O $182.97 $29.95 $29.95 N/A N/A $113.44 $113.44 $29.65 N/A $56.90 N/A $29.95 $137.23 $32.94 $118.93 $133.75 N/A N/A $109.78 "$7,492.00 " $101.81 "$4,407.00 " N/A $29.95 $35.93 N/A $146.38 N/A N/A N/A $41.92 N/A $29.95 $29.95 $32.64 $146.38 $155.52 N/A $137.23 N/A N/A $91.48 $49.41 $123.50 $123.50 $123.50 $123.50 N/A $31.44 $29.95 $122.04 N/A N/A $25.45 $25.45 $29.95 $25.45 "$7,492.00 " 330104 94668 5734 412 410 HC CHEST WALL MANIPULATION SUBSEQUENT O $503.97 $139.30 $139.30 $74.80 N/A $312.46 $312.46 $137.91 $74.80 $264.67 $74.80 $139.30 $377.98 $153.23 $327.58 $368.40 $89.76 $74.80 $302.38 "$7,492.00 " $473.63 "$4,407.00 " $74.80 $139.30 $167.16 $104.72 $403.18 $74.80 $74.80 $89.76 $195.02 $74.80 $139.30 $139.30 $151.84 $403.18 $428.37 $74.80 $377.98 $153.34 $74.80 $251.99 $229.85 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $74.80 $74.80 $118.41 $118.41 $139.30 $74.80 "$7,492.00 " 330104 94644 5734 412 410 HC CBT 1ST HOUR O "$1,520.47 " $139.30 $139.30 $74.80 N/A $942.69 $942.69 $137.91 $74.80 $264.67 $74.80 $139.30 "$1,140.35 " $153.23 $988.31 "$1,111.46 " $89.76 $74.80 $912.28 "$7,492.00 " $473.63 "$4,407.00 " $74.80 $139.30 $167.16 $104.72 "$1,216.38 " $74.80 $74.80 $89.76 $195.02 $74.80 $139.30 $139.30 $151.84 "$1,216.38 " "$1,292.40 " $74.80 "$1,140.35 " $153.34 $74.80 $760.24 $229.85 "$1,026.32 " "$1,026.32 " "$1,026.32 " "$1,026.32 " N/A $146.27 $139.30 "$1,014.15 " $74.80 $74.80 $118.41 $118.41 $139.30 $74.80 "$7,492.00 " 330104 94645 412 410 HC CBT EACH ADDL HOUR O "$1,142.76 " N/A N/A $74.80 N/A $708.51 $708.51 $19.48 $74.80 N/A $74.80 N/A $857.07 N/A $742.79 $835.36 $89.76 $74.80 $685.66 "$7,492.00 " N/A "$4,407.00 " $74.80 N/A $742.79 $104.72 $914.21 $74.80 $74.80 $89.76 N/A $74.80 N/A N/A N/A $914.21 $971.35 $100.98 $857.07 $153.34 $100.98 $571.38 $742.79 $771.36 $771.36 $771.36 $771.36 N/A N/A N/A $762.22 $74.80 $74.80 N/A N/A N/A $19.48 "$7,492.00 " 330104 94660 5791 2020 410 HC POS AIRWAY PRESSURE CPAP O "$1,683.11 " $229.75 $229.75 $190.32 N/A "$1,043.53 " "$1,043.53 " $227.45 $190.32 $436.53 $190.32 $229.75 "$1,262.33 " $252.73 "$1,094.02 " "$1,230.35 " $228.38 $190.32 "$1,009.87 " "$7,492.00 " $781.15 "$4,407.00 " $190.32 $229.75 $275.70 $266.45 "$1,346.49 " $190.32 $190.32 $228.38 $321.65 $190.32 $229.75 $229.75 $250.43 "$1,346.49 " "$1,430.64 " $190.32 "$1,262.33 " $390.15 $190.32 $841.55 $379.09 "$1,136.10 " "$1,136.10 " "$1,136.10 " "$1,136.10 " N/A $241.24 $229.75 "$1,122.63 " $190.32 $190.32 $195.29 $195.29 $229.75 $190.32 "$7,492.00 " 330104 94664 5791 412 410 HC EVALUATE PT USE OF INHALER O $878.47 $229.75 $229.75 $3.00 N/A $544.65 $544.65 $227.45 $3.00 $436.53 $3.00 $229.75 $658.85 $252.73 $571.01 $642.16 $3.60 $3.00 $527.08 "$7,492.00 " $781.15 "$4,407.00 " $3.00 $229.75 $275.70 $4.20 $702.78 $3.00 $3.00 $3.60 $321.65 $3.00 $229.75 $229.75 $250.43 $702.78 $746.70 $3.00 $658.85 $6.15 $3.00 $439.24 $379.09 $592.97 $592.97 $592.97 $592.97 N/A $241.24 $229.75 $585.94 $3.00 $3.00 $195.29 $195.29 $229.75 $3.00 "$7,492.00 " 330104 G0277 5061 17 413 HC HBOT FULL BODY CHAMBER PER 30MIN O "$1,966.66 " $150.05 $150.05 $705.44 $983.33 "$1,219.33 " "$1,219.33 " $148.55 $705.44 $285.10 $705.44 $150.05 "$1,475.00 " $165.06 "$1,278.33 " "$1,298.00 " $846.53 $705.44 "$1,180.00 " "$4,377.00 " $510.18 "$4,407.00 " $705.44 $150.05 $180.06 "$4,415.94 " "$1,573.33 " "$4,415.94 " $705.44 $846.53 $210.07 $705.44 $150.05 $150.05 $163.56 "$1,573.33 " "$1,671.66 " $705.44 "$1,475.00 " "$1,446.16 " $705.44 $983.33 $247.58 "$1,327.50 " "$1,327.50 " "$1,327.50 " "$1,327.50 " N/A $157.55 $150.05 "$1,311.76 " $705.44 $705.44 $127.54 $127.54 $150.05 $127.54 "$4,415.94 " 330104 99183 2003 413 HC HBO TREATMENT - PHYS. NP & PA SUPRVSION O "$2,123.95 " $127.46 $127.46 N/A "$1,061.97 " "$1,316.85 " "$1,316.85 " $126.18 N/A $242.17 N/A $127.46 "$1,592.96 " $140.20 "$1,380.57 " "$1,298.00 " N/A N/A "$1,274.37 " "$4,377.00 " $537.00 $912.00 N/A $127.46 "$1,380.57 " "$4,769.12 " "$1,699.16 " "$4,769.12 " N/A N/A $178.44 N/A $127.46 $127.46 $138.93 "$1,699.16 " "$1,805.36 " N/A "$1,592.96 " N/A N/A "$1,061.97 " "$1,380.57 " "$1,433.67 " "$1,433.67 " "$1,433.67 " "$1,433.67 " N/A $133.83 $127.46 "$1,416.67 " N/A N/A $108.34 $108.34 $127.46 $108.34 "$4,769.12 " 330104 97750 269 420 HC PHYSICAL PERFORMANCE TEST O $318.86 $39.47 $39.47 $72.07 $159.43 $197.69 $197.69 $39.08 $181.00 $238.00 $181.00 $125.00 $239.15 $43.42 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $39.47 $207.26 $100.90 $476.00 $72.07 $72.07 $86.49 $55.26 $72.07 $39.47 $39.47 $43.03 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $41.45 $39.47 $396.00 $181.18 $190.00 $33.55 $33.55 $39.47 $33.55 "$7,492.00 " 330104 97760 269 420 HC ORTHOTIC MGMT AND TRAINING O $318.86 $57.28 $57.28 $72.07 $159.43 $197.69 $197.69 $56.71 $181.00 $238.00 $181.00 $125.00 $239.15 $63.01 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $57.28 $207.26 $100.90 $476.00 $72.07 $72.07 $86.49 $80.19 $72.07 $57.28 $57.28 $62.44 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $60.15 $57.28 $396.00 $181.18 $190.00 $48.69 $48.69 $57.28 $48.69 "$7,492.00 " 330104 97016 493 420 HC VASOPNEUMATIC DEVICE THERAPY O $185.11 $13.79 $13.79 $25.56 $92.56 $114.77 $114.77 $13.66 $181.00 $238.00 $181.00 $125.00 $138.83 $15.17 $275.27 $294.00 $30.68 $25.56 $111.07 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $13.79 $120.32 $35.79 $476.00 $25.56 $25.56 $30.68 $19.31 $25.56 $13.79 $13.79 $15.04 $148.09 $157.34 $34.51 $223.00 $52.40 $34.51 $92.56 $120.32 $124.95 $124.95 $124.95 $124.95 $375.00 $14.48 $13.79 $396.00 $181.18 $190.00 $11.73 $11.73 $13.79 $11.73 "$7,492.00 " 330104 97110 269 420 HC THERAPEUTIC EXERCISES O $332.77 $34.13 $34.13 $72.07 $166.38 $206.32 $206.32 $33.79 $181.00 $238.00 $181.00 $125.00 $249.58 $37.55 $275.27 $294.00 $86.49 $72.07 $199.66 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $34.13 $216.30 $100.90 $476.00 $72.07 $72.07 $86.49 $47.79 $72.07 $34.13 $34.13 $37.21 $266.22 $282.85 $97.30 $223.00 $147.75 $97.30 $166.38 $216.30 $224.62 $224.62 $224.62 $224.62 $375.00 $35.84 $34.13 $396.00 $181.18 $190.00 $29.01 $29.01 $34.13 $29.01 "$7,492.00 " 330104 97116 493 420 HC GAIT TRAINING THERAPY O $332.77 $34.13 $34.13 $25.56 $166.38 $206.32 $206.32 $33.79 $181.00 $238.00 $181.00 $125.00 $249.58 $37.55 $275.27 $294.00 $30.68 $25.56 $199.66 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $34.13 $216.30 $35.79 $476.00 $25.56 $25.56 $30.68 $47.79 $25.56 $34.13 $34.13 $37.21 $266.22 $282.85 $34.51 $223.00 $52.40 $34.51 $166.38 $216.30 $224.62 $224.62 $224.62 $224.62 $375.00 $35.84 $34.13 $396.00 $181.18 $190.00 $29.01 $29.01 $34.13 $25.56 "$7,492.00 " 330104 97799 493 420 HC UNLISTED PHYSICAL MEDICINE/REHAB SVC OR PROCEDURE O $304.95 N/A N/A $25.56 $152.47 $189.07 $189.07 N/A $181.00 $238.00 $181.00 $125.00 $228.71 N/A $275.27 $294.00 $30.68 $25.56 $182.97 "$7,492.00 " $220.00 "$4,407.00 " $25.56 N/A $198.22 $35.79 $476.00 $25.56 $25.56 $30.68 N/A $25.56 N/A N/A N/A $243.96 $259.21 $34.51 $223.00 $52.40 $34.51 $152.47 $198.22 $205.84 $205.84 $205.84 $205.84 $375.00 N/A N/A $396.00 $181.18 $190.00 N/A N/A N/A $25.56 "$7,492.00 " 330104 97530 269 420 HC THERAPEUTIC ACTIVITIES O $182.97 $43.63 $43.63 $2.35 $91.48 $113.44 $113.44 $43.20 $181.00 $238.00 $181.00 $125.00 $137.23 $48.00 $275.27 $294.00 $2.82 $2.35 $109.78 "$7,492.00 " $220.00 "$4,407.00 " $2.35 $43.63 $118.93 $3.29 $476.00 $2.35 $2.35 $2.82 $61.09 $2.35 $43.63 $43.63 $47.56 $146.38 $155.52 $3.17 $223.00 $4.82 $3.17 $91.48 $118.93 $123.50 $123.50 $123.50 $123.50 $375.00 $45.82 $43.63 $396.00 $181.18 $190.00 $37.09 $37.09 $43.63 $2.35 "$7,492.00 " 330104 97535 493 420 HC SELF CARE MNGMENT TRAINING O $361.66 $38.24 $38.24 $25.56 $180.83 $224.23 $224.23 $37.86 $181.00 $238.00 $181.00 $125.00 $271.25 $42.07 $275.27 $294.00 $30.68 $25.56 $217.00 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $38.24 $235.08 $35.79 $476.00 $25.56 $25.56 $30.68 $53.54 $25.56 $38.24 $38.24 $41.68 $289.33 $307.41 $34.51 $223.00 $52.40 $34.51 $180.83 $235.08 $244.12 $244.12 $244.12 $244.12 $375.00 $40.15 $38.24 $396.00 $181.18 $190.00 $32.51 $32.51 $38.24 $25.56 "$7,492.00 " 330104 97537 269 420 HC COMMUNITY/WORK REINTEGRATION O $318.86 $36.85 $36.85 $72.07 $159.43 $197.69 $197.69 $36.48 $181.00 $238.00 $181.00 $125.00 $239.15 $40.54 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $36.85 $207.26 $100.90 $476.00 $72.07 $72.07 $86.49 $51.59 $72.07 $36.85 $36.85 $40.17 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $38.69 $36.85 $396.00 $181.18 $190.00 $31.32 $31.32 $36.85 $31.32 "$7,492.00 " 330104 97112 269 420 HC NEUROMUSCULAR REEDUCATION O $318.86 $39.21 $39.21 $72.07 $159.43 $197.69 $197.69 $38.82 $181.00 $238.00 $181.00 $125.00 $239.15 $43.13 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $39.21 $207.26 $100.90 $476.00 $72.07 $72.07 $86.49 $54.89 $72.07 $39.21 $39.21 $42.74 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $41.17 $39.21 $396.00 $181.18 $190.00 $33.33 $33.33 $39.21 $33.33 "$7,492.00 " 330104 97161 271 424 HC PT EVAL LOW COMPLEX 20 MIN O $637.72 $116.56 $116.56 $126.55 $318.86 $395.39 $395.39 $115.39 $181.00 $238.00 $181.00 $125.00 $478.29 $128.21 $275.27 $294.00 $151.87 $126.55 $382.63 "$7,492.00 " $220.00 "$4,407.00 " $126.55 $116.56 $414.52 $140.00 $476.00 $140.00 $126.55 $151.87 $163.18 $126.55 $116.56 $116.56 $127.05 $510.18 $542.06 $170.85 $223.00 $259.44 $170.85 $318.86 $414.52 $430.46 $430.46 $430.46 $430.46 $375.00 $318.86 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97163 271 424 HC PT EVAL HIGH COMPLEX 45 MIN O $758.63 $116.56 $116.56 $126.55 $379.31 $470.35 $470.35 $115.39 $181.00 $238.00 $181.00 $125.00 $568.97 $128.21 $275.27 $294.00 $151.87 $126.55 $455.18 "$7,492.00 " $220.00 "$4,407.00 " $126.55 $116.56 $493.11 $140.00 $476.00 $140.00 $126.55 $151.87 $163.18 $126.55 $116.56 $116.56 $127.05 $606.90 $644.84 $170.85 $223.00 $259.44 $170.85 $379.31 $493.11 $512.08 $512.08 $512.08 $512.08 $375.00 $379.31 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97164 271 424 HC PT RE-EVAL EST PLAN CARE O $449.40 $81.84 $81.84 $126.55 $224.70 $278.63 $278.63 $81.02 $181.00 $238.00 $181.00 $125.00 $337.05 $90.02 $275.27 $294.00 $151.87 $126.55 $269.64 "$7,492.00 " $220.00 "$4,407.00 " $126.55 $81.84 $292.11 $140.00 $476.00 $140.00 $126.55 $151.87 $114.57 $126.55 $81.84 $81.84 $89.20 $359.52 $381.99 $170.85 $223.00 $259.44 $170.85 $224.70 $292.11 $303.35 $303.35 $303.35 $303.35 $375.00 $224.70 $81.84 $396.00 $181.18 $190.00 $69.56 $69.56 $81.84 $69.56 "$7,492.00 " 330104 97162 271 424 HC PT EVAL MOD COMPLEX 30 MIN O $728.67 $116.56 $116.56 $126.55 $364.33 $451.78 $451.78 $115.39 $181.00 $238.00 $181.00 $125.00 $546.50 $128.21 $275.27 $294.00 $151.87 $126.55 $437.20 "$7,492.00 " $220.00 "$4,407.00 " $126.55 $116.56 $473.64 $140.00 $476.00 $140.00 $126.55 $151.87 $163.18 $126.55 $116.56 $116.56 $127.05 $582.94 $619.37 $170.85 $223.00 $259.44 $170.85 $364.33 $473.64 $491.85 $491.85 $491.85 $491.85 $375.00 $364.33 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97799 493 430 HC UNLISTED PHYSICAL MEDICINE/REHAB SVC OR PROCEDURE - OT O $304.95 N/A N/A $25.56 $152.47 $189.07 $189.07 N/A $181.00 $239.00 $181.00 $126.00 $228.71 N/A $275.27 $294.00 $30.68 $25.56 $182.97 "$7,492.00 " $220.00 "$4,407.00 " $25.56 N/A $198.22 $35.79 $631.00 $25.56 $25.56 $30.68 N/A $25.56 N/A N/A N/A $243.96 $259.21 $34.51 $223.00 $52.40 $34.51 $152.47 $198.22 $205.84 $205.84 $205.84 $205.84 $375.00 N/A N/A $396.00 $181.18 $190.00 N/A N/A N/A $25.56 "$7,492.00 " 330104 29085 5101 39 430 HC APPLY HAND/WRIST CAST O $679.45 $174.87 $174.87 $293.16 $339.73 $421.26 $421.26 $173.13 $181.00 $239.00 $181.00 $126.00 $509.59 $192.36 $275.27 $294.00 $351.80 $293.16 $407.67 "$7,492.00 " $220.00 "$4,407.00 " $293.16 $174.87 $209.85 $410.43 $631.00 $293.16 $293.16 $351.80 $244.82 $293.16 $174.87 $174.87 $190.61 $543.56 $577.53 $293.16 $223.00 $600.98 $293.16 $339.73 $259.00 $458.63 $458.63 $458.63 $458.63 $375.00 $183.62 $174.87 $396.00 $181.18 $190.00 $148.64 $148.64 $174.87 $126.00 "$7,492.00 " 330104 97110 269 430 HC OT THERAPEUTIC EXERCISES O $332.77 $34.13 $34.13 $72.07 $166.38 $206.32 $206.32 $33.79 $181.00 $239.00 $181.00 $126.00 $249.58 $37.55 $275.27 $294.00 $86.49 $72.07 $199.66 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $34.13 $216.30 $100.90 $631.00 $72.07 $72.07 $86.49 $47.79 $72.07 $34.13 $34.13 $37.21 $266.22 $282.85 $97.30 $223.00 $147.75 $97.30 $166.38 $216.30 $224.62 $224.62 $224.62 $224.62 $375.00 $35.84 $34.13 $396.00 $181.18 $190.00 $29.01 $29.01 $34.13 $29.01 "$7,492.00 " 330104 97116 493 430 HC OT GAIT TRAINING O $332.77 $34.13 $34.13 $25.56 $166.38 $206.32 $206.32 $33.79 $181.00 $239.00 $181.00 $126.00 $249.58 $37.55 $275.27 $294.00 $30.68 $25.56 $199.66 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $34.13 $216.30 $35.79 $631.00 $25.56 $25.56 $30.68 $47.79 $25.56 $34.13 $34.13 $37.21 $266.22 $282.85 $34.51 $223.00 $52.40 $34.51 $166.38 $216.30 $224.62 $224.62 $224.62 $224.62 $375.00 $35.84 $34.13 $396.00 $181.18 $190.00 $29.01 $29.01 $34.13 $25.56 "$7,492.00 " 330104 97530 269 430 HC OT THERAPEUTIC ACTIVITIES O $182.97 $43.63 $43.63 $2.35 $91.48 $113.44 $113.44 $43.20 $181.00 $239.00 $181.00 $126.00 $137.23 $48.00 $275.27 $294.00 $2.82 $2.35 $109.78 "$7,492.00 " $220.00 "$4,407.00 " $2.35 $43.63 $118.93 $3.29 $631.00 $2.35 $2.35 $2.82 $61.09 $2.35 $43.63 $43.63 $47.56 $146.38 $155.52 $3.17 $223.00 $4.82 $3.17 $91.48 $118.93 $123.50 $123.50 $123.50 $123.50 $375.00 $45.82 $43.63 $396.00 $181.18 $190.00 $37.09 $37.09 $43.63 $2.35 "$7,492.00 " 330104 97535 493 430 HC OT SELF CARE MNGMENT TRAINING O $361.66 $38.24 $38.24 $25.56 $180.83 $224.23 $224.23 $37.86 $181.00 $239.00 $181.00 $126.00 $271.25 $42.07 $275.27 $294.00 $30.68 $25.56 $217.00 "$7,492.00 " $220.00 "$4,407.00 " $25.56 $38.24 $235.08 $35.79 $631.00 $25.56 $25.56 $30.68 $53.54 $25.56 $38.24 $38.24 $41.68 $289.33 $307.41 $34.51 $223.00 $52.40 $34.51 $180.83 $235.08 $244.12 $244.12 $244.12 $244.12 $375.00 $40.15 $38.24 $396.00 $181.18 $190.00 $32.51 $32.51 $38.24 $25.56 "$7,492.00 " 330104 97760 269 430 HC OT ORTHOTIC MGMT AND TRAINING O $318.86 $57.28 $57.28 $72.07 $159.43 $197.69 $197.69 $56.71 $181.00 $239.00 $181.00 $126.00 $239.15 $63.01 $275.27 $294.00 $86.49 $72.07 $191.32 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $57.28 $207.26 $100.90 $631.00 $72.07 $72.07 $86.49 $80.19 $72.07 $57.28 $57.28 $62.44 $255.09 $271.03 $97.30 $223.00 $147.75 $97.30 $159.43 $207.26 $215.23 $215.23 $215.23 $215.23 $375.00 $60.15 $57.28 $396.00 $181.18 $190.00 $48.69 $48.69 $57.28 $48.69 "$7,492.00 " 330104 97166 270 434 HC OT DRIVER EVAL MOD COMPLEX 45 MIN O $588.50 $116.56 $116.56 $134.22 $294.25 $364.87 $364.87 $115.39 $181.00 $239.00 $181.00 $126.00 $441.38 $128.21 $275.27 $294.00 $161.07 $134.22 $353.10 "$7,492.00 " $220.00 "$4,407.00 " $134.22 $116.56 $382.53 $140.00 $631.00 $140.00 $134.22 $161.07 $163.18 $134.22 $116.56 $116.56 $127.05 $470.80 $500.22 $181.20 $223.00 $275.16 $181.20 $294.25 $382.53 $397.24 $397.24 $397.24 $397.24 $375.00 $294.25 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97167 270 434 HC OT EVAL HIGH COMPLEX 60 MIN O $758.63 $116.56 $116.56 $134.22 $379.31 $470.35 $470.35 $115.39 $181.00 $239.00 $181.00 $126.00 $568.97 $128.21 $275.27 $294.00 $161.07 $134.22 $455.18 "$7,492.00 " $220.00 "$4,407.00 " $134.22 $116.56 $493.11 $140.00 $631.00 $140.00 $134.22 $161.07 $163.18 $134.22 $116.56 $116.56 $127.05 $606.90 $644.84 $181.20 $223.00 $275.16 $181.20 $379.31 $493.11 $512.08 $512.08 $512.08 $512.08 $375.00 $379.31 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97165 270 434 HC OT EVAL LOW COMPLEX 30 MIN O $590.64 $116.56 $116.56 $134.22 $295.32 $366.20 $366.20 $115.39 $181.00 $239.00 $181.00 $126.00 $442.98 $128.21 $275.27 $294.00 $161.07 $134.22 $354.38 "$7,492.00 " $220.00 "$4,407.00 " $134.22 $116.56 $383.92 $140.00 $631.00 $140.00 $134.22 $161.07 $163.18 $134.22 $116.56 $116.56 $127.05 $472.51 $502.04 $181.20 $223.00 $275.16 $181.20 $295.32 $383.92 $398.68 $398.68 $398.68 $398.68 $375.00 $295.32 $116.56 $396.00 $181.18 $190.00 $99.07 $99.07 $116.56 $99.07 "$7,492.00 " 330104 97130 269 440 HC ST THER IVNTJ EA ADDL 15 MIN O $98.44 $24.12 $24.12 $72.07 $49.22 $61.03 $61.03 $23.88 $181.00 $258.00 $181.00 $136.00 $73.83 $26.53 $275.27 $294.00 $86.49 $72.07 $59.06 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $24.12 $63.99 $100.90 $639.00 $72.07 $72.07 $86.49 $33.77 $72.07 $24.12 $24.12 $26.29 $78.75 $83.67 $97.30 $223.00 $147.75 $97.30 $49.22 $63.99 $66.45 $66.45 $66.45 $66.45 $375.00 $25.33 $24.12 $396.00 $181.18 $190.00 $20.50 $20.50 $24.12 $20.50 "$7,492.00 " 330104 97129 269 440 HC ST THER IVNTJ 1ST 15 MIN O $103.79 $24.83 $24.83 $72.07 $51.90 $64.35 $64.35 $24.59 $181.00 $258.00 $181.00 $136.00 $77.84 $27.32 $275.27 $294.00 $86.49 $72.07 $62.27 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $24.83 $67.46 $100.90 $639.00 $72.07 $72.07 $86.49 $34.77 $72.07 $24.83 $24.83 $27.07 $83.03 $88.22 $97.30 $223.00 $147.75 $97.30 $51.90 $67.46 $70.06 $70.06 $70.06 $70.06 $375.00 $26.08 $24.83 $396.00 $181.18 $190.00 $21.11 $21.11 $24.83 $21.11 "$7,492.00 " 330104 96125 310 440 HC COGNITIVE TEST BY HC PRO O $485.78 $118.51 $118.51 $153.40 $242.89 $301.18 $301.18 $117.32 $181.00 $258.00 $181.00 $136.00 $364.33 $130.36 $275.27 $294.00 $184.08 $153.40 $291.47 "$7,492.00 " $220.00 "$4,407.00 " $153.40 $118.51 $315.76 $214.76 $639.00 $153.40 $153.40 $184.08 $165.91 $153.40 $118.51 $118.51 $129.17 $388.62 $412.91 $207.09 $223.00 $314.47 $207.09 $242.89 $315.76 $327.90 $327.90 $327.90 $327.90 $375.00 $124.43 $118.51 $396.00 $181.18 $190.00 $100.73 $100.73 $118.51 $100.73 "$7,492.00 " 330104 97799 493 440 HC UNLISTED PHYSICAL MEDICINE/REHAB SVC OR PROCEDURE - ST O $304.95 N/A N/A $25.56 $152.47 $189.07 $189.07 N/A $181.00 $258.00 $181.00 $136.00 $228.71 N/A $275.27 $294.00 $30.68 $25.56 $182.97 "$7,492.00 " $220.00 "$4,407.00 " $25.56 N/A $198.22 $35.79 $639.00 $25.56 $25.56 $30.68 N/A $25.56 N/A N/A N/A $243.96 $259.21 $34.51 $223.00 $52.40 $34.51 $152.47 $198.22 $205.84 $205.84 $205.84 $205.84 $375.00 N/A N/A $396.00 $181.18 $190.00 N/A N/A N/A $25.56 "$7,492.00 " 330104 92524 272 440 HC BEHAVRAL QUALIT ANALYS VOICE O "$1,530.10 " $126.75 $126.75 $29.03 $765.05 $948.66 $948.66 $125.48 $181.00 $258.00 $181.00 $136.00 "$1,147.57 " $139.43 $275.27 $294.00 $34.84 $29.03 $918.06 "$7,492.00 " $220.00 "$4,407.00 " $29.03 $126.75 $994.56 $40.64 $639.00 $29.03 $29.03 $34.84 $177.45 $29.03 $126.75 $126.75 $138.16 "$1,224.08 " "$1,300.58 " $39.19 $223.00 $59.51 $39.19 $765.05 $994.56 "$1,032.82 " "$1,032.82 " "$1,032.82 " "$1,032.82 " $375.00 $133.09 $126.75 $396.00 $181.18 $190.00 $107.74 $107.74 $126.75 $29.03 "$7,492.00 " 330104 92523 272 440 HC SPEECH SOUND LANG COMPREHEN O $849.58 $262.28 $262.28 $57.84 $424.79 $526.74 $526.74 $259.66 $181.00 $258.00 $181.00 $136.00 $637.19 $288.51 $275.27 $294.00 $69.41 $57.84 $509.75 "$7,492.00 " $220.00 "$4,407.00 " $57.84 $262.28 $552.23 $80.98 $639.00 $57.84 $57.84 $69.41 $367.20 $57.84 $262.28 $262.28 $285.89 $679.66 $722.14 $78.08 $223.00 $118.57 $78.08 $424.79 $552.23 $573.47 $573.47 $573.47 $573.47 $375.00 $275.40 $262.28 $396.00 $181.18 $190.00 $222.94 $222.94 $262.28 $57.84 "$7,492.00 " 330104 92507 272 440 HC SPEECH/HEARING THERAPY; INDIVIDUAL O $511.46 $88.25 $88.25 $4.70 $255.73 $317.11 $317.11 $87.37 $181.00 $258.00 $181.00 $136.00 $383.59 $97.08 $275.27 $294.00 $5.64 $4.70 $306.88 "$7,492.00 " $220.00 "$4,407.00 " $4.70 $88.25 $332.45 $6.58 $639.00 $4.70 $4.70 $5.64 $123.56 $4.70 $88.25 $88.25 $96.20 $409.17 $434.74 $6.35 $223.00 $9.63 $6.35 $255.73 $332.45 $345.24 $345.24 $345.24 $345.24 $375.00 $92.67 $88.25 $396.00 $181.18 $190.00 $75.02 $75.02 $88.25 $4.70 "$7,492.00 " 330104 92526 269 440 HC ORAL FUNCTION THERAPY O $511.46 $98.31 $98.31 $72.07 $255.73 $317.11 $317.11 $97.33 $181.00 $258.00 $181.00 $136.00 $383.59 $108.14 $275.27 $294.00 $86.49 $72.07 $306.88 "$7,492.00 " $220.00 "$4,407.00 " $72.07 $98.31 $332.45 $100.90 $639.00 $72.07 $72.07 $86.49 $137.64 $72.07 $98.31 $98.31 $107.16 $409.17 $434.74 $97.30 $223.00 $147.75 $97.30 $255.73 $332.45 $345.24 $345.24 $345.24 $345.24 $375.00 $103.23 $98.31 $396.00 $181.18 $190.00 $83.56 $83.56 $98.31 $72.07 "$7,492.00 " 330104 92611 389 444 HC MOTION FLUOROSCOPY/SWALLOW O "$1,021.85 " $108.01 $108.01 $258.22 $510.93 $633.55 $633.55 $106.93 $181.00 $258.00 $181.00 $136.00 $766.39 $118.81 $275.27 $294.00 $309.86 $258.22 $613.11 "$7,492.00 " $220.00 "$4,407.00 " $258.22 $108.01 $664.20 $140.00 $639.00 $140.00 $258.22 $309.86 $151.21 $258.22 $108.01 $108.01 $117.73 $817.48 $868.57 $348.60 $223.00 $529.35 $348.60 $510.93 $664.20 $689.75 $689.75 $689.75 $689.75 $375.00 $510.93 $108.01 $396.00 $181.18 $190.00 $91.81 $91.81 $108.01 $91.81 "$7,492.00 " 330104 92610 272 444 HC EVALUATE SWALLOWING FUNCTION O "$1,530.10 " $80.04 $80.04 $122.72 $765.05 $948.66 $948.66 $79.24 $181.00 $258.00 $181.00 $136.00 "$1,147.57 " $88.04 $275.27 $294.00 $147.26 $122.72 $918.06 "$7,492.00 " $220.00 "$4,407.00 " $122.72 $80.04 $994.56 $140.00 $639.00 $140.00 $122.72 $147.26 $112.06 $122.72 $80.04 $80.04 $87.24 "$1,224.08 " "$1,300.58 " $165.67 $223.00 $251.57 $165.67 $765.05 $994.56 "$1,032.82 " "$1,032.82 " "$1,032.82 " "$1,032.82 " $375.00 $765.05 $80.04 $396.00 $181.18 $190.00 $68.03 $68.03 $80.04 $68.03 "$7,492.00 " 330104 27266 5112 44 450 HC CLOSED RX POST HIP FIX DISLOCANESTH O "$5,510.50 " "$1,721.05 " "$1,721.05 " "$1,007.83 " "$2,523.00 " N/A N/A "$1,703.84 " "$1,007.83 " "$3,270.00 " "$1,007.83 " "$1,721.05 " "$4,132.88 " "$1,893.16 " N/A "$3,763.67 " "$1,209.40 " "$1,007.83 " "$3,306.30 " N/A N/A N/A "$1,007.83 " "$1,721.05 " "$2,065.26 " "$1,410.96 " N/A "$1,007.83 " "$1,007.83 " "$1,209.40 " "$2,409.47 " "$1,007.83 " "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,408.40 " "$4,683.93 " "$1,007.83 " N/A "$2,066.05 " "$1,007.83 " "$2,755.25 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,675.50 " "$1,007.83 " "$1,007.83 " N/A "$1,462.89 " "$1,721.05 " "$1,007.83 " "$4,683.93 " 330104 27788 5111 41 450 HC CLSD TX DIST FIB FX/LAT MALL W/ MANIP O "$1,213.38 " $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $910.04 $273.19 N/A $828.74 $656.27 $546.89 $728.03 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $970.70 "$1,031.37 " $546.89 N/A "$1,121.12 " $546.89 $606.69 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $809.32 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 27762 5112 41 450 HC CLTX MED ANKLE FX W/MNPJ O "$5,674.21 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " $656.27 $546.89 "$3,404.53 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " $546.89 N/A "$1,121.12 " $546.89 "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,823.08 " 330104 27560 5111 41 450 HC CLSD TX PATELLAR DISL O "$1,031.48 " $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $773.61 $273.19 N/A $704.50 $656.27 $546.89 $618.89 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $825.18 $876.76 $546.89 N/A "$1,121.12 " $546.89 $515.74 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $688.00 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 27550 5111 41 450 HC CLSD TX KNEE DISLOC O $955.51 $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $716.63 $273.19 N/A $652.61 $656.27 $546.89 $573.31 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $764.41 $812.18 $546.89 N/A "$1,121.12 " $546.89 $477.75 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $637.33 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 27265 5111 41 450 HC CLSD TX DISLOC TOTAL HIP O $971.56 $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $728.67 $273.19 N/A $663.58 $656.27 $546.89 $582.94 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $777.25 $825.83 $546.89 N/A "$1,121.12 " $546.89 $485.78 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $648.03 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 26742 5112 41 450 HC CLSD TX FING JT FX W/M O "$5,674.21 " "$1,721.05 " "$1,721.05 " $546.89 "$2,523.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " $656.27 $546.89 "$3,404.53 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " $546.89 N/A "$1,121.12 " $546.89 "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,823.08 " 330104 27250 5111 41 450 HC CLSD TX HIP DISL TRAUMATIC O $843.16 $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $632.37 $273.19 N/A $575.88 $656.27 $546.89 $505.90 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $674.53 $716.69 $546.89 N/A "$1,121.12 " $546.89 $421.58 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $562.39 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 27220 5111 41 450 HC CLSD TX HIP SOCKET FX W/O MANIP O "$1,092.47 " $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $819.35 $273.19 N/A $746.16 $656.27 $546.89 $655.48 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $873.98 $928.60 $546.89 N/A "$1,121.12 " $546.89 $546.24 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $728.68 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 26755 5111 41 450 HC CLSD TX DISTAL PHAL W/ MANIP O $856.00 $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $642.00 $273.19 N/A $584.65 $656.27 $546.89 $513.60 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $684.80 $727.60 $546.89 N/A "$1,121.12 " $546.89 $428.00 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $570.95 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 26700 5111 41 450 HC CLSD TX MCP DISL SINGLE W/ MANIP O $802.50 $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $601.88 $273.19 N/A $548.11 $656.27 $546.89 $481.50 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $642.00 $682.12 $546.89 N/A "$1,121.12 " $546.89 $401.25 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $535.27 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 26641 5111 41 450 HC CLSD TX CARPO/METAC DISL THUMB W/MANIP O $856.00 $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $642.00 $273.19 N/A $584.65 $656.27 $546.89 $513.60 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $684.80 $727.60 $546.89 N/A "$1,121.12 " $546.89 $428.00 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $570.95 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 26410 5112 33 450 HC REPAIR HAND TENDON O "$5,674.21 " "$1,721.05 " "$1,721.05 " "$1,376.65 " "$2,886.00 " N/A N/A "$1,703.84 " "$1,376.65 " "$3,270.00 " "$1,376.65 " "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " "$1,651.98 " "$1,376.65 " "$3,404.53 " N/A N/A N/A "$1,376.65 " "$1,721.05 " "$2,065.26 " "$1,927.31 " N/A "$1,376.65 " "$1,376.65 " "$1,651.98 " "$2,409.47 " "$1,376.65 " "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " "$1,376.65 " N/A "$2,822.14 " "$1,376.65 " "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " "$1,376.65 " "$1,376.65 " N/A "$1,462.89 " "$1,721.05 " "$1,376.65 " "$4,823.08 " 330104 27256 5111 41 450 HC TX SPONTANEOUS HIP DISL W/O MANIP O $856.00 $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $642.00 $273.19 N/A $584.65 $656.27 $546.89 $513.60 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $684.80 $727.60 $546.89 N/A "$1,121.12 " $546.89 $428.00 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $570.95 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,121.12 " 330104 27810 5112 41 450 HC CLSD TX BIMALLEOLAR ANK FX W/ MANIP O "$5,783.35 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,337.51 " "$1,893.16 " N/A "$3,950.03 " $656.27 $546.89 "$3,470.01 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,626.68 " "$4,915.85 " $546.89 N/A "$1,121.12 " $546.89 "$2,891.68 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,857.49 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,915.85 " 330104 27840 5111 41 450 HC TREAT ANKLE DISLOCATION O $843.16 $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $632.37 $273.19 N/A $575.88 $656.27 $546.89 $505.90 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $674.53 $716.69 $546.89 N/A "$1,121.12 " $546.89 $421.58 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $562.39 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 25565 5112 41 450 HC CLSD TX RAD & ULNAR SJAFT FX W/MANIP O "$8,556.79 " "$1,721.05 " "$1,721.05 " $546.89 "$2,523.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$6,417.59 " "$1,893.16 " N/A "$5,844.29 " $656.27 $546.89 "$5,134.07 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$6,845.43 " "$7,273.27 " $546.89 N/A "$1,121.12 " $546.89 "$4,278.40 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$5,707.38 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$7,273.27 " 330104 31238 5153 63 450 HC NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMRRG O "$6,179.25 " "$1,917.86 " "$1,917.86 " "$1,833.44 " "$1,878.00 " N/A N/A "$1,898.68 " "$1,833.44 " "$3,643.93 " "$1,833.44 " "$1,917.86 " "$4,634.44 " "$2,109.64 " N/A "$4,220.43 " "$2,200.13 " "$1,833.44 " "$3,707.55 " N/A N/A N/A "$1,833.44 " "$1,917.86 " "$2,301.43 " "$2,566.82 " N/A "$1,833.44 " "$1,833.44 " "$2,200.13 " "$2,685.00 " "$1,833.44 " "$1,917.86 " "$1,917.86 " "$2,090.46 " "$4,943.40 " "$5,252.36 " "$1,833.44 " N/A "$3,758.56 " "$1,833.44 " "$3,089.62 " N/A N/A N/A N/A N/A N/A "$2,013.75 " "$1,917.86 " "$4,121.56 " "$1,833.44 " "$1,833.44 " N/A "$1,630.18 " "$1,917.86 " "$1,630.18 " "$5,252.36 " 330104 31500 5161 92 450 HC INSERT EMERGENCY AIRWAY O "$2,546.60 " $249.34 $249.34 $623.67 $482.00 N/A N/A $246.85 $623.67 $473.75 $623.67 $249.34 "$1,909.95 " $274.28 N/A "$1,739.33 " $748.41 $623.67 "$1,527.96 " N/A N/A N/A $623.67 $249.34 $299.21 $873.14 N/A $623.67 $623.67 $748.41 $349.08 $623.67 $249.34 $249.34 $271.78 "$2,037.28 " "$2,164.61 " $623.67 N/A "$1,278.53 " $623.67 "$1,273.30 " N/A N/A N/A N/A N/A N/A $261.81 $249.34 "$1,698.58 " $623.67 $623.67 N/A $211.94 $249.34 $211.94 "$2,164.61 " 330104 31605 5161 72 450 HC TRACHEOSTOMY EMERGENCY; CRICOTHYROID MEMBRANE O "$3,170.41 " $249.34 $249.34 "$2,170.70 " "$1,099.00 " N/A N/A $246.85 "$2,170.70 " $473.75 "$2,170.70 " $249.34 "$2,377.81 " $274.28 N/A "$2,165.39 " "$2,604.84 " "$2,170.70 " "$1,902.25 " N/A N/A N/A "$2,170.70 " $249.34 $299.21 "$3,038.98 " N/A "$2,170.70 " "$2,170.70 " "$2,604.84 " $349.08 "$2,170.70 " $249.34 $249.34 $271.78 "$2,536.33 " "$2,694.85 " "$2,170.70 " N/A "$4,449.94 " "$2,170.70 " "$1,585.20 " N/A N/A N/A N/A N/A N/A $261.81 $249.34 "$2,114.66 " "$2,170.70 " "$2,170.70 " N/A $211.94 $249.34 $211.94 "$4,449.94 " 330104 36680 5735 49 450 HC INSERT NEEDLE BONE CAVITY O "$1,676.69 " $452.99 $452.99 $318.87 $482.00 N/A N/A $448.46 $318.87 $860.67 $318.87 $452.99 "$1,257.52 " $498.28 N/A "$1,145.18 " $382.65 $318.87 "$1,006.01 " N/A N/A N/A $318.87 $452.99 $543.58 $446.42 N/A $318.87 $318.87 $382.65 $634.18 $318.87 $452.99 $452.99 $493.75 "$1,341.35 " "$1,425.19 " $318.87 N/A $653.69 $318.87 $838.35 N/A N/A N/A N/A N/A N/A $475.64 $452.99 "$1,118.35 " $318.87 $318.87 N/A $385.04 $452.99 $318.87 "$1,425.19 " 330104 37195 5694 111 450 HC THROMBOLYTIC THERAPY STROKE O "$2,168.89 " $399.06 $399.06 $291.54 $482.00 N/A N/A $395.07 $291.54 $758.21 $291.54 $399.06 "$1,626.67 " $438.96 N/A "$1,481.35 " $349.84 $291.54 "$1,301.33 " N/A N/A N/A $291.54 $399.06 $478.87 $408.15 N/A $291.54 $291.54 $349.84 $558.68 $291.54 $399.06 $399.06 $434.97 "$1,735.11 " "$1,843.56 " $291.54 N/A $597.65 $291.54 "$1,084.44 " N/A N/A N/A N/A N/A N/A $419.01 $399.06 "$1,446.65 " $291.54 $291.54 N/A $339.20 $399.06 $291.54 "$1,843.56 " 330104 40650 5162 249 450 HC REPAIR LIP FULL THICKNESS; VERMILION ONLY O "$3,154.36 " $548.07 $548.07 $145.68 "$2,886.00 " N/A N/A $542.58 $145.68 "$1,041.32 " $145.68 $548.07 "$2,365.77 " $602.87 N/A "$2,154.43 " $174.82 $145.68 "$1,892.62 " N/A N/A N/A $145.68 $548.07 $657.68 $203.96 N/A $145.68 $145.68 $174.82 $767.29 $145.68 $548.07 $548.07 $597.39 "$2,523.49 " "$2,681.21 " $145.68 N/A $298.65 $145.68 "$1,577.18 " N/A N/A N/A N/A N/A N/A $575.47 $548.07 "$2,103.96 " $145.68 $145.68 N/A $465.86 $548.07 $145.68 "$2,886.00 " 330104 40652 5162 249 450 HC REPAIR LIP FULL THICKNESS; UPTO HALF VERTICL HEGHT O "$1,887.48 " $548.07 $548.07 $145.68 "$2,886.00 " N/A N/A $542.58 $145.68 "$1,041.32 " $145.68 $548.07 "$1,415.61 " $602.87 N/A "$1,289.15 " $174.82 $145.68 "$1,132.49 " N/A N/A N/A $145.68 $548.07 $657.68 $203.96 N/A $145.68 $145.68 $174.82 $767.29 $145.68 $548.07 $548.07 $597.39 "$1,509.98 " "$1,604.36 " $145.68 N/A $298.65 $145.68 $943.74 N/A N/A N/A N/A N/A N/A $575.47 $548.07 "$1,258.95 " $145.68 $145.68 N/A $465.86 $548.07 $145.68 "$2,886.00 " 330104 40654 5163 252 450 HC REPAIR LIP FULL THICK;OVR ONE-HALF VERT HT/CMPLX O "$5,350.00 " "$1,665.41 " "$1,665.41 " "$1,354.83 " "$2,886.00 " N/A N/A "$1,648.75 " "$1,354.83 " "$3,164.27 " "$1,354.83 " "$1,665.41 " "$4,012.50 " "$1,831.95 " N/A "$3,654.05 " "$1,625.80 " "$1,354.83 " "$3,210.00 " N/A N/A N/A "$1,354.83 " "$1,665.41 " "$1,998.49 " "$1,896.77 " N/A "$1,354.83 " "$1,354.83 " "$1,625.80 " "$2,331.57 " "$1,354.83 " "$1,665.41 " "$1,665.41 " "$1,815.29 " "$4,280.00 " "$4,547.50 " "$1,354.83 " N/A "$2,777.41 " "$1,354.83 " "$2,675.00 " N/A N/A N/A N/A N/A N/A "$1,748.68 " "$1,665.41 " "$3,568.45 " "$1,354.83 " "$1,354.83 " N/A "$1,415.60 " "$1,665.41 " "$1,354.83 " "$4,547.50 " 330104 40830 5161 249 450 HC CLS LACERATION VESTIBULE OF MOUTH; 2.5 CM OR LESS O "$1,722.70 " $249.34 $249.34 $145.68 "$1,099.00 " N/A N/A $246.85 $145.68 $473.75 $145.68 $249.34 "$1,292.03 " $274.28 N/A "$1,176.60 " $174.82 $145.68 "$1,033.62 " N/A N/A N/A $145.68 $249.34 $299.21 $203.96 N/A $145.68 $145.68 $174.82 $349.08 $145.68 $249.34 $249.34 $271.78 "$1,378.16 " "$1,464.30 " $145.68 N/A $298.65 $145.68 $861.35 N/A N/A N/A N/A N/A N/A $261.81 $249.34 "$1,149.04 " $145.68 $145.68 N/A $211.94 $249.34 $145.68 "$1,464.30 " 330104 41800 5734 249 450 HC DRAINAGE OF GUM LESION O $506.11 $139.30 $139.30 $145.68 "$1,878.00 " N/A N/A $137.91 $145.68 $264.67 $145.68 $139.30 $379.58 $153.23 N/A $345.67 $174.82 $145.68 $303.67 N/A N/A N/A $145.68 $139.30 $167.16 $203.96 N/A $145.68 $145.68 $174.82 $195.02 $145.68 $139.30 $139.30 $151.84 $404.89 $430.19 $145.68 N/A $298.65 $145.68 $253.06 N/A N/A N/A N/A N/A N/A $146.27 $139.30 $337.58 $145.68 $145.68 N/A $118.41 $139.30 $118.41 "$1,878.00 " 330104 42809 5735 249 450 HC REMOVE PHARYNX FOREIGN BODY O "$2,189.22 " $452.99 $452.99 $145.68 $482.00 N/A N/A $448.46 $145.68 $860.67 $145.68 $452.99 "$1,641.92 " $498.28 N/A "$1,495.24 " $174.82 $145.68 "$1,313.53 " N/A N/A N/A $145.68 $452.99 $543.58 $203.96 N/A $145.68 $145.68 $174.82 $634.18 $145.68 $452.99 $452.99 $493.75 "$1,751.38 " "$1,860.84 " $145.68 N/A $298.65 $145.68 "$1,094.61 " N/A N/A N/A N/A N/A N/A $475.64 $452.99 "$1,460.21 " $145.68 $145.68 N/A $385.04 $452.99 $145.68 "$1,860.84 " 330104 43752 5735 130 450 HC NASAL/OROGASTRIC W/TUBE PLMT O "$1,644.59 " $452.99 $452.99 $546.19 $482.00 N/A N/A $448.46 $546.19 $860.67 $546.19 $452.99 "$1,233.44 " $498.28 N/A "$1,123.25 " $655.43 $546.19 $986.75 N/A N/A N/A $546.19 $452.99 $543.58 $764.67 N/A $546.19 $546.19 $655.43 $634.18 $546.19 $452.99 $452.99 $493.75 "$1,315.67 " "$1,397.90 " $546.19 N/A "$1,119.69 " $546.19 $822.29 N/A N/A N/A N/A N/A N/A $475.64 $452.99 "$1,096.94 " $546.19 $546.19 N/A $385.04 $452.99 $385.04 "$1,397.90 " 330104 43753 5722 2003 450 HC TX GASTRO INTUB W/ASP O "$1,884.27 " $336.00 $336.00 N/A $482.00 N/A N/A $332.64 N/A $638.40 N/A $336.00 "$1,413.20 " $369.60 N/A "$1,286.96 " N/A N/A "$1,130.56 " N/A N/A N/A N/A $336.00 $403.20 N/A N/A N/A N/A N/A $470.40 N/A $336.00 $336.00 $366.24 "$1,507.42 " "$1,601.63 " N/A N/A N/A N/A $942.13 N/A N/A N/A N/A N/A N/A $352.80 $336.00 "$1,256.81 " N/A N/A N/A $285.60 $336.00 $285.60 "$1,601.63 " 330104 45005 5312 141 450 HC I&D OF SUBMUCOSAL ABSCESS RECTUM O "$6,263.78 " "$1,299.21 " "$1,299.21 " "$1,185.74 " "$2,523.00 " N/A N/A "$1,286.22 " "$1,185.74 " "$2,468.50 " "$1,185.74 " "$1,299.21 " "$4,697.84 " "$1,429.13 " N/A "$4,278.16 " "$1,422.89 " "$1,185.74 " "$3,758.27 " N/A N/A N/A "$1,185.74 " "$1,299.21 " "$1,559.05 " "$1,660.04 " N/A "$1,185.74 " "$1,185.74 " "$1,422.89 " "$1,818.89 " "$1,185.74 " "$1,299.21 " "$1,299.21 " "$1,416.14 " "$5,011.02 " "$5,324.21 " "$1,185.74 " N/A "$2,430.77 " "$1,185.74 " "$3,131.89 " N/A N/A N/A N/A N/A N/A "$1,364.17 " "$1,299.21 " "$4,177.94 " "$1,185.74 " "$1,185.74 " N/A "$1,104.33 " "$1,299.21 " "$1,104.33 " "$5,324.21 " 330104 45915 5312 141 450 HC RMVL FECAL IMPACTION/FB SPX UNDER ANES O "$4,494.00 " "$1,299.21 " "$1,299.21 " "$1,185.74 " "$1,878.00 " N/A N/A "$1,286.22 " "$1,185.74 " "$2,468.50 " "$1,185.74 " "$1,299.21 " "$3,370.50 " "$1,429.13 " N/A "$3,069.40 " "$1,422.89 " "$1,185.74 " "$2,696.40 " N/A N/A N/A "$1,185.74 " "$1,299.21 " "$1,559.05 " "$1,660.04 " N/A "$1,185.74 " "$1,185.74 " "$1,422.89 " "$1,818.89 " "$1,185.74 " "$1,299.21 " "$1,299.21 " "$1,416.14 " "$3,595.20 " "$3,819.90 " "$1,185.74 " N/A "$2,430.77 " "$1,185.74 " "$2,247.00 " N/A N/A N/A N/A N/A N/A "$1,364.17 " "$1,299.21 " "$2,997.50 " "$1,185.74 " "$1,185.74 " N/A "$1,104.33 " "$1,299.21 " "$1,104.33 " "$3,819.90 " 330104 50435 5373 170 450 HC EXCHANGE NEPHROSTOMY CATH O "$8,164.10 " "$2,225.37 " "$2,225.37 " "$1,193.01 " "$1,878.00 " N/A N/A "$2,203.12 " "$1,193.01 " "$4,228.21 " "$1,193.01 " "$2,225.37 " "$6,123.08 " "$2,447.91 " N/A "$5,576.08 " "$1,431.61 " "$1,193.01 " "$4,898.46 " N/A N/A N/A "$1,193.01 " "$2,225.37 " "$2,670.45 " "$1,670.21 " N/A "$1,193.01 " "$1,193.01 " "$1,431.61 " "$3,115.52 " "$1,193.01 " "$2,225.37 " "$2,225.37 " "$2,425.66 " "$6,531.28 " "$6,939.49 " "$1,193.01 " N/A "$2,445.67 " "$1,193.01 " "$4,082.05 " N/A N/A N/A N/A N/A N/A "$2,336.64 " "$2,225.37 " "$5,445.45 " "$1,193.01 " "$1,193.01 " N/A "$1,891.57 " "$2,225.37 " "$1,193.01 " "$6,939.49 " 330104 55100 5072 180 450 HC DRAINAGE OF SCROTUM ABSCESS O "$5,564.00 " "$1,799.07 " "$1,799.07 " "$1,414.56 " "$1,878.00 " N/A N/A "$1,781.08 " "$1,414.56 " "$3,418.23 " "$1,414.56 " "$1,799.07 " "$4,173.00 " "$1,978.98 " N/A "$3,800.21 " "$1,697.47 " "$1,414.56 " "$3,338.40 " N/A N/A N/A "$1,414.56 " "$1,799.07 " "$2,158.88 " "$1,980.39 " N/A "$1,414.56 " "$1,414.56 " "$1,697.47 " "$2,518.70 " "$1,414.56 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$4,451.20 " "$4,729.40 " "$1,414.56 " N/A "$2,899.85 " "$1,414.56 " "$2,782.00 " N/A N/A N/A N/A N/A N/A "$1,889.02 " "$1,799.07 " "$3,711.19 " "$1,414.56 " "$1,414.56 " N/A "$1,529.21 " "$1,799.07 " "$1,414.56 " "$4,729.40 " 330104 92953 5781 93 450 HC TEMPORARY EXTERNAL PACING O "$2,471.70 " $705.62 $705.62 $578.53 N/A N/A N/A $698.56 $578.53 "$1,340.67 " $578.53 $705.62 "$1,853.77 " $776.18 N/A "$1,688.17 " $694.24 $578.53 "$1,483.02 " N/A N/A N/A $578.53 $705.62 $846.74 $809.95 N/A $578.53 $578.53 $694.24 $987.86 $578.53 $705.62 $705.62 $769.12 "$1,977.36 " "$2,100.94 " $578.53 N/A "$1,185.99 " $578.53 "$1,235.85 " N/A N/A N/A N/A N/A N/A $740.90 $705.62 "$1,648.62 " $578.53 $578.53 N/A $599.77 $705.62 $578.53 "$2,100.94 " 330104 92977 5694 110 450 HC DISSOLVE CLOT HEART VESSEL;IV INFUSION O "$2,471.70 " $399.06 $399.06 $778.42 N/A N/A N/A $395.07 $778.42 $758.21 $778.42 $399.06 "$1,853.77 " $438.96 N/A "$1,688.17 " $934.10 $778.42 "$1,483.02 " N/A N/A N/A $778.42 $399.06 $478.87 "$1,089.78 " N/A $778.42 $778.42 $934.10 $558.68 $778.42 $399.06 $399.06 $434.97 "$1,977.36 " "$2,100.94 " $778.42 N/A "$1,595.75 " $778.42 "$1,235.85 " N/A N/A N/A N/A N/A N/A $419.01 $399.06 "$1,648.62 " $778.42 $778.42 N/A $339.20 $399.06 $339.20 "$2,100.94 " 330104 99281 5021 491 450 HC EMERGENCY DEPT VISIT LVL 1 O $731.88 $90.09 $90.09 $197.38 N/A $800.00 $729.00 $89.19 $197.38 $171.17 $197.38 $90.09 $548.91 $99.10 "$2,217.33 " $499.87 $236.86 $197.38 $439.13 "$2,946.00 " $323.42 "$2,689.00 " $197.38 $90.09 $108.11 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $126.12 $197.38 $90.09 $90.09 $98.20 $585.50 $622.10 $197.38 "$1,952.00 " $404.63 $197.38 $365.94 "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $94.59 $90.09 "$1,819.00 " $197.38 $197.38 $250.00 $76.58 $90.09 $76.58 "$2,946.00 " 330104 99282 5022 491 450 HC EMERGENCY DEPT VISIT LVL 2 O $924.48 $167.59 $167.59 $197.38 N/A $800.00 $729.00 $165.92 $197.38 $318.42 $197.38 $167.59 $693.36 $184.35 "$2,217.33 " $631.42 $236.86 $197.38 $554.69 "$2,946.00 " $601.65 "$2,689.00 " $197.38 $167.59 $201.11 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $234.63 $197.38 $167.59 $167.59 $182.67 $739.58 $785.81 $197.38 "$1,952.00 " $404.63 $197.38 $462.24 "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $175.97 $167.59 "$1,819.00 " $197.38 $197.38 $250.00 $142.45 $167.59 $142.45 "$2,946.00 " 330104 99283 5023 491 450 HC EMERGENCY DEPT VISIT LVL 3 O "$1,600.72 " $293.97 $293.97 $197.38 N/A $800.00 $729.00 $291.03 $197.38 $558.55 $197.38 $293.97 "$1,200.54 " $323.37 "$2,217.33 " "$1,093.29 " $236.86 $197.38 $960.43 "$2,946.00 " "$1,055.36 " "$2,689.00 " $197.38 $293.97 $352.77 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $411.56 $197.38 $293.97 $293.97 $320.43 "$1,280.58 " "$1,360.61 " $197.38 "$1,952.00 " $404.63 $197.38 $800.36 "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $308.67 $293.97 "$1,819.00 " $197.38 $197.38 $250.00 $249.88 $293.97 $197.38 "$2,946.00 " 330104 99284 5024 491 450 HC EMERGENCY DEPT VISIT LVL 4 O "$2,086.50 " $457.83 $457.83 $197.38 N/A $800.00 $729.00 $453.25 $197.38 $869.88 $197.38 $457.83 "$1,564.88 " $503.62 "$2,217.33 " "$1,425.08 " $236.86 $197.38 "$1,251.90 " "$2,946.00 " "$1,643.62 " "$2,689.00 " $197.38 $457.83 $549.40 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $640.97 $197.38 $457.83 $457.83 $499.04 "$1,669.20 " "$1,773.52 " $197.38 "$1,952.00 " $404.63 $197.38 "$1,043.25 " "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $480.72 $457.83 "$1,819.00 " $197.38 $197.38 $250.00 $389.16 $457.83 $197.38 "$2,946.00 " 330104 99285 5025 491 450 HC EMERGENCY DEPT VISIT LVL 5 O "$2,571.21 " $657.59 $657.59 $197.38 N/A $800.00 $729.00 $651.01 $197.38 "$1,249.42 " $197.38 $657.59 "$1,928.41 " $723.35 "$2,217.33 " "$1,756.14 " $236.86 $197.38 "$1,542.73 " "$2,946.00 " "$2,360.75 " "$2,689.00 " $197.38 $657.59 $789.11 $276.33 "$2,467.00 " $197.38 $197.38 $236.86 $920.63 $197.38 $657.59 $657.59 $716.77 "$2,056.97 " "$2,185.53 " $197.38 "$1,952.00 " $404.63 $197.38 "$1,285.61 " "$2,086.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,562.00 " "$1,382.00 " $690.47 $657.59 "$1,819.00 " $197.38 $197.38 $250.00 $558.95 $657.59 $197.38 "$2,946.00 " 330104 99291 5041 491 450 HC CRITICAL CARE FIRST HOUR O "$6,260.57 " $921.06 $921.06 $197.38 N/A N/A N/A $911.85 $197.38 "$1,750.02 " $197.38 $921.06 "$4,695.43 " "$1,013.17 " N/A "$4,275.97 " $236.86 $197.38 "$3,756.34 " N/A N/A N/A $197.38 $921.06 "$1,105.28 " $276.33 N/A $197.38 $197.38 $236.86 "$1,289.49 " $197.38 $921.06 $921.06 "$1,003.96 " "$5,008.46 " "$5,321.48 " $197.38 N/A $404.63 $197.38 "$3,130.28 " N/A N/A N/A N/A N/A N/A $967.12 $921.06 "$4,175.80 " $197.38 $197.38 N/A $782.90 $921.06 $197.38 "$5,321.48 " 330104 27818 5112 41 450 HC CLSD TX TRIMALLEOLAR ANK FX W/ MANIP O "$6,179.25 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,634.44 " "$1,893.16 " N/A "$4,220.43 " $656.27 $546.89 "$3,707.55 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,943.40 " "$5,252.36 " $546.89 N/A "$1,121.12 " $546.89 "$3,089.62 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$4,121.56 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$5,252.36 " 330104 25505 5112 41 450 HC CLSD TX RAD SHAFT FX W/ MANIP O "$5,510.50 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,132.88 " "$1,893.16 " N/A "$3,763.67 " $656.27 $546.89 "$3,306.30 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,408.40 " "$4,683.93 " $546.89 N/A "$1,121.12 " $546.89 "$2,755.25 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,675.50 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,683.93 " 330104 99292 491 450 HC CRITICAL CARE ADDL 30 MIN O "$5,695.61 " N/A N/A N/A N/A N/A N/A $125.20 N/A N/A N/A N/A "$4,271.71 " N/A N/A "$3,890.10 " N/A N/A "$3,417.37 " N/A N/A N/A N/A N/A "$3,702.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,556.49 " "$4,841.27 " N/A N/A N/A N/A "$2,847.80 " N/A N/A N/A N/A N/A N/A N/A N/A "$3,798.97 " N/A N/A N/A N/A N/A $125.20 "$4,841.27 " 330104 24640 5111 41 450 HC CLSD TREAT CHILD NURSEMAID ELBOW DISLOCATION O "$1,845.75 " $248.36 $248.36 $546.89 $482.00 N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 "$1,384.31 " $273.19 N/A "$1,260.65 " $656.27 $546.89 "$1,107.45 " N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $546.89 N/A "$1,121.12 " $546.89 $922.88 N/A N/A N/A N/A N/A N/A $260.78 $248.36 "$1,231.12 " $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,568.89 " 330104 24655 5112 41 450 HC CLSD TX RAD HD/NK FX W/ MANIP O "$5,350.00 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,012.50 " "$1,893.16 " N/A "$3,654.05 " $656.27 $546.89 "$3,210.00 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,280.00 " "$4,547.50 " $546.89 N/A "$1,121.12 " $546.89 "$2,675.00 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,568.45 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,547.50 " 330104 11001 17 450 HC DEBRIDE INFECTED SKIN (ADD-ON) EA.ADDL.10%BODYSURF O $160.50 N/A N/A $758.65 $482.00 N/A N/A $17.79 $758.65 N/A $758.65 N/A $120.38 N/A N/A $109.62 $910.38 $758.65 $96.30 N/A N/A N/A $758.65 N/A $104.33 "$1,062.10 " N/A $758.65 $758.65 $910.38 N/A $758.65 N/A N/A N/A $128.40 $136.42 "$1,024.17 " N/A "$1,555.23 " "$1,024.17 " $80.25 N/A N/A N/A N/A N/A N/A N/A N/A $107.05 $758.65 $758.65 N/A N/A N/A $17.79 "$1,555.23 " 330104 11010 5071 17 450 HC DEBRIDE SKIN&SUBQ TISSUES AT FX SITE O "$3,143.66 " $778.60 $778.60 $758.65 "$2,523.00 " N/A N/A $770.81 $758.65 "$1,479.33 " $758.65 $778.60 "$2,357.74 " $856.45 N/A "$2,147.12 " $910.38 $758.65 "$1,886.20 " N/A N/A N/A $758.65 $778.60 $934.31 "$1,062.10 " N/A $758.65 $758.65 $910.38 "$1,090.03 " $758.65 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $758.65 N/A "$1,555.23 " $758.65 "$1,571.83 " N/A N/A N/A N/A N/A N/A $817.53 $778.60 "$2,096.82 " $758.65 $758.65 N/A $661.81 $778.60 $661.81 "$2,672.11 " 330104 11760 5053 5 450 HC REPAIR OF NAIL BED O "$3,210.00 " $696.99 $696.99 $99.85 $482.00 N/A N/A $690.02 $99.85 "$1,324.28 " $99.85 $696.99 "$2,407.50 " $766.69 N/A "$2,192.43 " $119.82 $99.85 "$1,926.00 " N/A N/A N/A $99.85 $696.99 $836.39 $139.79 N/A $99.85 $99.85 $119.82 $975.78 $99.85 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $99.85 N/A $204.69 $99.85 "$1,605.00 " N/A N/A N/A N/A N/A N/A $731.84 $696.99 "$2,141.07 " $99.85 $99.85 N/A $592.44 $696.99 $99.85 "$2,728.50 " 330104 12006 5052 16 450 HC SIMPLE RPR S/N/A/GEN/TRK20.1-30.0CM O "$1,685.25 " $447.59 $447.59 $498.28 "$2,523.00 " N/A N/A $443.11 $498.28 $850.42 $498.28 $447.59 "$1,263.94 " $492.35 N/A "$1,151.03 " $597.93 $498.28 "$1,011.15 " N/A N/A N/A $498.28 $447.59 $537.10 $697.59 N/A $498.28 $498.28 $597.93 $626.62 $498.28 $447.59 $447.59 $487.87 "$1,348.20 " "$1,432.46 " $498.28 N/A "$1,021.46 " $498.28 $842.62 N/A N/A N/A N/A N/A N/A $469.97 $447.59 "$1,124.06 " $498.28 $498.28 N/A $380.45 $447.59 $380.45 "$2,523.00 " 330104 12057 5052 17 450 HC INTMD RPR FACE/MM >30.0 CM O "$1,415.61 " $447.59 $447.59 $758.65 "$2,523.00 " N/A N/A $443.11 $758.65 $850.42 $758.65 $447.59 "$1,061.71 " $492.35 N/A $966.86 $910.38 $758.65 $849.37 N/A N/A N/A $758.65 $447.59 $537.10 "$1,062.10 " N/A $758.65 $758.65 $910.38 $626.62 $758.65 $447.59 $447.59 $487.87 "$1,132.49 " "$1,203.27 " $758.65 N/A "$1,555.23 " $758.65 $707.80 N/A N/A N/A N/A N/A N/A $469.97 $447.59 $944.21 $758.65 $758.65 N/A $380.45 $447.59 $380.45 "$2,523.00 " 330104 13120 5053 9 450 HC REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM O "$2,354.00 " $696.99 $696.99 $684.98 "$2,523.00 " N/A N/A $690.02 $684.98 "$1,324.28 " $684.98 $696.99 "$1,765.50 " $766.69 N/A "$1,607.78 " $821.98 $684.98 "$1,412.40 " N/A N/A N/A $684.98 $696.99 $836.39 $958.98 N/A $684.98 $684.98 $821.98 $975.78 $684.98 $696.99 $696.99 $759.72 "$1,883.20 " "$2,000.90 " $684.98 N/A "$1,404.22 " $684.98 "$1,177.00 " N/A N/A N/A N/A N/A N/A $731.84 $696.99 "$1,570.12 " $684.98 $684.98 N/A $592.44 $696.99 $592.44 "$2,523.00 " 330104 21337 5164 41 450 HC CLOSED TX SEPTAL&NOSE FX O "$11,179.36 " "$3,413.30 " "$3,413.30 " $546.89 "$2,523.00 " N/A N/A "$3,379.16 " $546.89 "$6,485.26 " $546.89 "$3,413.30 " "$8,384.52 " "$3,754.63 " N/A "$7,635.50 " $656.27 $546.89 "$6,707.62 " N/A N/A N/A $546.89 "$3,413.30 " "$4,095.96 " $765.64 N/A $546.89 $546.89 $656.27 "$4,778.61 " $546.89 "$3,413.30 " "$3,413.30 " "$3,720.49 " "$8,943.49 " "$9,502.46 " $546.89 N/A "$1,121.12 " $546.89 "$5,589.68 " N/A N/A N/A N/A N/A N/A "$3,583.96 " "$3,413.30 " "$7,456.63 " $546.89 $546.89 N/A "$2,901.30 " "$3,413.30 " $546.89 "$9,502.46 " 330104 12005 5052 16 450 HC SIMPLE RPR S/N/A/GEN/TRK12.6-20.0CM O "$2,346.51 " $447.59 $447.59 $498.28 "$2,523.00 " N/A N/A $443.11 $498.28 $850.42 $498.28 $447.59 "$1,759.88 " $492.35 N/A "$1,602.67 " $597.93 $498.28 "$1,407.91 " N/A N/A N/A $498.28 $447.59 $537.10 $697.59 N/A $498.28 $498.28 $597.93 $626.62 $498.28 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $498.28 N/A "$1,021.46 " $498.28 "$1,173.26 " N/A N/A N/A N/A N/A N/A $469.97 $447.59 "$1,565.12 " $498.28 $498.28 N/A $380.45 $447.59 $380.45 "$2,523.00 " 330104 23650 5111 41 450 HC CLSD TX SHOULDER DISL W /MANIP O "$1,845.75 " $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 "$1,384.31 " $273.19 N/A "$1,260.65 " $656.27 $546.89 "$1,107.45 " N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $546.89 N/A "$1,121.12 " $546.89 $922.88 N/A N/A N/A N/A N/A N/A $260.78 $248.36 "$1,231.12 " $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 23655 5112 44 450 HC CLOSED RX SHLDR DISLOCANESTHESIA O "$8,556.79 " "$1,721.05 " "$1,721.05 " "$1,007.83 " "$1,878.00 " N/A N/A "$1,703.84 " "$1,007.83 " "$3,270.00 " "$1,007.83 " "$1,721.05 " "$6,417.59 " "$1,893.16 " N/A "$5,844.29 " "$1,209.40 " "$1,007.83 " "$5,134.07 " N/A N/A N/A "$1,007.83 " "$1,721.05 " "$2,065.26 " "$1,410.96 " N/A "$1,007.83 " "$1,007.83 " "$1,209.40 " "$2,409.47 " "$1,007.83 " "$1,721.05 " "$1,721.05 " "$1,875.95 " "$6,845.43 " "$7,273.27 " "$1,007.83 " N/A "$2,066.05 " "$1,007.83 " "$4,278.40 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$5,707.38 " "$1,007.83 " "$1,007.83 " N/A "$1,462.89 " "$1,721.05 " "$1,007.83 " "$7,273.27 " 330104 23665 5112 41 450 HC CLSD TREAT SHLDR W/HUMERAL DISLOCAT/FX W/MANIPULAT O "$5,674.21 " "$1,721.05 " "$1,721.05 " $546.89 "$2,523.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " $656.27 $546.89 "$3,404.53 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " $546.89 N/A "$1,121.12 " $546.89 "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,823.08 " 330104 24200 5072 51 450 HC REMOVAL OF ARM FOREIGN BODY O "$5,842.20 " "$1,799.07 " "$1,799.07 " "$1,167.87 " "$1,099.00 " N/A N/A "$1,781.08 " "$1,167.87 " "$3,418.23 " "$1,167.87 " "$1,799.07 " "$4,381.65 " "$1,978.98 " N/A "$3,990.22 " "$1,401.45 " "$1,167.87 " "$3,505.32 " N/A N/A N/A "$1,167.87 " "$1,799.07 " "$2,158.88 " "$1,635.02 " N/A "$1,167.87 " "$1,167.87 " "$1,401.45 " "$2,518.70 " "$1,167.87 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$4,673.76 " "$4,965.87 " "$1,167.87 " N/A "$2,394.14 " "$1,167.87 " "$2,921.10 " N/A N/A N/A N/A N/A N/A "$1,889.02 " "$1,799.07 " "$3,896.75 " "$1,167.87 " "$1,167.87 " N/A "$1,529.21 " "$1,799.07 " "$1,099.00 " "$4,965.87 " 330104 24577 5112 41 450 HC CLSD TX HYMERAL CONDYLAR FX W/ MANIP O "$5,674.21 " "$1,721.05 " "$1,721.05 " $546.89 "$1,878.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,255.66 " "$1,893.16 " N/A "$3,875.49 " $656.27 $546.89 "$3,404.53 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,539.37 " "$4,823.08 " $546.89 N/A "$1,121.12 " $546.89 "$2,837.11 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,784.70 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,823.08 " 330104 24600 5111 41 450 HC CLSD TREAT ELBOW DISLOCATION W/O ANESTH O "$1,166.30 " $248.36 $248.36 $546.89 "$1,878.00 " N/A N/A $245.87 $546.89 $471.88 $546.89 $248.36 $874.72 $273.19 N/A $796.58 $656.27 $546.89 $699.78 N/A N/A N/A $546.89 $248.36 $298.03 $765.64 N/A $546.89 $546.89 $656.27 $347.70 $546.89 $248.36 $248.36 $270.71 $933.04 $991.35 $546.89 N/A "$1,121.12 " $546.89 $583.15 N/A N/A N/A N/A N/A N/A $260.78 $248.36 $777.92 $546.89 $546.89 N/A $211.10 $248.36 $211.10 "$1,878.00 " 330104 24605 5112 44 450 HC CLOSED RX ELBOW DISLOCATNANESTHESIA O "$8,556.79 " "$1,721.05 " "$1,721.05 " "$1,007.83 " "$2,523.00 " N/A N/A "$1,703.84 " "$1,007.83 " "$3,270.00 " "$1,007.83 " "$1,721.05 " "$6,417.59 " "$1,893.16 " N/A "$5,844.29 " "$1,209.40 " "$1,007.83 " "$5,134.07 " N/A N/A N/A "$1,007.83 " "$1,721.05 " "$2,065.26 " "$1,410.96 " N/A "$1,007.83 " "$1,007.83 " "$1,209.40 " "$2,409.47 " "$1,007.83 " "$1,721.05 " "$1,721.05 " "$1,875.95 " "$6,845.43 " "$7,273.27 " "$1,007.83 " N/A "$2,066.05 " "$1,007.83 " "$4,278.40 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$5,707.38 " "$1,007.83 " "$1,007.83 " N/A "$1,462.89 " "$1,721.05 " "$1,007.83 " "$7,273.27 " 330104 23605 5112 41 450 HC FX HUMERAL NECK CLOSED W/MAN O "$5,842.20 " "$1,721.05 " "$1,721.05 " $546.89 "$2,523.00 " N/A N/A "$1,703.84 " $546.89 "$3,270.00 " $546.89 "$1,721.05 " "$4,381.65 " "$1,893.16 " N/A "$3,990.22 " $656.27 $546.89 "$3,505.32 " N/A N/A N/A $546.89 "$1,721.05 " "$2,065.26 " $765.64 N/A $546.89 $546.89 $656.27 "$2,409.47 " $546.89 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$4,673.76 " "$4,965.87 " $546.89 N/A "$1,121.12 " $546.89 "$2,921.10 " N/A N/A N/A N/A N/A N/A "$1,807.10 " "$1,721.05 " "$3,896.75 " $546.89 $546.89 N/A "$1,462.89 " "$1,721.05 " $546.89 "$4,965.87 " 330104 94729 412 460 HC CO/MEMBANE DIFFUSE CAPACITY O $791.80 N/A N/A $16.88 $395.90 $490.92 $490.92 $68.46 $16.88 N/A $16.88 N/A $593.85 N/A $514.67 $578.81 $20.26 $16.88 $475.08 "$7,492.00 " N/A "$4,407.00 " $16.88 N/A $514.67 $23.63 $633.44 $16.88 $16.88 $20.26 N/A $16.88 N/A N/A N/A $633.44 $673.03 $22.79 $593.85 $34.60 $22.79 $395.90 $514.67 $534.47 $534.47 $534.47 $534.47 N/A N/A N/A $528.13 $16.88 $16.88 N/A N/A N/A $16.88 "$7,492.00 " 330104 94727 5721 412 460 HC PULM FUNCTION TEST BY GAS O $791.80 $174.48 $174.48 $13.33 $395.90 $490.92 $490.92 $172.73 $13.33 $331.51 $13.33 $174.48 $593.85 $191.93 $514.67 $578.81 $16.00 $13.33 $475.08 "$7,492.00 " $593.23 "$4,407.00 " $13.33 $174.48 $209.37 $18.66 $633.44 $13.33 $13.33 $16.00 $244.27 $13.33 $174.48 $174.48 $190.18 $633.44 $673.03 $13.33 $593.85 $27.33 $13.33 $395.90 $287.89 $534.47 $534.47 $534.47 $534.47 N/A $183.20 $174.48 $528.13 $13.33 $13.33 $148.31 $148.31 $174.48 $13.33 "$7,492.00 " 330104 94626 5733 66 460 HC PHYS/QHP SVCS OP PULM REHAB W/CONT OXIMTRY MNTR O $211.86 $68.96 $68.96 $6.02 $105.93 $131.35 $131.35 $68.27 $6.02 $131.03 $6.02 $68.96 $158.90 $75.86 $137.71 $154.87 $7.22 $6.02 $127.12 "$7,492.00 " $234.47 "$4,407.00 " $6.02 $68.96 $82.75 $8.43 $169.49 $6.02 $6.02 $7.22 $96.55 $6.02 $68.96 $68.96 $75.17 $169.49 $180.08 $6.02 $158.90 $12.34 $6.02 $105.93 $113.79 $143.01 $143.01 $143.01 $143.01 N/A $72.41 $68.96 $141.31 $6.02 $6.02 $58.62 $58.62 $68.96 $6.02 "$7,492.00 " 330104 94625 5733 66 460 HC HYS/QHP SVCS OP PULM REHAB WO CONT OXIMTRY MNTR O $211.86 $68.96 $68.96 $3.87 $105.93 $131.35 $131.35 $68.27 $3.87 $131.03 $3.87 $68.96 $158.90 $75.86 $137.71 $154.87 $4.64 $3.87 $127.12 "$7,492.00 " $234.47 "$4,407.00 " $3.87 $68.96 $82.75 $5.42 $169.49 $3.87 $3.87 $4.64 $96.55 $3.87 $68.96 $68.96 $75.17 $169.49 $180.08 $3.87 $158.90 $7.93 $3.87 $105.93 $113.79 $143.01 $143.01 $143.01 $143.01 N/A $72.41 $68.96 $141.31 $3.87 $3.87 $58.62 $58.62 $68.96 $3.87 "$7,492.00 " 330104 94060 5722 60 460 HC BRONCHODILATION RESPONSE SPIROMETRY PRE/POST ADMIN O "$1,403.84 " $336.00 $336.00 $25.00 $701.92 $870.38 $870.38 $332.64 $25.00 $638.40 $25.00 $336.00 "$1,052.88 " $369.60 $912.50 "$1,026.21 " $30.00 $25.00 $842.30 "$7,492.00 " "$1,142.40 " "$4,407.00 " $25.00 $336.00 $403.20 $35.00 "$1,123.07 " $25.00 $25.00 $30.00 $470.40 $25.00 $336.00 $336.00 $366.24 "$1,123.07 " "$1,193.26 " $25.00 "$1,052.88 " $51.25 $25.00 $701.92 $554.40 $947.59 $947.59 $947.59 $947.59 N/A $352.80 $336.00 $936.36 $25.00 $25.00 $285.60 $285.60 $336.00 $25.00 "$7,492.00 " 330104 94200 5733 412 460 HC LUNG FUNCTION TEST (MBC/MVV) O $372.36 $68.96 $68.96 $10.00 $186.18 $230.86 $230.86 $68.27 $10.00 $131.03 $10.00 $68.96 $279.27 $75.86 $242.03 $272.20 $12.00 $10.00 $223.42 "$7,492.00 " $234.47 "$4,407.00 " $10.00 $68.96 $82.75 $14.00 $297.89 $10.00 $10.00 $12.00 $96.55 $10.00 $68.96 $68.96 $75.17 $297.89 $316.51 $10.00 $279.27 $20.50 $10.00 $186.18 $113.79 $251.34 $251.34 $251.34 $251.34 N/A $72.41 $68.96 $248.36 $10.00 $10.00 $58.62 $58.62 $68.96 $10.00 "$7,492.00 " 330104 94150 5721 412 460 HC VITAL CAPACITY TEST O $639.86 $174.48 $174.48 $3.00 $319.93 $396.71 $396.71 $172.73 $3.00 $331.51 $3.00 $174.48 $479.89 $191.93 $415.91 $467.74 $3.60 $3.00 $383.92 "$7,492.00 " $593.23 "$4,407.00 " $3.00 $174.48 $209.37 $4.20 $511.89 $3.00 $3.00 $3.60 $244.27 $3.00 $174.48 $174.48 $190.18 $511.89 $543.88 $3.00 $479.89 $6.15 $3.00 $319.93 $287.89 $431.91 $431.91 $431.91 $431.91 N/A $183.20 $174.48 $426.79 $3.00 $3.00 $148.31 $148.31 $174.48 $3.00 "$7,492.00 " 330104 94761 2004 460 HC NONINVASIVE EAR OR PULSE OXIMETRY MULT O $914.85 N/A N/A N/A $457.43 $567.21 $567.21 $4.84 N/A N/A N/A N/A $686.14 N/A $594.65 $668.76 N/A N/A $548.91 "$7,492.00 " N/A "$4,407.00 " N/A N/A $594.65 N/A $731.88 N/A N/A N/A N/A N/A N/A N/A N/A $731.88 $777.62 N/A $686.14 N/A N/A $457.43 $594.65 $617.52 $617.52 $617.52 $617.52 N/A N/A N/A $610.20 N/A N/A N/A N/A N/A $4.84 "$7,492.00 " 330104 94618 5734 412 460 HC PULMONARY STRESS TESTING O $773.61 $139.30 $139.30 $4.84 $386.81 $479.64 $479.64 $137.91 $4.84 $264.67 $4.84 $139.30 $580.21 $153.23 $502.85 $565.51 $5.81 $4.84 $464.17 "$7,492.00 " $473.63 "$4,407.00 " $4.84 $139.30 $167.16 $6.78 $618.89 $4.84 $4.84 $5.81 $195.02 $4.84 $139.30 $139.30 $151.84 $618.89 $657.57 $4.84 $580.21 $9.92 $4.84 $386.81 $229.85 $522.19 $522.19 $522.19 $522.19 N/A $146.27 $139.30 $516.00 $4.84 $4.84 $118.41 $118.41 $139.30 $4.84 "$7,492.00 " 330104 94762 5721 412 460 HC MEASURE BLOOD OXYGEN LEVEL O "$1,388.86 " $174.48 $174.48 $74.80 $694.43 $861.09 $861.09 $172.73 $74.80 $331.51 $74.80 $174.48 "$1,041.64 " $191.93 $902.76 "$1,015.26 " $89.76 $74.80 $833.32 "$7,492.00 " $593.23 "$4,407.00 " $74.80 $174.48 $209.37 $104.72 "$1,111.09 " $74.80 $74.80 $89.76 $244.27 $74.80 $174.48 $174.48 $190.18 "$1,111.09 " "$1,180.53 " $74.80 "$1,041.64 " $153.34 $74.80 $694.43 $287.89 $937.48 $937.48 $937.48 $937.48 N/A $183.20 $174.48 $926.37 $74.80 $74.80 $148.31 $148.31 $174.48 $74.80 "$7,492.00 " 330104 94760 2004 460 HC MEASURE BLOOD OXYGEN LEVEL; SINGLE O $709.41 N/A N/A N/A $354.70 $439.83 $439.83 $3.21 N/A N/A N/A N/A $532.06 N/A $461.12 $518.58 N/A N/A $425.65 "$7,492.00 " N/A "$4,407.00 " N/A N/A $461.12 N/A $567.53 N/A N/A N/A N/A N/A N/A N/A N/A $567.53 $603.00 N/A $532.06 N/A N/A $354.70 $461.12 $478.85 $478.85 $478.85 $478.85 N/A N/A N/A $473.18 N/A N/A N/A N/A N/A $3.21 "$7,492.00 " 330104 94010 5721 412 460 HC BREATHING CAPACITY TEST O "$1,118.15 " $174.48 $174.48 $15.00 $559.08 $693.25 $693.25 $172.73 $15.00 $331.51 $15.00 $174.48 $838.61 $191.93 $726.80 $817.37 $18.00 $15.00 $670.89 "$7,492.00 " $593.23 "$4,407.00 " $15.00 $174.48 $209.37 $21.00 $894.52 $15.00 $15.00 $18.00 $244.27 $15.00 $174.48 $174.48 $190.18 $894.52 $950.43 $15.00 $838.61 $30.75 $15.00 $559.08 $287.89 $754.75 $754.75 $754.75 $754.75 N/A $183.20 $174.48 $745.81 $15.00 $15.00 $148.31 $148.31 $174.48 $15.00 "$7,492.00 " 330104 92653 5722 257 471 HC AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT O "$1,123.50 " $336.00 $336.00 $11.29 $561.75 $696.57 $696.57 $332.64 $11.29 $638.40 $11.29 $336.00 $842.62 $369.60 $730.27 $821.28 $13.55 $11.29 $674.10 "$7,492.00 " "$1,142.40 " "$4,407.00 " $11.29 $336.00 $403.20 $15.81 $898.80 $11.29 $11.29 $13.55 $470.40 $11.29 $336.00 $336.00 $366.24 $898.80 $954.98 $11.29 $842.62 $23.14 $11.29 $561.75 $554.40 $758.36 $758.36 $758.36 $758.36 N/A $352.80 $336.00 $749.37 $11.29 $11.29 $285.60 $285.60 $336.00 $11.29 "$7,492.00 " 330104 92558 229 471 HC EVOKED AUDITORY TEST QUAL O "$1,288.28 " N/A N/A $81.73 $644.14 $798.73 $798.73 $9.64 $81.73 N/A $81.73 N/A $966.21 N/A $837.38 $941.73 $98.08 $81.73 $772.97 "$7,492.00 " N/A "$4,407.00 " $81.73 N/A $837.38 $114.42 "$1,030.62 " $81.73 $81.73 $98.08 N/A $81.73 N/A N/A N/A "$1,030.62 " "$1,095.04 " $110.34 $966.21 $167.55 $110.34 $644.14 $837.38 $869.59 $869.59 $869.59 $869.59 N/A N/A N/A $859.28 $81.73 $81.73 N/A N/A N/A $9.64 "$7,492.00 " 330104 92950 5722 92 480 HC HEART/LUNG RESUSCITATION CPR O "$1,660.64 " $336.00 $336.00 $579.94 $830.32 "$1,029.60 " "$1,029.60 " $332.64 $579.94 $638.40 $579.94 $336.00 "$1,245.48 " $369.60 "$1,079.42 " "$1,213.93 " $695.93 $579.94 $996.38 "$7,492.00 " "$1,142.40 " "$1,915.20 " $579.94 $336.00 $403.20 $811.91 "$1,328.51 " $579.94 $579.94 $695.93 $470.40 $579.94 $336.00 $336.00 $366.24 "$1,328.51 " "$1,411.54 " $579.94 "$1,245.48 " "$1,188.87 " $579.94 $830.32 $554.40 "$1,120.93 " "$1,120.93 " "$1,120.93 " "$1,120.93 " N/A $352.80 $336.00 "$1,107.65 " $579.94 $579.94 $285.60 $285.60 $336.00 $285.60 "$7,492.00 " 330104 0502T 2002 480 HC COR FFR DATA PREP & TRANSMIS O "$1,070.00 " N/A N/A N/A $535.00 $663.40 $663.40 N/A N/A N/A N/A N/A $802.50 N/A $695.50 $782.17 N/A N/A $642.00 "$7,492.00 " N/A N/A N/A N/A $695.50 N/A $856.00 N/A N/A N/A N/A N/A N/A N/A N/A $856.00 $909.50 N/A $802.50 N/A N/A $535.00 $695.50 $722.25 $722.25 $722.25 $722.25 N/A N/A N/A $713.69 N/A N/A N/A N/A N/A $535.00 "$7,492.00 " 330104 0503T 5724 4001 480 HC COR FFR ALYS GNRJ FFR MDL O "$5,350.00 " "$1,121.01 " "$1,121.01 " $84.23 "$2,675.00 " "$3,317.00 " "$3,317.00 " "$1,109.80 " $84.23 "$2,129.92 " $84.23 "$1,121.01 " "$4,012.50 " "$1,233.11 " "$3,477.50 " "$3,910.85 " $101.08 $84.23 "$3,210.00 " "$7,492.00 " "$3,811.44 " "$6,389.77 " $84.23 "$1,121.01 " "$1,345.22 " $117.92 "$4,280.00 " $84.23 $84.23 $101.08 "$1,569.42 " $84.23 "$1,121.01 " "$1,121.01 " "$1,221.90 " "$4,280.00 " "$4,547.50 " $84.23 "$4,012.50 " $172.68 $84.23 "$2,675.00 " "$1,849.67 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " N/A "$1,177.06 " "$1,121.01 " "$3,568.45 " $84.23 $84.23 $952.86 $952.86 "$1,121.01 " $84.23 "$7,492.00 " 330104 93280 5741 488 480 HC PM DEVICE PROGR EVAL DUAL O $515.74 $41.99 $41.99 $19.67 $257.87 $319.76 $319.76 $41.57 $19.67 $79.78 $19.67 $41.99 $386.81 $46.19 $335.23 $377.01 $23.60 $19.67 $309.44 "$7,492.00 " $142.77 $239.35 $19.67 $41.99 $50.39 $27.54 $412.59 $19.67 $19.67 $23.60 $58.79 $19.67 $41.99 $41.99 $45.77 $412.59 $438.38 $19.67 $386.81 $40.32 $19.67 $257.87 $69.28 $348.12 $348.12 $348.12 $348.12 N/A $44.09 $41.99 $344.00 $19.67 $19.67 $35.69 $35.69 $41.99 $19.67 "$7,492.00 " 330104 93308 5523 81 480 HC TTE F-UP OR LMTD O "$2,107.90 " $280.16 $280.16 $60.00 "$1,053.95 " "$1,306.90 " "$1,306.90 " $277.36 $60.00 $532.31 $60.00 $280.16 "$1,580.93 " $308.18 "$1,370.14 " "$1,540.87 " $72.00 $60.00 "$1,264.74 " "$7,492.00 " $952.56 "$1,596.93 " $60.00 $280.16 $336.20 $84.00 "$1,686.32 " $60.00 $60.00 $72.00 $392.23 $60.00 $280.16 $280.16 $305.38 "$1,686.32 " "$1,791.71 " $60.00 "$1,580.93 " $123.00 $60.00 "$1,053.95 " $462.27 "$1,422.83 " "$1,422.83 " "$1,422.83 " "$1,422.83 " N/A $294.17 $280.16 "$1,405.97 " $60.00 $60.00 $238.14 $238.14 $280.16 $60.00 "$7,492.00 " 330104 93312 5524 81 480 HC ECHO TRANSESOPHAGEAL;INCL PROBE &INTERP/RPRT O "$4,136.62 " $603.63 $603.63 $105.00 "$2,068.31 " "$2,564.70 " "$2,564.70 " $597.59 $105.00 "$1,146.89 " $105.00 $603.63 "$3,102.47 " $663.99 "$2,688.80 " "$3,023.87 " $126.00 $105.00 "$2,481.97 " "$7,492.00 " "$2,052.33 " "$3,440.66 " $105.00 $603.63 $724.35 $147.00 "$3,309.30 " $105.00 $105.00 $126.00 $845.08 $105.00 $603.63 $603.63 $657.95 "$3,309.30 " "$3,516.13 " $105.00 "$3,102.47 " $215.25 $105.00 "$2,068.31 " $995.98 "$2,792.22 " "$2,792.22 " "$2,792.22 " "$2,792.22 " N/A $633.81 $603.63 "$2,759.13 " $105.00 $105.00 $513.08 $513.08 $603.63 $105.00 "$7,492.00 " 330104 93319 81 480 HC 3D ECHO IMG&PST-PXESSING TEE/TTE CGEN CAR ANOMAL O $535.00 N/A N/A $5.38 $267.50 $331.70 $331.70 $27.72 $5.38 N/A $5.38 N/A $401.25 N/A $347.75 $391.08 $6.46 $5.38 $321.00 "$7,492.00 " N/A N/A $5.38 N/A $347.75 $7.53 $428.00 $5.38 $5.38 $6.46 N/A $5.38 N/A N/A N/A $428.00 $454.75 $7.26 $401.25 $11.03 $7.26 $267.50 $347.75 $361.12 $361.12 $361.12 $361.12 N/A N/A N/A $356.85 $5.38 $5.38 N/A N/A N/A $5.38 "$7,492.00 " 330104 93321 81 480 HC DOPPLER ECHO EXAM HEART; F/U OR LIMITED O "$1,744.10 " N/A N/A $60.00 $872.05 "$1,081.34 " "$1,081.34 " $30.08 $60.00 N/A $60.00 N/A "$1,308.07 " N/A "$1,133.66 " "$1,274.94 " $72.00 $60.00 "$1,046.46 " "$7,492.00 " N/A N/A $60.00 N/A "$1,133.66 " $84.00 "$1,395.28 " $60.00 $60.00 $72.00 N/A $60.00 N/A N/A N/A "$1,395.28 " "$1,482.48 " $81.00 "$1,308.07 " $123.00 $81.00 $872.05 "$1,133.66 " "$1,177.27 " "$1,177.27 " "$1,177.27 " "$1,177.27 " N/A N/A N/A "$1,163.31 " $60.00 $60.00 N/A N/A N/A $30.08 "$7,492.00 " 330104 93325 288 480 HC DOPPLER COLOR FLOW ADD-ON O "$1,884.27 " N/A N/A $32.80 $942.13 "$1,168.25 " "$1,168.25 " $28.10 $32.80 N/A $32.80 N/A "$1,413.20 " N/A "$1,224.78 " "$1,377.40 " $39.36 $32.80 "$1,130.56 " "$7,492.00 " N/A N/A $32.80 N/A "$1,224.78 " $45.92 "$1,507.42 " $32.80 $32.80 $39.36 N/A $32.80 N/A N/A N/A "$1,507.42 " "$1,601.63 " $44.28 "$1,413.20 " $67.24 $44.28 $942.13 "$1,224.78 " "$1,271.88 " "$1,271.88 " "$1,271.88 " "$1,271.88 " N/A N/A N/A "$1,256.81 " $32.80 $32.80 N/A N/A N/A $28.10 "$7,492.00 " 330104 93351 5524 81 480 HC STRESS TTE COMPLETE O "$1,820.07 " $603.63 $603.63 $142.00 $910.03 "$1,128.44 " "$1,128.44 " $597.59 $142.00 "$1,146.89 " $142.00 $603.63 "$1,365.05 " $663.99 "$1,183.05 " "$1,330.47 " $170.40 $142.00 "$1,092.04 " "$7,492.00 " "$2,052.33 " "$3,440.66 " $142.00 $603.63 $724.35 $198.80 "$1,456.06 " $142.00 $142.00 $170.40 $845.08 $142.00 $603.63 $603.63 $657.95 "$1,456.06 " "$1,547.06 " $142.00 "$1,365.05 " $291.10 $142.00 $910.03 $995.98 "$1,228.55 " "$1,228.55 " "$1,228.55 " "$1,228.55 " N/A $633.81 $603.63 "$1,213.99 " $142.00 $142.00 $513.08 $513.08 $603.63 $142.00 "$7,492.00 " 330104 92960 5781 93 480 HC CARDIOVERSION ELECTRIC EXT O "$2,936.08 " $705.62 $705.62 $537.96 "$1,468.04 " "$1,820.37 " "$1,820.37 " $698.56 $537.96 "$1,340.67 " $537.96 $705.62 "$2,202.06 " $776.18 "$1,908.45 " "$2,146.27 " $645.55 $537.96 "$1,761.65 " "$7,492.00 " "$2,399.09 " "$4,022.01 " $537.96 $705.62 $846.74 $753.15 "$2,348.86 " $537.96 $537.96 $645.55 $987.86 $537.96 $705.62 $705.62 $769.12 "$2,348.86 " "$2,495.67 " $537.96 "$2,202.06 " "$1,102.82 " $537.96 "$1,468.04 " "$1,164.26 " "$1,981.85 " "$1,981.85 " "$1,981.85 " "$1,981.85 " N/A $740.90 $705.62 "$1,958.37 " $537.96 $537.96 $599.77 $599.77 $705.62 $537.96 "$7,492.00 " 330104 93320 81 480 HC DOPPLER ECHO EXAM HEART; COMPLETE O "$1,884.27 " N/A N/A $87.00 $942.13 "$1,168.25 " "$1,168.25 " $60.14 $87.00 N/A $87.00 N/A "$1,413.20 " N/A "$1,224.78 " "$1,377.40 " $104.40 $87.00 "$1,130.56 " "$7,492.00 " N/A N/A $87.00 N/A "$1,224.78 " $121.80 "$1,507.42 " $87.00 $87.00 $104.40 N/A $87.00 N/A N/A N/A "$1,507.42 " "$1,601.63 " $117.45 "$1,413.20 " $178.35 $117.45 $942.13 "$1,224.78 " "$1,271.88 " "$1,271.88 " "$1,271.88 " "$1,271.88 " N/A N/A N/A "$1,256.81 " $87.00 $87.00 N/A N/A N/A $60.14 "$7,492.00 " 330104 93306 5524 81 480 HC TTE W/DOPPLER COMPLETE O "$2,548.74 " $603.63 $603.63 $206.50 "$1,274.37 " "$1,580.22 " "$1,580.22 " $597.59 $206.50 "$1,146.89 " $206.50 $603.63 "$1,911.55 " $663.99 "$1,656.68 " "$1,863.13 " $247.80 $206.50 "$1,529.24 " "$7,492.00 " "$2,052.33 " "$3,440.66 " $206.50 $603.63 $724.35 $289.10 "$2,038.99 " $206.50 $206.50 $247.80 $845.08 $206.50 $603.63 $603.63 $657.95 "$2,038.99 " "$2,166.43 " $206.50 "$1,911.55 " $423.32 $206.50 "$1,274.37 " $995.98 "$1,720.40 " "$1,720.40 " "$1,720.40 " "$1,720.40 " N/A $633.81 $603.63 "$1,700.01 " $206.50 $206.50 $513.08 $513.08 $603.63 $206.50 "$7,492.00 " 330104 481 HC CARDIOLOGY: CARDIAC CATH LAB PER 30 MIN O N/A N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,492.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,372.00 " N/A N/A N/A N/A N/A "$2,215.00 " "$7,492.00 " 330104 0680T 223 481 HC INSJ/RPLCMT PG ONLY ISDSS O "$10,453.90 " N/A N/A "$12,479.94 " N/A "$2,432.00 " "$2,215.00 " N/A "$12,479.94 " N/A "$12,479.94 " N/A "$7,840.42 " N/A "$6,795.03 " "$7,641.80 " "$14,975.93 " "$12,479.94 " "$6,272.34 " "$7,492.00 " N/A N/A "$12,479.94 " N/A "$6,795.03 " "$17,471.92 " "$8,363.12 " "$12,479.94 " "$12,479.94 " "$14,975.93 " N/A "$12,479.94 " N/A N/A N/A "$8,363.12 " "$8,885.81 " "$16,847.92 " "$7,840.42 " "$25,583.88 " "$16,847.92 " "$5,226.95 " "$6,795.03 " "$7,056.38 " "$7,056.38 " "$7,056.38 " "$7,056.38 " N/A N/A N/A "$3,372.00 " "$12,479.94 " "$12,479.94 " N/A N/A N/A "$2,215.00 " "$25,583.88 " 330104 0695T 413 481 HC BODY SRF MAPG PM/CVDFB TM IMPL O $124.12 N/A N/A N/A N/A "$2,432.00 " "$2,215.00 " N/A N/A N/A N/A N/A $93.09 N/A $80.68 $90.73 N/A N/A $74.47 "$7,492.00 " N/A N/A N/A N/A $80.68 N/A $99.30 N/A N/A N/A N/A N/A N/A N/A N/A $99.30 $105.50 N/A $93.09 N/A N/A $62.06 $80.68 $83.78 $83.78 $83.78 $83.78 N/A N/A N/A "$3,372.00 " N/A N/A N/A N/A N/A $62.06 "$7,492.00 " 330104 0696T 5741 413 481 HC BODY SURF MAPG PM/CVDFB F/UP O $99.51 $41.99 $41.99 N/A N/A "$2,432.00 " "$2,215.00 " $41.57 N/A $79.78 N/A $41.99 $74.63 $46.19 $64.68 $72.74 N/A N/A $59.71 "$7,492.00 " $142.77 $239.35 N/A $41.99 $50.39 N/A $79.61 N/A N/A N/A $58.79 N/A $41.99 $41.99 $45.77 $79.61 $84.58 N/A $74.63 N/A N/A $49.76 $69.28 $67.17 $67.17 $67.17 $67.17 N/A $44.09 $41.99 "$3,372.00 " N/A N/A $35.69 $35.69 $41.99 $35.69 "$7,492.00 " 330104 93017 5722 80 482 HC CARDIOVASCULAR STRESS TEST TRACING ONLY O "$2,403.22 " $336.00 $336.00 $30.00 "$1,201.61 " "$1,490.00 " "$1,490.00 " $332.64 $30.00 $638.40 $30.00 $336.00 "$1,802.42 " $369.60 "$1,562.09 " "$1,756.75 " $36.00 $30.00 "$1,441.93 " "$7,492.00 " "$1,142.40 " "$4,407.00 " $30.00 $336.00 $403.20 $42.00 "$1,922.58 " $30.00 $30.00 $36.00 $470.40 $30.00 $336.00 $336.00 $366.24 "$1,922.58 " "$2,042.74 " $30.00 "$1,802.42 " $61.50 $30.00 "$1,201.61 " $554.40 "$1,622.17 " "$1,622.17 " "$1,622.17 " "$1,622.17 " N/A $352.80 $336.00 "$1,602.95 " $30.00 $30.00 $285.60 $285.60 $336.00 $30.00 "$7,492.00 " 330104 93308 5523 81 483 HC 2D TTE W OR W/O FOL W/CONFU O "$2,278.03 " $280.16 $280.16 $60.00 "$1,139.02 " "$1,412.38 " "$1,412.38 " $277.36 $60.00 $532.31 $60.00 $280.16 "$1,708.52 " $308.18 "$1,480.72 " "$1,665.24 " $72.00 $60.00 "$1,366.82 " "$7,492.00 " $952.56 "$4,407.00 " $60.00 $280.16 $336.20 $84.00 "$1,822.42 " $60.00 $60.00 $72.00 $392.23 $60.00 $280.16 $280.16 $305.38 "$1,822.42 " "$1,936.33 " $60.00 "$1,708.52 " $123.00 $60.00 "$1,139.02 " $462.27 "$1,537.67 " "$1,537.67 " "$1,537.67 " "$1,537.67 " N/A $294.17 $280.16 "$1,519.45 " $60.00 $60.00 $238.14 $238.14 $280.16 $60.00 "$7,492.00 " 330104 93356 81 483 HC MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH O $143.38 N/A N/A $327.87 $71.69 $88.90 $88.90 $13.30 $327.87 N/A $327.87 N/A $107.53 N/A $93.20 $104.81 $393.44 $327.87 $86.03 "$7,492.00 " N/A "$4,407.00 " $327.87 N/A $93.20 $459.02 $114.70 $327.87 $327.87 $393.44 N/A $327.87 N/A N/A N/A $114.70 $121.87 $442.62 $107.53 $672.13 $442.62 $71.69 $93.20 $96.78 $96.78 $96.78 $96.78 N/A N/A N/A $95.63 $327.87 $327.87 N/A N/A N/A $13.30 "$7,492.00 " 330104 C8930 5573 81 483 HC TTE W OR W/O CONTR CONT ECG O "$2,295.15 " $888.71 $888.71 $327.87 "$1,147.58 " "$1,422.99 " "$1,422.99 " $879.82 $327.87 "$1,688.54 " $327.87 $888.71 "$1,721.36 " $977.58 "$1,491.85 " "$1,677.75 " $393.44 $327.87 "$1,377.09 " "$7,492.00 " "$3,021.61 " "$4,407.00 " $327.87 $888.71 "$1,066.45 " $459.02 "$1,836.12 " $327.87 $327.87 $393.44 "$1,244.19 " $327.87 $888.71 $888.71 $968.69 "$1,836.12 " "$1,950.88 " $327.87 "$1,721.36 " $672.13 $327.87 "$1,147.58 " "$1,466.37 " "$1,549.23 " "$1,549.23 " "$1,549.23 " "$1,549.23 " N/A $933.14 $888.71 "$1,530.87 " $327.87 $327.87 $755.40 $755.40 $888.71 $327.87 "$7,492.00 " 330104 93306 5524 81 483 HC TTE W OR WO FOL WCONDOPPLER O "$3,137.24 " $603.63 $603.63 $206.50 "$1,568.62 " "$1,945.09 " "$1,945.09 " $597.59 $206.50 "$1,146.89 " $206.50 $603.63 "$2,352.93 " $663.99 "$2,039.21 " "$2,293.32 " $247.80 $206.50 "$1,882.34 " "$7,492.00 " "$2,052.33 " "$4,407.00 " $206.50 $603.63 $724.35 $289.10 "$2,509.79 " $206.50 $206.50 $247.80 $845.08 $206.50 $603.63 $603.63 $657.95 "$2,509.79 " "$2,666.65 " $206.50 "$2,352.93 " $423.32 $206.50 "$1,568.62 " $995.98 "$2,117.64 " "$2,117.64 " "$2,117.64 " "$2,117.64 " N/A $633.81 $603.63 "$2,092.54 " $206.50 $206.50 $513.08 $513.08 $603.63 $206.50 "$7,492.00 " 330104 0399T 81 483 HC MYOCARDIAL STRAIN IMAGING QUAN ASSMT O $143.38 N/A N/A $327.87 $71.69 $88.90 $88.90 $93.77 $327.87 N/A $327.87 N/A $107.53 N/A $93.20 $104.81 $393.44 $327.87 $86.03 "$7,492.00 " N/A "$4,407.00 " $327.87 N/A N/A $459.02 $114.70 $327.87 $327.87 $393.44 N/A $327.87 N/A N/A N/A $114.70 $121.87 $442.62 $107.53 $672.13 $442.62 $71.69 $93.20 $96.78 $96.78 $96.78 $96.78 N/A N/A N/A $95.63 $327.87 $327.87 N/A N/A N/A $71.69 "$7,492.00 " 330104 93303 5524 81 483 HC TTE W OR W/O FOL W/CONT COM O "$2,621.50 " $603.63 $603.63 $90.00 "$1,310.75 " "$1,625.33 " "$1,625.33 " $597.59 $90.00 "$1,146.89 " $90.00 $603.63 "$1,966.12 " $663.99 "$1,703.98 " "$1,916.32 " $108.00 $90.00 "$1,572.90 " "$7,492.00 " "$2,052.33 " "$4,407.00 " $90.00 $603.63 $724.35 $126.00 "$2,097.20 " $90.00 $90.00 $108.00 $845.08 $90.00 $603.63 $603.63 $657.95 "$2,097.20 " "$2,228.28 " $90.00 "$1,966.12 " $184.50 $90.00 "$1,310.75 " $995.98 "$1,769.51 " "$1,769.51 " "$1,769.51 " "$1,769.51 " N/A $633.81 $603.63 "$1,748.54 " $90.00 $90.00 $513.08 $513.08 $603.63 $90.00 "$7,492.00 " 330104 31502 5161 249 510 HC CHANGE OF WINDPIPE AIRWAY O "$2,363.63 " $249.34 $249.34 $135.47 $482.00 "$1,465.45 " "$1,465.45 " $246.85 $135.47 $473.75 $135.47 $249.34 "$1,772.72 " $274.28 "$1,489.09 " N/A $162.56 $135.47 "$1,418.18 " "$1,890.90 " $847.76 "$1,181.82 " $135.47 $249.34 $299.21 $189.66 "$1,890.90 " $135.47 $135.47 $162.56 $349.08 $135.47 $249.34 $249.34 $271.78 "$1,890.90 " "$2,009.09 " $135.47 "$1,772.72 " $277.71 $135.47 "$1,181.82 " $670.73 "$1,595.45 " "$1,595.45 " "$1,595.45 " "$1,595.45 " N/A $261.81 $249.34 "$1,576.54 " $135.47 $135.47 $211.94 $211.94 $249.34 $135.47 "$2,009.09 " 330104 30905 5734 249 510 HC CONTROL OF NOSEBLEED W/NASAL PACKS OR CAUTERY O "$1,307.54 " $139.30 $139.30 $135.47 "$1,878.00 " $810.67 $810.67 $137.91 $135.47 $264.67 $135.47 $139.30 $980.65 $153.23 $823.75 N/A $162.56 $135.47 $784.52 "$1,046.03 " $473.63 $653.77 $135.47 $139.30 $167.16 $189.66 "$1,046.03 " $135.47 $135.47 $162.56 $195.02 $135.47 $139.30 $139.30 $151.84 "$1,046.03 " "$1,111.41 " $135.47 "$3,883.00 " $277.71 $135.47 $653.77 $374.72 $882.59 $882.59 $882.59 $882.59 N/A $146.27 $139.30 $872.13 $135.47 $135.47 $118.41 $118.41 $139.30 $118.41 "$3,883.00 " 330104 28630 5111 41 510 HC TREAT- TOE DISLOCATION O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 $642.00 "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$1,042.50 " 330104 30903 5734 249 510 HC CONTROL OF NOSEBLEED COMPLEX O $503.97 $139.30 $139.30 $135.47 "$1,878.00 " $312.46 $312.46 $137.91 $135.47 $264.67 $135.47 $139.30 $377.98 $153.23 $317.50 N/A $162.56 $135.47 $302.38 $403.18 $473.63 $251.99 $135.47 $139.30 $167.16 $189.66 $403.18 $135.47 $135.47 $162.56 $195.02 $135.47 $139.30 $139.30 $151.84 $403.18 $428.37 $135.47 $377.98 $277.71 $135.47 $251.99 $374.72 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $135.47 $135.47 $118.41 $118.41 $139.30 $118.41 "$1,878.00 " 330104 30901 5734 249 510 HC CONTROL OF NOSEBLEED SIMPLE O "$1,307.54 " $139.30 $139.30 $135.47 $482.00 $810.67 $810.67 $137.91 $135.47 $264.67 $135.47 $139.30 $980.65 $153.23 $823.75 N/A $162.56 $135.47 $784.52 "$1,046.03 " $473.63 $653.77 $135.47 $139.30 $167.16 $189.66 "$1,046.03 " $135.47 $135.47 $162.56 $195.02 $135.47 $139.30 $139.30 $151.84 "$1,046.03 " "$1,111.41 " $135.47 $980.65 $277.71 $135.47 $653.77 $374.72 $882.59 $882.59 $882.59 $882.59 N/A $146.27 $139.30 $872.13 $135.47 $135.47 $118.41 $118.41 $139.30 $118.41 "$1,111.41 " 330104 30300 5734 249 510 HC REMOVE NASAL FOREIGN BODY O "$1,307.54 " $139.30 $139.30 $135.47 $482.00 $810.67 $810.67 $137.91 $135.47 $264.67 $135.47 $139.30 $980.65 $153.23 $823.75 N/A $162.56 $135.47 $784.52 "$1,046.03 " $473.63 $653.77 $135.47 $139.30 $167.16 $189.66 "$1,046.03 " $135.47 $135.47 $162.56 $195.02 $135.47 $139.30 $139.30 $151.84 "$1,046.03 " "$1,111.41 " $135.47 $980.65 $277.71 $135.47 $653.77 $374.72 $882.59 $882.59 $882.59 $882.59 N/A $146.27 $139.30 $872.13 $135.47 $135.47 $118.41 $118.41 $139.30 $118.41 "$1,111.41 " 330104 29581 5101 39 510 HC APPLY MULTLAY COMPRS LWR LEG O $814.27 $174.87 $174.87 $293.16 $482.00 $504.85 $504.85 $173.13 $293.16 $332.26 $293.16 $174.87 $610.70 $192.36 $512.99 N/A $351.80 $293.16 $488.56 $651.42 $594.57 $407.13 $293.16 $174.87 $209.85 $410.43 $651.42 $293.16 $293.16 $351.80 $244.82 $293.16 $174.87 $174.87 $190.61 $651.42 $692.13 $293.16 $610.70 $600.98 $293.16 $407.13 $470.41 $549.63 $549.63 $549.63 $549.63 N/A $183.62 $174.87 $543.12 $293.16 $293.16 $148.64 $148.64 $174.87 $148.64 $692.13 330104 29580 5101 39 510 HC APPLICATION OF PASTE BOOT O $814.27 $174.87 $174.87 $293.16 $482.00 $504.85 $504.85 $173.13 $293.16 $332.26 $293.16 $174.87 $610.70 $192.36 $512.99 N/A $351.80 $293.16 $488.56 $651.42 $594.57 $407.13 $293.16 $174.87 $209.85 $410.43 $651.42 $293.16 $293.16 $351.80 $244.82 $293.16 $174.87 $174.87 $190.61 $651.42 $692.13 $293.16 $610.70 $600.98 $293.16 $407.13 $470.41 $549.63 $549.63 $549.63 $549.63 N/A $183.62 $174.87 $543.12 $293.16 $293.16 $148.64 $148.64 $174.87 $148.64 $692.13 330104 29540 5101 40 510 HC STRAPPING OF ANKLE AND/OR FT O $546.77 $174.87 $174.87 $214.50 $482.00 $339.00 $339.00 $173.13 $214.50 $332.26 $214.50 $174.87 $410.08 $192.36 $344.47 N/A $257.41 $214.50 $328.06 $437.42 $594.57 $273.38 $214.50 $174.87 $209.85 $300.31 $437.42 $214.50 $214.50 $257.41 $244.82 $214.50 $174.87 $174.87 $190.61 $437.42 $464.75 $214.50 $410.08 $439.74 $214.50 $273.38 $470.41 $369.07 $369.07 $369.07 $369.07 N/A $183.62 $174.87 $364.70 $214.50 $214.50 $148.64 $148.64 $174.87 $148.64 $594.57 330104 29530 5734 40 510 HC STRAPPING OF KNEE O $485.78 $139.30 $139.30 $214.50 $482.00 $301.18 $301.18 $137.91 $214.50 $264.67 $214.50 $139.30 $364.33 $153.23 $306.04 N/A $257.41 $214.50 $291.47 $388.62 $473.63 $242.89 $214.50 $139.30 $167.16 $300.31 $388.62 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $388.62 $412.91 $214.50 $364.33 $439.74 $214.50 $242.89 $374.72 $327.90 $327.90 $327.90 $327.90 N/A $146.27 $139.30 $324.02 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 $482.00 330104 31575 5151 249 510 HC LARYNGOSCOPY; FLEXIBLE DIAGNOSTIC O "$1,719.49 " $214.45 $214.45 $135.47 $482.00 "$1,066.08 " "$1,066.08 " $212.31 $135.47 $407.46 $135.47 $214.45 "$1,289.62 " $235.90 "$1,083.28 " N/A $162.56 $135.47 "$1,031.69 " "$1,375.59 " $729.14 $859.75 $135.47 $214.45 $257.34 $189.66 "$1,375.59 " $135.47 $135.47 $162.56 $300.23 $135.47 $214.45 $214.45 $233.75 "$1,375.59 " "$1,461.57 " $135.47 "$1,289.62 " $277.71 $135.47 $859.75 $576.88 "$4,600.00 " "$4,600.00 " "$4,600.00 " "$4,600.00 " N/A $225.18 $214.45 "$1,146.90 " $135.47 $135.47 $182.29 $182.29 $214.45 $135.47 "$4,600.00 " 330104 29515 5101 40 510 HC APPLICATION LOWER LEG SPLINT O $789.66 $174.87 $174.87 $214.50 $482.00 $489.59 $489.59 $173.13 $214.50 $332.26 $214.50 $174.87 $592.25 $192.36 $497.49 N/A $257.41 $214.50 $473.80 $631.73 $594.57 $394.83 $214.50 $174.87 $209.85 $300.31 $631.73 $214.50 $214.50 $257.41 $244.82 $214.50 $174.87 $174.87 $190.61 $631.73 $671.21 $214.50 $592.25 $439.74 $214.50 $394.83 $470.41 $533.02 $533.02 $533.02 $533.02 N/A $183.62 $174.87 $526.70 $214.50 $214.50 $148.64 $148.64 $174.87 $148.64 $671.21 330104 32554 5181 68 510 HC ASPIRATE PLEURA W/O IMAGING O "$6,718.53 " $694.05 $694.05 $609.85 "$1,099.00 " "$4,165.49 " "$4,165.49 " $687.11 $609.85 "$1,318.69 " $609.85 $694.05 "$5,038.90 " $763.45 "$4,232.67 " N/A $731.82 $609.85 "$4,031.12 " "$5,374.82 " "$2,359.77 " "$3,359.26 " $609.85 $694.05 $832.86 $853.79 "$5,374.82 " $609.85 $609.85 $731.82 $971.67 $609.85 $694.05 $694.05 $756.51 "$5,374.82 " "$5,710.75 " $609.85 "$3,883.00 " "$1,250.19 " $609.85 "$3,359.26 " "$1,866.99 " "$4,535.01 " "$4,535.01 " "$4,535.01 " "$4,535.01 " N/A $728.75 $694.05 "$4,481.26 " $609.85 $609.85 $589.94 $589.94 $694.05 $589.94 "$5,710.75 " 330104 36511 5242 114 510 HC APHERESIS WBC O "$8,708.73 " "$1,631.45 " "$1,631.45 " $150.00 "$1,878.00 " "$5,399.41 " "$5,399.41 " "$1,615.14 " $150.00 "$3,099.76 " $150.00 "$1,631.45 " "$6,531.55 " "$1,794.60 " "$5,486.50 " N/A $180.00 $150.00 "$5,225.24 " "$6,966.98 " "$5,546.95 " "$4,354.36 " $150.00 "$1,631.45 " "$1,957.75 " $210.00 "$6,966.98 " $150.00 $150.00 $180.00 "$2,284.04 " $150.00 "$1,631.45 " "$1,631.45 " "$1,778.29 " "$6,966.98 " "$7,402.42 " $150.00 "$6,531.55 " $307.50 $150.00 "$4,354.36 " "$4,388.61 " "$5,878.39 " "$5,878.39 " "$5,878.39 " "$5,878.39 " N/A "$1,713.03 " "$1,631.45 " "$5,808.72 " $150.00 $150.00 "$1,386.74 " "$1,386.74 " "$1,631.45 " $150.00 "$7,402.42 " 330104 46083 5371 141 510 HC INCISE EXTERNAL HEMORRHOID O "$1,123.50 " $257.79 $257.79 "$1,102.59 " $482.00 $696.57 $696.57 $255.21 "$1,102.59 " $489.80 "$1,102.59 " $257.79 $842.62 $283.57 $707.80 N/A "$1,323.10 " "$1,102.59 " $674.10 $898.80 $876.48 $561.75 "$1,102.59 " $257.79 $309.35 "$1,543.62 " $898.80 "$1,102.59 " "$1,102.59 " "$1,323.10 " $360.90 "$1,102.59 " $257.79 $257.79 $280.99 $898.80 $954.98 "$1,102.59 " $842.62 "$2,260.30 " "$1,102.59 " $561.75 $693.45 $758.36 $758.36 $758.36 $758.36 N/A $270.68 $257.79 $749.37 "$1,102.59 " "$1,102.59 " $219.12 $219.12 $257.79 $219.12 "$2,260.30 " 330104 46050 5311 141 510 HC INCISION OF ANAL ABSCESS O "$3,640.14 " $997.03 $997.03 "$1,102.59 " "$1,878.00 " "$2,256.89 " "$2,256.89 " $987.06 "$1,102.59 " "$1,894.36 " "$1,102.59 " $997.03 "$2,730.11 " "$1,096.74 " "$2,293.29 " N/A "$1,323.10 " "$1,102.59 " "$2,184.08 " "$2,912.11 " "$3,389.91 " "$1,820.07 " "$1,102.59 " $997.03 "$1,196.44 " "$1,543.62 " "$2,912.11 " "$1,102.59 " "$1,102.59 " "$1,323.10 " "$1,395.84 " "$1,102.59 " $997.03 $997.03 "$1,086.76 " "$2,912.11 " "$3,094.12 " "$1,102.59 " "$2,730.11 " "$2,260.30 " "$1,102.59 " "$1,820.07 " "$2,682.02 " "$2,457.09 " "$2,457.09 " "$2,457.09 " "$2,457.09 " N/A "$1,046.88 " $997.03 "$2,427.97 " "$1,102.59 " "$1,102.59 " $847.48 $847.48 $997.03 $847.48 "$3,389.91 " 330104 46040 5312 141 510 HC INCISION OF RECTAL ABSCESS O "$4,494.00 " "$1,299.21 " "$1,299.21 " "$1,102.59 " "$2,886.00 " "$2,786.28 " "$2,786.28 " "$1,286.22 " "$1,102.59 " "$2,468.50 " "$1,102.59 " "$1,299.21 " "$3,370.50 " "$1,429.13 " "$2,831.22 " N/A "$1,323.10 " "$1,102.59 " "$2,696.40 " "$3,595.20 " "$4,417.32 " "$2,247.00 " "$1,102.59 " "$1,299.21 " "$1,559.05 " "$1,543.62 " "$3,595.20 " "$1,102.59 " "$1,102.59 " "$1,323.10 " "$1,818.89 " "$1,102.59 " "$1,299.21 " "$1,299.21 " "$1,416.14 " "$3,595.20 " "$3,819.90 " "$1,102.59 " "$3,883.00 " "$2,260.30 " "$1,102.59 " "$2,247.00 " "$3,494.88 " "$3,033.45 " "$3,033.45 " "$3,033.45 " "$3,033.45 " N/A "$1,364.17 " "$1,299.21 " "$2,997.50 " "$1,102.59 " "$1,102.59 " "$1,104.33 " "$1,104.33 " "$1,299.21 " "$1,102.59 " "$4,417.32 " 330104 43262 5303 138 510 HC ERCP W/SPHINCTEROTOMY/PAPILLOTOMY O "$13,816.91 " "$3,911.98 " "$3,911.98 " "$1,316.62 " "$2,523.00 " "$8,566.48 " "$8,566.48 " "$3,872.86 " "$1,316.62 " "$7,432.76 " "$1,316.62 " "$3,911.98 " "$10,362.68 " "$4,303.18 " "$8,704.65 " N/A "$1,579.94 " "$1,316.62 " "$8,290.15 " "$11,053.53 " "$13,300.73 " "$6,908.45 " "$1,316.62 " "$3,911.98 " "$4,694.38 " "$1,843.27 " "$11,053.53 " "$1,316.62 " "$1,316.62 " "$1,579.94 " "$5,476.77 " "$1,316.62 " "$3,911.98 " "$3,911.98 " "$4,264.06 " "$11,053.53 " "$11,744.37 " "$1,316.62 " "$10,362.68 " "$2,699.07 " "$1,316.62 " "$6,908.45 " "$10,523.23 " "$9,326.41 " "$9,326.41 " "$9,326.41 " "$9,326.41 " N/A "$4,107.58 " "$3,911.98 " "$9,215.88 " "$1,316.62 " "$1,316.62 " "$3,325.18 " "$3,325.18 " "$3,911.98 " "$1,316.62 " "$13,300.73 " 330104 43260 5303 138 510 HC ERCP W/SPECIMEN COLLECTION O "$13,816.91 " "$3,911.98 " "$3,911.98 " "$1,316.62 " "$2,523.00 " "$1,792.00 " "$1,631.00 " "$3,872.86 " "$1,316.62 " "$7,432.76 " "$1,316.62 " "$3,911.98 " "$10,362.68 " "$4,303.18 " "$8,704.65 " N/A "$1,579.94 " "$1,316.62 " "$8,290.15 " "$11,053.53 " "$13,300.73 " "$6,908.45 " "$1,316.62 " "$3,911.98 " "$4,694.38 " "$1,843.27 " "$11,053.53 " "$1,316.62 " "$1,316.62 " "$1,579.94 " "$5,476.77 " "$1,316.62 " "$3,911.98 " "$3,911.98 " "$4,264.06 " "$11,053.53 " "$11,744.37 " "$1,316.62 " "$10,362.68 " "$2,699.07 " "$1,316.62 " "$6,908.45 " "$10,523.23 " "$4,600.00 " "$4,600.00 " "$4,600.00 " "$4,600.00 " N/A "$4,107.58 " "$3,911.98 " "$9,215.88 " "$1,316.62 " "$1,316.62 " "$3,325.18 " "$3,325.18 " "$3,911.98 " "$1,316.62 " "$13,300.73 " 330104 43247 5301 134 510 HC EGD REMOVE FOREIGN BODY O "$3,370.50 " $990.40 $990.40 $814.80 "$2,523.00 " "$1,792.00 " "$1,631.00 " $980.49 $814.80 "$1,881.75 " $814.80 $990.40 "$2,527.88 " "$1,089.44 " "$2,123.41 " N/A $977.76 $814.80 "$2,022.30 " "$2,696.40 " "$3,367.35 " "$1,685.25 " $814.80 $990.40 "$1,188.48 " "$1,140.72 " "$2,696.40 " $814.80 $814.80 $977.76 "$1,386.56 " $814.80 $990.40 $990.40 "$1,079.53 " "$2,696.40 " "$2,864.92 " $814.80 "$2,527.88 " "$1,670.35 " $814.80 "$1,685.25 " "$2,664.17 " "$4,600.00 " "$4,600.00 " "$4,600.00 " "$4,600.00 " N/A "$1,039.92 " $990.40 "$2,248.12 " $814.80 $814.80 $841.84 $841.84 $990.40 $814.80 "$4,600.00 " 330104 43246 5302 134 510 HC EGD PLACE GASTROSTOMY TUBE O "$7,886.97 " "$2,089.46 " "$2,089.46 " $814.80 "$2,523.00 " "$1,792.00 " "$1,631.00 " "$2,068.56 " $814.80 "$3,969.96 " $814.80 "$2,089.46 " "$5,915.23 " "$2,298.40 " "$4,968.79 " N/A $977.76 $814.80 "$4,732.18 " "$6,309.58 " "$7,104.15 " "$3,943.49 " $814.80 "$2,089.46 " "$2,507.35 " "$1,140.72 " "$6,309.58 " $814.80 $814.80 $977.76 "$2,925.24 " $814.80 "$2,089.46 " "$2,089.46 " "$2,277.51 " "$6,309.58 " "$6,703.92 " $814.80 "$5,915.23 " "$1,670.35 " $814.80 "$3,943.49 " "$5,620.63 " "$5,323.70 " "$5,323.70 " "$5,323.70 " "$5,323.70 " N/A "$2,193.93 " "$2,089.46 " "$5,260.61 " $814.80 $814.80 "$1,776.04 " "$1,776.04 " "$2,089.46 " $814.80 "$7,104.15 " 330104 43239 5301 134 510 HC EGD BIOPSY SINGLE/MULTIPLE O "$3,210.00 " $990.40 $990.40 $814.80 "$2,523.00 " "$1,792.00 " "$1,631.00 " $980.49 $814.80 "$1,881.75 " $814.80 $990.40 "$2,407.50 " "$1,089.44 " "$2,022.30 " N/A $977.76 $814.80 "$1,926.00 " "$2,568.00 " "$3,367.35 " "$1,605.00 " $814.80 $990.40 "$1,188.48 " "$1,140.72 " "$2,568.00 " $814.80 $814.80 $977.76 "$1,386.56 " $814.80 $990.40 $990.40 "$1,079.53 " "$2,568.00 " "$2,728.50 " $814.80 "$2,407.50 " "$1,670.35 " $814.80 "$1,605.00 " "$2,664.17 " "$4,600.00 " "$4,600.00 " "$4,600.00 " "$4,600.00 " N/A "$1,039.92 " $990.40 "$2,141.07 " $814.80 $814.80 $841.84 $841.84 $990.40 $814.80 "$4,600.00 " 330104 42700 5161 249 510 HC DRAINAGE OF TONSIL ABSCESS O "$1,722.70 " $249.34 $249.34 $135.47 "$1,878.00 " "$1,068.07 " "$1,068.07 " $246.85 $135.47 $473.75 $135.47 $249.34 "$1,292.03 " $274.28 "$1,085.30 " N/A $162.56 $135.47 "$1,033.62 " "$1,378.16 " $847.76 $861.35 $135.47 $249.34 $299.21 $189.66 "$1,378.16 " $135.47 $135.47 $162.56 $349.08 $135.47 $249.34 $249.34 $271.78 "$1,378.16 " "$1,464.30 " $135.47 "$1,292.03 " $277.71 $135.47 $861.35 $670.73 "$1,162.82 " "$1,162.82 " "$1,162.82 " "$1,162.82 " N/A $261.81 $249.34 "$1,149.04 " $135.47 $135.47 $211.94 $211.94 $249.34 $135.47 "$1,878.00 " 330104 32555 5181 68 510 HC ASPIRATE PLEURA W/ IMAGING O "$6,222.05 " $694.05 $694.05 $609.85 "$1,099.00 " "$3,857.67 " "$3,857.67 " $687.11 $609.85 "$1,318.69 " $609.85 $694.05 "$4,666.54 " $763.45 "$3,919.89 " N/A $731.82 $609.85 "$3,733.23 " "$4,977.64 " "$2,359.77 " "$3,111.03 " $609.85 $694.05 $832.86 $853.79 "$4,977.64 " $609.85 $609.85 $731.82 $971.67 $609.85 $694.05 $694.05 $756.51 "$4,977.64 " "$5,288.74 " $609.85 "$3,883.00 " "$1,250.19 " $609.85 "$3,111.03 " "$1,866.99 " "$4,199.88 " "$4,199.88 " "$4,199.88 " "$4,199.88 " N/A $728.75 $694.05 "$4,150.11 " $609.85 $609.85 $589.94 $589.94 $694.05 $589.94 "$5,288.74 " 330104 38505 5072 10 510 HC NEEDLE BIOPSY LYMPH NODES O "$7,463.25 " "$1,799.07 " "$1,799.07 " "$1,250.80 " "$1,878.00 " "$4,627.22 " "$4,627.22 " "$1,781.08 " "$1,250.80 " "$3,418.23 " "$1,250.80 " "$1,799.07 " "$5,597.44 " "$1,978.98 " "$4,701.85 " N/A "$1,500.96 " "$1,250.80 " "$4,477.95 " "$5,970.60 " "$6,116.84 " "$3,731.62 " "$1,250.80 " "$1,799.07 " "$2,158.88 " "$1,751.12 " "$5,970.60 " "$1,250.80 " "$1,250.80 " "$1,500.96 " "$2,518.70 " "$1,250.80 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,970.60 " "$6,343.76 " "$1,250.80 " "$5,597.44 " "$2,564.14 " "$1,250.80 " "$3,731.62 " "$4,839.50 " "$5,037.69 " "$5,037.69 " "$5,037.69 " "$5,037.69 " N/A "$1,889.02 " "$1,799.07 " "$4,977.99 " "$1,250.80 " "$1,250.80 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,250.80 " "$6,343.76 " 330104 37799 5181 78 510 HB VASCULAR SURGERY PROCEDURE UNLIST O "$2,691.05 " $694.05 $694.05 "$2,585.49 " "$2,523.00 " "$1,668.45 " "$1,668.45 " $687.11 "$2,585.49 " "$1,318.69 " "$2,585.49 " $694.05 "$2,018.29 " $763.45 "$1,695.36 " N/A "$3,102.58 " "$2,585.49 " "$1,614.63 " "$2,152.84 " "$2,359.77 " "$1,345.53 " "$2,585.49 " $694.05 $832.86 "$3,619.68 " "$2,152.84 " "$2,585.49 " "$2,585.49 " "$3,102.58 " $971.67 "$2,585.49 " $694.05 $694.05 $756.51 "$2,152.84 " "$2,287.39 " "$2,585.49 " "$2,018.29 " "$5,300.24 " "$2,585.49 " "$1,345.53 " "$1,866.99 " "$1,816.46 " "$1,816.46 " "$1,816.46 " "$1,816.46 " N/A $728.75 $694.05 "$1,794.93 " "$2,585.49 " "$2,585.49 " $589.94 $589.94 $694.05 $589.94 "$5,300.24 " 330104 36600 5734 494 510 HC ARTERIAL PUNCTURE BLOOD FOR DX O $503.97 $139.30 $139.30 $32.33 $482.00 "$1,296.00 " "$1,180.00 " $137.91 $32.33 $264.67 $32.33 $139.30 $377.98 $153.23 $317.50 N/A $38.79 $32.33 $302.38 $403.18 $473.63 $251.99 $32.33 $139.30 $167.16 $45.26 $403.18 $32.33 $32.33 $38.79 $195.02 $32.33 $139.30 $139.30 $151.84 $403.18 $428.37 $32.33 $377.98 $66.27 $32.33 $251.99 $374.72 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $32.33 $32.33 $118.41 $118.41 $139.30 $32.33 "$1,296.00 " 330104 36593 5694 111 510 HC DECLOT VASCULAR DEVICE O "$1,760.15 " $399.06 $399.06 $271.09 $482.00 "$1,091.29 " "$1,091.29 " $395.07 $271.09 $758.21 $271.09 $399.06 "$1,320.11 " $438.96 "$1,108.89 " N/A $325.31 $271.09 "$1,056.09 " "$1,408.12 " "$1,356.80 " $880.08 $271.09 $399.06 $478.87 $379.53 "$1,408.12 " $271.09 $271.09 $325.31 $558.68 $271.09 $399.06 $399.06 $434.97 "$1,408.12 " "$1,496.13 " $271.09 "$1,320.11 " $555.74 $271.09 $880.08 "$1,073.46 " "$1,188.10 " "$1,188.10 " "$1,188.10 " "$1,188.10 " N/A $419.01 $399.06 "$1,174.02 " $271.09 $271.09 $339.20 $339.20 $399.06 $271.09 "$1,496.13 " 330104 36592 5734 494 510 HC COLLECT BLOOD FROM PICC O $503.97 $139.30 $139.30 $32.33 $482.00 $312.46 $312.46 $137.91 $32.33 $264.67 $32.33 $139.30 $377.98 $153.23 $317.50 N/A $38.79 $32.33 $302.38 $403.18 $473.63 $251.99 $32.33 $139.30 $167.16 $45.26 $403.18 $32.33 $32.33 $38.79 $195.02 $32.33 $139.30 $139.30 $151.84 $403.18 $428.37 $32.33 $377.98 $66.27 $32.33 $251.99 $374.72 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $32.33 $32.33 $118.41 $118.41 $139.30 $32.33 $482.00 330104 36591 5734 494 510 HC DRAW BLOOD OFF VENOUS DEVICE O $632.37 $139.30 $139.30 $32.33 $482.00 $392.07 $392.07 $137.91 $32.33 $264.67 $32.33 $139.30 $474.28 $153.23 $398.39 N/A $38.79 $32.33 $379.42 $505.90 $473.63 $316.19 $32.33 $139.30 $167.16 $45.26 $505.90 $32.33 $32.33 $38.79 $195.02 $32.33 $139.30 $139.30 $151.84 $505.90 $537.51 $32.33 $474.28 $66.27 $32.33 $316.19 $374.72 $426.85 $426.85 $426.85 $426.85 N/A $146.27 $139.30 $421.79 $32.33 $32.33 $118.41 $118.41 $139.30 $32.33 $537.51 330104 20604 5441 50 510 HC US GUIDED JOINT ASP/INJECTION - SMALL O "$1,347.13 " $326.20 $326.20 $538.09 $482.00 $835.22 $835.22 $322.94 $538.09 $619.77 $538.09 $326.20 "$1,010.35 " $358.82 $848.69 N/A $645.71 $538.09 $808.28 "$1,077.70 " "$1,109.07 " $673.57 $538.09 $326.20 $391.44 $753.33 "$1,077.70 " $538.09 $538.09 $645.71 $456.68 $538.09 $326.20 $326.20 $355.56 "$1,077.70 " "$1,145.06 " $538.09 "$1,010.35 " "$1,103.09 " $538.09 $673.57 $877.47 $909.31 $909.31 $909.31 $909.31 N/A $342.51 $326.20 $898.54 $538.09 $538.09 $277.27 $277.27 $326.20 $277.27 "$1,145.06 " 330104 36514 5242 114 510 HC APHERESIS PLASMA O "$8,708.73 " "$1,631.45 " "$1,631.45 " $150.00 "$1,878.00 " "$5,399.41 " "$5,399.41 " "$1,615.14 " $150.00 "$3,099.76 " $150.00 "$1,631.45 " "$6,531.55 " "$1,794.60 " "$5,486.50 " N/A $180.00 $150.00 "$5,225.24 " "$6,966.98 " "$5,546.95 " "$4,354.36 " $150.00 "$1,631.45 " "$1,957.75 " $210.00 "$6,966.98 " $150.00 $150.00 $180.00 "$2,284.04 " $150.00 "$1,631.45 " "$1,631.45 " "$1,778.29 " "$6,966.98 " "$7,402.42 " $150.00 "$6,531.55 " $307.50 $150.00 "$4,354.36 " "$4,388.61 " "$5,878.39 " "$5,878.39 " "$5,878.39 " "$5,878.39 " N/A "$1,713.03 " "$1,631.45 " "$5,808.72 " $150.00 $150.00 "$1,386.74 " "$1,386.74 " "$1,631.45 " $150.00 "$7,402.42 " 330104 36513 5241 114 510 HC APHERESIS PLATELETS O "$8,062.45 " $489.19 $489.19 $150.00 "$1,878.00 " "$4,998.72 " "$4,998.72 " $484.30 $150.00 $929.47 $150.00 $489.19 "$6,046.84 " $538.11 "$5,079.34 " N/A $180.00 $150.00 "$4,837.47 " "$6,449.96 " "$1,663.26 " "$4,031.22 " $150.00 $489.19 $587.03 $210.00 "$6,449.96 " $150.00 $150.00 $180.00 $684.87 $150.00 $489.19 $489.19 $533.22 "$6,449.96 " "$6,853.08 " $150.00 "$6,046.84 " $307.50 $150.00 "$4,031.22 " "$1,315.93 " "$5,442.15 " "$5,442.15 " "$5,442.15 " "$5,442.15 " N/A $513.65 $489.19 "$5,377.65 " $150.00 $150.00 $415.81 $415.81 $489.19 $150.00 "$6,853.08 " 330104 36512 5242 114 510 HC APHERESIS RBC O "$8,708.73 " "$1,631.45 " "$1,631.45 " $150.00 "$1,878.00 " "$5,399.41 " "$5,399.41 " "$1,615.14 " $150.00 "$3,099.76 " $150.00 "$1,631.45 " "$6,531.55 " "$1,794.60 " "$5,486.50 " N/A $180.00 $150.00 "$5,225.24 " "$6,966.98 " "$5,546.95 " "$4,354.36 " $150.00 "$1,631.45 " "$1,957.75 " $210.00 "$6,966.98 " $150.00 $150.00 $180.00 "$2,284.04 " $150.00 "$1,631.45 " "$1,631.45 " "$1,778.29 " "$6,966.98 " "$7,402.42 " $150.00 "$6,531.55 " $307.50 $150.00 "$4,354.36 " "$4,388.61 " "$5,878.39 " "$5,878.39 " "$5,878.39 " "$5,878.39 " N/A "$1,713.03 " "$1,631.45 " "$5,808.72 " $150.00 $150.00 "$1,386.74 " "$1,386.74 " "$1,631.45 " $150.00 "$7,402.42 " 330104 38221 5072 124 510 HC BONE MARROW BIOPSY NEEDLE/TROCAR O "$6,324.77 " "$1,799.07 " "$1,799.07 " $512.29 "$1,878.00 " "$3,921.36 " "$3,921.36 " "$1,781.08 " $512.29 "$3,418.23 " $512.29 "$1,799.07 " "$4,743.58 " "$1,978.98 " "$3,984.61 " N/A $614.75 $512.29 "$3,794.86 " "$5,059.82 " "$6,116.84 " "$3,162.39 " $512.29 "$1,799.07 " "$2,158.88 " $717.20 "$5,059.82 " $512.29 $512.29 $614.75 "$2,518.70 " $512.29 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " $512.29 "$4,743.58 " "$1,050.19 " $512.29 "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " N/A "$1,889.02 " "$1,799.07 " "$4,218.62 " $512.29 $512.29 "$1,529.21 " "$1,529.21 " "$1,799.07 " $512.29 "$6,116.84 " 330104 29505 5101 40 510 HC APPLICATION LONG LEG SPLINT O "$1,443.43 " $174.87 $174.87 $214.50 $482.00 $894.93 $894.93 $173.13 $214.50 $332.26 $214.50 $174.87 "$1,082.57 " $192.36 $909.36 N/A $257.41 $214.50 $866.06 "$1,154.74 " $594.57 $721.72 $214.50 $174.87 $209.85 $300.31 "$1,154.74 " $214.50 $214.50 $257.41 $244.82 $214.50 $174.87 $174.87 $190.61 "$1,154.74 " "$1,226.92 " $214.50 "$1,082.57 " $439.74 $214.50 $721.72 $470.41 $974.32 $974.32 $974.32 $974.32 N/A $183.62 $174.87 $962.77 $214.50 $214.50 $148.64 $148.64 $174.87 $148.64 "$1,226.92 " 330104 29240 5734 40 510 HC STRAPPING OF SHOULDER O $385.20 $139.30 $139.30 $214.50 $482.00 $238.82 $238.82 $137.91 $214.50 $264.67 $214.50 $139.30 $288.90 $153.23 $242.68 N/A $257.41 $214.50 $231.12 $308.16 $473.63 $192.60 $214.50 $139.30 $167.16 $300.31 $308.16 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $308.16 $327.42 $214.50 $288.90 $439.74 $214.50 $192.60 $374.72 $260.01 $260.01 $260.01 $260.01 N/A $146.27 $139.30 $256.93 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 $482.00 330104 29445 5102 39 510 HC APPLY RIGID LEG CAST O "$1,769.78 " $287.83 $287.83 $293.16 $482.00 "$1,097.26 " "$1,097.26 " $284.95 $293.16 $546.88 $293.16 $287.83 "$1,327.34 " $316.61 "$1,114.96 " N/A $351.80 $293.16 "$1,061.87 " "$1,415.82 " $978.62 $884.89 $293.16 $287.83 $345.40 $410.43 "$1,415.82 " $293.16 $293.16 $351.80 $402.96 $293.16 $287.83 $287.83 $313.73 "$1,415.82 " "$1,504.31 " $293.16 "$3,883.00 " $600.98 $293.16 $884.89 $774.26 "$1,194.60 " "$1,194.60 " "$1,194.60 " "$1,194.60 " N/A $302.22 $287.83 "$1,180.44 " $293.16 $293.16 $244.66 $244.66 $287.83 $244.66 "$3,883.00 " 330104 25560 5111 41 510 HC CLSD TREAT FRACTURE RADIUS & ULNA O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 25605 5112 41 510 HC CLSDFX RADIAL/ULNA (COLLES/SMITH)W/MANIP O "$8,556.79 " "$1,721.05 " "$1,721.05 " $508.54 "$2,886.00 " "$5,305.21 " "$5,305.21 " "$1,703.84 " $508.54 "$3,270.00 " $508.54 "$1,721.05 " "$6,417.59 " "$1,893.16 " "$5,390.78 " N/A $610.24 $508.54 "$5,134.07 " "$6,845.43 " "$5,851.57 " "$4,278.40 " $508.54 "$1,721.05 " "$2,065.26 " $711.95 "$6,845.43 " $508.54 $508.54 $610.24 "$2,409.47 " $508.54 "$1,721.05 " "$1,721.05 " "$1,875.95 " "$6,845.43 " "$7,273.27 " $508.54 "$3,883.00 " "$1,042.50 " $508.54 "$4,278.40 " "$4,629.63 " "$5,775.83 " "$5,775.83 " "$5,775.83 " "$5,775.83 " N/A "$1,807.10 " "$1,721.05 " "$5,707.38 " $508.54 $508.54 "$1,462.89 " "$1,462.89 " "$1,721.05 " $508.54 "$7,273.27 " 330104 25650 5111 41 510 HC CLSD TREAT ULNA STYLOID FX O "$1,070.00 " $248.36 $248.36 $508.54 $482.00 $663.40 $663.40 $245.87 $508.54 $471.88 $508.54 $248.36 $802.50 $273.19 $674.10 N/A $610.24 $508.54 $642.00 $856.00 $844.42 $535.00 $508.54 $248.36 $298.03 $711.95 $856.00 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $856.00 $909.50 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $535.00 $668.08 $722.25 $722.25 $722.25 $722.25 N/A $260.78 $248.36 $713.69 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 26010 5051 3 510 HC DRAINAGE OF FINGER ABSCESS; SIMPLE O $828.18 $216.65 $216.65 $325.60 $482.00 $513.47 $513.47 $214.48 $325.60 $411.63 $325.60 $216.65 $621.14 $238.31 $521.75 N/A $390.72 $325.60 $496.91 $662.54 $736.61 $414.09 $325.60 $216.65 $259.98 $455.84 $662.54 $325.60 $325.60 $390.72 $303.31 $325.60 $216.65 $216.65 $236.15 $662.54 $703.95 $325.60 $621.14 $667.48 $325.60 $414.09 $582.79 $559.02 $559.02 $559.02 $559.02 N/A $227.48 $216.65 $552.40 $325.60 $325.60 $184.15 $184.15 $216.65 $184.15 $736.61 330104 26600 5111 41 510 HC CLSD TREAT METACARPAL FRCTR W/O MANIP EA O "$1,070.00 " $248.36 $248.36 $508.54 $482.00 $663.40 $663.40 $245.87 $508.54 $471.88 $508.54 $248.36 $802.50 $273.19 $674.10 N/A $610.24 $508.54 $642.00 $856.00 $844.42 $535.00 $508.54 $248.36 $298.03 $711.95 $856.00 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $856.00 $909.50 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $535.00 $668.08 $722.25 $722.25 $722.25 $722.25 N/A $260.78 $248.36 $713.69 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 26720 5111 41 510 HC CLSD TREAT FINGER FX EA. W/O MANIP O "$1,845.75 " $248.36 $248.36 $508.54 $482.00 "$1,144.37 " "$1,144.37 " $245.87 $508.54 $471.88 $508.54 $248.36 "$1,384.31 " $273.19 "$1,162.82 " N/A $610.24 $508.54 "$1,107.45 " "$1,476.60 " $844.42 $922.88 $508.54 $248.36 $298.03 $711.95 "$1,476.60 " $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $508.54 "$1,384.31 " "$1,042.50 " $508.54 $922.88 $668.08 "$1,245.88 " "$1,245.88 " "$1,245.88 " "$1,245.88 " N/A $260.78 $248.36 "$1,231.12 " $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$1,568.89 " 330104 26725 5111 41 510 HC CLSD.TREAT.FINGER FX EA. W/MANIP - EACH O "$1,845.75 " $248.36 $248.36 $508.54 $482.00 "$1,144.37 " "$1,144.37 " $245.87 $508.54 $471.88 $508.54 $248.36 "$1,384.31 " $273.19 "$1,162.82 " N/A $610.24 $508.54 "$1,107.45 " "$1,476.60 " $844.42 $922.88 $508.54 $248.36 $298.03 $711.95 "$1,476.60 " $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $508.54 "$3,883.00 " "$1,042.50 " $508.54 $922.88 $668.08 "$1,245.88 " "$1,245.88 " "$1,245.88 " "$1,245.88 " N/A $260.78 $248.36 "$1,231.12 " $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 26750 5111 41 510 HC CLOSED TREAT FINGER FRACTR EA W/O MANIP O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 $642.00 "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$1,042.50 " 330104 26770 5111 41 510 HC TREAT FINGER DISLOCATION O "$1,845.75 " $248.36 $248.36 $508.54 $482.00 "$1,144.37 " "$1,144.37 " $245.87 $508.54 $471.88 $508.54 $248.36 "$1,384.31 " $273.19 "$1,162.82 " N/A $610.24 $508.54 "$1,107.45 " "$1,476.60 " $844.42 $922.88 $508.54 $248.36 $298.03 $711.95 "$1,476.60 " $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 "$1,476.60 " "$1,568.89 " $508.54 "$3,883.00 " "$1,042.50 " $508.54 $922.88 $668.08 "$1,245.88 " "$1,245.88 " "$1,245.88 " "$1,245.88 " N/A $260.78 $248.36 "$1,231.12 " $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 27096 50 510 HC INJECT SACROILIAC JOINT O "$1,095.68 " $98.00 $98.00 $538.09 $482.00 $679.32 $679.32 $97.02 $538.09 $186.19 $538.09 $98.00 $821.76 $107.80 $690.28 N/A $645.71 $538.09 $657.41 $876.54 $333.19 $547.84 $538.09 $98.00 $712.19 $753.33 $876.54 $538.09 $538.09 $645.71 $137.19 $538.09 $98.00 $98.00 $106.82 $876.54 $931.33 $726.42 $821.76 "$1,103.09 " $726.42 $547.84 $712.19 $739.58 $739.58 $739.58 $739.58 N/A $102.90 $98.00 $730.82 $538.09 $538.09 $83.30 $83.30 $98.00 $83.30 "$1,103.09 " 330104 27750 5111 41 510 HC TREATMENT.. OF TIBIA FRACTURE O $856.00 $248.36 $248.36 $508.54 "$1,878.00 " $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 27786 5111 41 510 HC CLSD TREAT DISTAL FIBULAR FX O $802.50 $248.36 $248.36 $508.54 "$1,878.00 " $497.55 $497.55 $245.87 $508.54 $471.88 $508.54 $248.36 $601.88 $273.19 $505.57 N/A $610.24 $508.54 $481.50 $642.00 $844.42 $401.25 $508.54 $248.36 $298.03 $711.95 $642.00 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $642.00 $682.12 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $401.25 $668.08 $541.69 $541.69 $541.69 $541.69 N/A $260.78 $248.36 $535.27 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 28190 5071 9 510 HC REMOVAL OF FOREIGN BODY FOOT; SUBCUTANEOUS O "$2,808.75 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,741.42 " "$1,741.42 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,106.56 " $856.45 "$1,769.51 " N/A $764.34 $636.95 "$1,685.25 " "$2,247.00 " "$2,647.22 " "$1,404.38 " $636.95 $778.60 $934.31 $891.73 "$2,247.00 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,247.00 " "$2,387.44 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,404.38 " "$2,094.42 " "$1,895.91 " "$1,895.91 " "$1,895.91 " "$1,895.91 " N/A $817.53 $778.60 "$1,873.44 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 28470 5111 41 510 HC TREAT METATARSAL FRACTURE O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 28515 5111 41 510 HC TREATMENT - OF TOE FRACTURE W/MANIP-EA O $843.16 $248.36 $248.36 $508.54 $482.00 $522.76 $522.76 $245.87 $508.54 $471.88 $508.54 $248.36 $632.37 $273.19 $531.19 N/A $610.24 $508.54 $505.90 $674.53 $844.42 $421.58 $508.54 $248.36 $298.03 $711.95 $674.53 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $674.53 $716.69 $508.54 $632.37 "$1,042.50 " $508.54 $421.58 $668.08 $569.13 $569.13 $569.13 $569.13 N/A $260.78 $248.36 $562.39 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$1,042.50 " 330104 25500 5111 41 510 HC CLSD TREAT. FRACTURE OF RADIAL SHAFT O "$1,070.00 " $248.36 $248.36 $508.54 $482.00 $663.40 $663.40 $245.87 $508.54 $471.88 $508.54 $248.36 $802.50 $273.19 $674.10 N/A $610.24 $508.54 $642.00 $856.00 $844.42 $535.00 $508.54 $248.36 $298.03 $711.95 $856.00 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $856.00 $909.50 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $535.00 $668.08 $722.25 $722.25 $722.25 $722.25 N/A $260.78 $248.36 $713.69 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 29450 5101 39 510 HC APPLICATION OF LEG CAST O $546.77 $174.87 $174.87 $293.16 $482.00 $339.00 $339.00 $173.13 $293.16 $332.26 $293.16 $174.87 $410.08 $192.36 $344.47 N/A $351.80 $293.16 $328.06 $437.42 $594.57 $273.38 $293.16 $174.87 $209.85 $410.43 $437.42 $293.16 $293.16 $351.80 $244.82 $293.16 $174.87 $174.87 $190.61 $437.42 $464.75 $293.16 "$3,883.00 " $600.98 $293.16 $273.38 $470.41 $369.07 $369.07 $369.07 $369.07 N/A $183.62 $174.87 $364.70 $293.16 $293.16 $148.64 $148.64 $174.87 $148.64 "$3,883.00 " 330104 24670 5111 41 510 HC CLSD TREAT PROX.END ULNAR FRACTURE O $856.00 $248.36 $248.36 $508.54 "$1,878.00 " $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 49083 5301 150 510 HC ABD PARACENTESIS W/IMAGING O "$3,773.89 " $990.40 $990.40 $609.85 "$2,523.00 " "$2,339.81 " "$2,339.81 " $980.49 $609.85 "$1,881.75 " $609.85 $990.40 "$2,830.42 " "$1,089.44 " "$2,377.55 " N/A $731.82 $609.85 "$2,264.33 " "$3,019.11 " "$3,367.35 " "$1,886.94 " $609.85 $990.40 "$1,188.48 " $853.79 "$3,019.11 " $609.85 $609.85 $731.82 "$1,386.56 " $609.85 $990.40 $990.40 "$1,079.53 " "$3,019.11 " "$3,207.81 " $609.85 "$3,883.00 " "$1,250.19 " $609.85 "$1,886.94 " "$2,664.17 " "$2,547.38 " "$2,547.38 " "$2,547.38 " "$2,547.38 " N/A "$1,039.92 " $990.40 "$2,517.18 " $609.85 $609.85 $841.84 $841.84 $990.40 $609.85 "$3,883.00 " 330104 29425 5102 39 510 HC APPLICATION SHORT LEG CAST(BELOW KNEE-TOES)WALKING O "$1,959.17 " $287.83 $287.83 $293.16 $482.00 "$1,214.69 " "$1,214.69 " $284.95 $293.16 $546.88 $293.16 $287.83 "$1,469.38 " $316.61 "$1,234.28 " N/A $351.80 $293.16 "$1,175.50 " "$1,567.34 " $978.62 $979.59 $293.16 $287.83 $345.40 $410.43 "$1,567.34 " $293.16 $293.16 $351.80 $402.96 $293.16 $287.83 $287.83 $313.73 "$1,567.34 " "$1,665.29 " $293.16 "$1,469.38 " $600.98 $293.16 $979.59 $774.26 "$1,322.44 " "$1,322.44 " "$1,322.44 " "$1,322.44 " N/A $302.22 $287.83 "$1,306.77 " $293.16 $293.16 $244.66 $244.66 $287.83 $244.66 "$1,665.29 " 330104 29405 5102 39 510 HC APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES) O "$1,683.11 " $287.83 $287.83 $293.16 $482.00 "$1,296.00 " "$1,180.00 " $284.95 $293.16 $546.88 $293.16 $287.83 "$1,262.33 " $316.61 "$1,060.36 " N/A $351.80 $293.16 "$1,009.87 " "$1,346.49 " $978.62 $841.55 $293.16 $287.83 $345.40 $410.43 "$1,346.49 " $293.16 $293.16 $351.80 $402.96 $293.16 $287.83 $287.83 $313.73 "$1,346.49 " "$1,430.64 " $293.16 "$1,262.33 " $600.98 $293.16 $841.55 $774.26 "$1,136.10 " "$1,136.10 " "$1,136.10 " "$1,136.10 " N/A $302.22 $287.83 "$1,122.63 " $293.16 $293.16 $244.66 $244.66 $287.83 $244.66 "$1,430.64 " 330104 29260 5733 40 510 HC STRAPPING OF ELBOW OR WRIST O $546.77 $68.96 $68.96 $214.50 $482.00 $339.00 $339.00 $68.27 $214.50 $131.03 $214.50 $68.96 $410.08 $75.86 $344.47 N/A $257.41 $214.50 $328.06 $437.42 $234.47 $273.38 $214.50 $68.96 $82.75 $300.31 $437.42 $214.50 $214.50 $257.41 $96.55 $214.50 $68.96 $68.96 $75.17 $437.42 $464.75 $214.50 $410.08 $439.74 $214.50 $273.38 $185.51 $369.07 $369.07 $369.07 $369.07 N/A $72.41 $68.96 $364.70 $214.50 $214.50 $58.62 $58.62 $68.96 $58.62 $482.00 330104 29075 5102 39 510 HC APPLICATION OF FOREARM CAST O "$1,959.17 " $287.83 $287.83 $293.16 $482.00 "$1,296.00 " "$1,180.00 " $284.95 $293.16 $546.88 $293.16 $287.83 "$1,469.38 " $316.61 "$1,234.28 " N/A $351.80 $293.16 "$1,175.50 " "$1,567.34 " $978.62 $979.59 $293.16 $287.83 $345.40 $410.43 "$1,567.34 " $293.16 $293.16 $351.80 $402.96 $293.16 $287.83 $287.83 $313.73 "$1,567.34 " "$1,665.29 " $293.16 "$1,469.38 " $600.98 $293.16 $979.59 $774.26 "$1,322.44 " "$1,322.44 " "$1,322.44 " "$1,322.44 " N/A $302.22 $287.83 "$1,306.77 " $293.16 $293.16 $244.66 $244.66 $287.83 $244.66 "$1,665.29 " 330104 29130 5734 40 510 HC APPLICATION OF FINGER SPLINT; STATIC O "$1,060.37 " $139.30 $139.30 $214.50 $482.00 $657.43 $657.43 $137.91 $214.50 $264.67 $214.50 $139.30 $795.28 $153.23 $668.03 N/A $257.41 $214.50 $636.22 $848.30 $473.63 $530.18 $214.50 $139.30 $167.16 $300.31 $848.30 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $848.30 $901.31 $214.50 $795.28 $439.74 $214.50 $530.18 $374.72 $715.75 $715.75 $715.75 $715.75 N/A $146.27 $139.30 $707.27 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 $901.31 330104 29126 5734 40 510 HC APPLICATION SHORT ARM SPLINT (FOREARM-HAND)DYNAMIC O $642.00 $139.30 $139.30 $214.50 $482.00 $398.04 $398.04 $137.91 $214.50 $264.67 $214.50 $139.30 $481.50 $153.23 $404.46 N/A $257.41 $214.50 $385.20 $513.60 $473.63 $321.00 $214.50 $139.30 $167.16 $300.31 $513.60 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $513.60 $545.70 $214.50 $481.50 $439.74 $214.50 $321.00 $374.72 $433.35 $433.35 $433.35 $433.35 N/A $146.27 $139.30 $428.21 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 $545.70 330104 29125 5734 40 510 HC APPLICATION SHORT ARM SPLINT (FOREARM-HAND)STATIC O $728.67 $139.30 $139.30 $214.50 $482.00 "$1,296.00 " "$1,180.00 " $137.91 $214.50 $264.67 $214.50 $139.30 $546.50 $153.23 $459.06 N/A $257.41 $214.50 $437.20 $582.94 $473.63 $364.33 $214.50 $139.30 $167.16 $300.31 $582.94 $214.50 $214.50 $257.41 $195.02 $214.50 $139.30 $139.30 $151.84 $582.94 $619.37 $214.50 $546.50 $439.74 $214.50 $364.33 $374.72 $491.85 $491.85 $491.85 $491.85 N/A $146.27 $139.30 $486.02 $214.50 $214.50 $118.41 $118.41 $139.30 $118.41 "$1,296.00 " 330104 29105 5101 40 510 HC APPLY LONG ARM SPLINT O $679.45 $174.87 $174.87 $214.50 $482.00 $421.26 $421.26 $173.13 $214.50 $332.26 $214.50 $174.87 $509.59 $192.36 $428.05 N/A $257.41 $214.50 $407.67 $543.56 $594.57 $339.73 $214.50 $174.87 $209.85 $300.31 $543.56 $214.50 $214.50 $257.41 $244.82 $214.50 $174.87 $174.87 $190.61 $543.56 $577.53 $214.50 $509.59 $439.74 $214.50 $339.73 $470.41 $458.63 $458.63 $458.63 $458.63 N/A $183.62 $174.87 $453.19 $214.50 $214.50 $148.64 $148.64 $174.87 $148.64 $594.57 330104 20605 5441 49 510 HC DRAIN/INJECT INTERMED. JOINT/BURSA O "$1,206.96 " $326.20 $326.20 $296.51 $482.00 $748.32 $748.32 $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 $760.38 N/A $355.81 $296.51 $724.18 $965.57 "$1,109.07 " $603.48 $296.51 $326.20 $391.44 $415.11 $965.57 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $965.57 "$1,025.92 " $296.51 $905.22 $607.85 $296.51 $603.48 $877.47 $814.70 $814.70 $814.70 $814.70 N/A $342.51 $326.20 $805.04 $296.51 $296.51 $277.27 $277.27 $326.20 $277.27 "$1,109.07 " 330104 20610 5441 49 510 HC DRAIN/INJECT MAJOR JOINT/BURSA O "$1,206.96 " $326.20 $326.20 $296.51 $482.00 "$1,296.00 " "$1,180.00 " $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 $760.38 N/A $355.81 $296.51 $724.18 $965.57 "$1,109.07 " $603.48 $296.51 $326.20 $391.44 $415.11 $965.57 $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 $965.57 "$1,025.92 " $296.51 $905.22 $607.85 $296.51 $603.48 $877.47 $814.70 $814.70 $814.70 $814.70 N/A $342.51 $326.20 $805.04 $296.51 $296.51 $277.27 $277.27 $326.20 $277.27 "$1,296.00 " 330104 20612 5441 49 510 HC ASPIRATE/INJ GANGLION CYST O "$1,346.06 " $326.20 $326.20 $296.51 $482.00 $834.56 $834.56 $322.94 $296.51 $619.77 $296.51 $326.20 "$1,009.54 " $358.82 $848.02 N/A $355.81 $296.51 $807.64 "$1,076.85 " "$1,109.07 " $673.03 $296.51 $326.20 $391.44 $415.11 "$1,076.85 " $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 $326.20 $355.56 "$1,076.85 " "$1,144.15 " $296.51 "$1,009.54 " $607.85 $296.51 $673.03 $877.47 $908.59 $908.59 $908.59 $908.59 N/A $342.51 $326.20 $897.82 $296.51 $296.51 $277.27 $277.27 $326.20 $277.27 "$1,144.15 " 330104 21320 5164 41 510 HC CLOSED TX NOSE FX W/ STABLJ O "$13,715.26 " "$3,413.30 " "$3,413.30 " $508.54 "$2,523.00 " "$8,503.46 " "$8,503.46 " "$3,379.16 " $508.54 "$6,485.26 " $508.54 "$3,413.30 " "$10,286.44 " "$3,754.63 " "$8,640.61 " N/A $610.24 $508.54 "$8,229.16 " "$10,972.21 " "$11,605.21 " "$6,857.63 " $508.54 "$3,413.30 " "$4,095.96 " $711.95 "$10,972.21 " $508.54 $508.54 $610.24 "$4,778.61 " $508.54 "$3,413.30 " "$3,413.30 " "$3,720.49 " "$10,972.21 " "$11,657.97 " $508.54 "$3,883.00 " "$1,042.50 " $508.54 "$6,857.63 " "$9,181.77 " "$9,257.80 " "$9,257.80 " "$9,257.80 " "$9,257.80 " N/A "$3,583.96 " "$3,413.30 " "$9,148.08 " $508.54 $508.54 "$2,901.30 " "$2,901.30 " "$3,413.30 " $508.54 "$11,657.97 " 330104 21550 5072 69 510 HC BIOPSY OF NECK/CHEST O "$6,721.74 " "$1,799.07 " "$1,799.07 " "$1,816.61 " "$1,878.00 " "$4,167.48 " "$4,167.48 " "$1,781.08 " "$1,816.61 " "$3,418.23 " "$1,816.61 " "$1,799.07 " "$5,041.31 " "$1,978.98 " "$4,234.70 " N/A "$2,179.93 " "$1,816.61 " "$4,033.04 " "$5,377.39 " "$6,116.84 " "$3,360.87 " "$1,816.61 " "$1,799.07 " "$2,158.88 " "$2,543.25 " "$5,377.39 " "$1,816.61 " "$1,816.61 " "$2,179.93 " "$2,518.70 " "$1,816.61 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,377.39 " "$5,713.48 " "$1,816.61 " "$3,883.00 " "$3,724.05 " "$1,816.61 " "$3,360.87 " "$4,839.50 " "$4,537.17 " "$4,537.17 " "$4,537.17 " "$4,537.17 " N/A "$1,889.02 " "$1,799.07 " "$4,483.40 " "$1,816.61 " "$1,816.61 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,529.21 " "$6,116.84 " 330104 23600 5111 41 510 HC CLSD TREAT PROX. HUMERUS FRACTURE O $910.57 $248.36 $248.36 $508.54 $482.00 $564.55 $564.55 $245.87 $508.54 $471.88 $508.54 $248.36 $682.93 $273.19 $573.66 N/A $610.24 $508.54 $546.34 $728.46 $844.42 $455.29 $508.54 $248.36 $298.03 $711.95 $728.46 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $728.46 $773.98 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $455.29 $668.08 $614.63 $614.63 $614.63 $614.63 N/A $260.78 $248.36 $607.35 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 24530 5111 41 510 HC CLSD TREATSUB/TRANS W/O INTER HUMERUS FX O $856.00 $248.36 $248.36 $508.54 "$1,878.00 " $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 24650 5111 41 510 HC CLSD TREAT HEAD / NECK RADIUS FRACTURE O $856.00 $248.36 $248.36 $508.54 $482.00 $530.72 $530.72 $245.87 $508.54 $471.88 $508.54 $248.36 $642.00 $273.19 $539.28 N/A $610.24 $508.54 $513.60 $684.80 $844.42 $428.00 $508.54 $248.36 $298.03 $711.95 $684.80 $508.54 $508.54 $610.24 $347.70 $508.54 $248.36 $248.36 $270.71 $684.80 $727.60 $508.54 "$3,883.00 " "$1,042.50 " $508.54 $428.00 $668.08 $577.80 $577.80 $577.80 $577.80 N/A $260.78 $248.36 $570.95 $508.54 $508.54 $211.10 $211.10 $248.36 $211.10 "$3,883.00 " 330104 49440 5302 130 510 HC PLACE GASTROSTOMY TUBE PERC O "$4,815.00 " "$2,089.46 " "$2,089.46 " $507.89 "$2,523.00 " "$2,985.30 " "$2,985.30 " "$2,068.56 " $507.89 "$3,969.96 " $507.89 "$2,089.46 " "$3,611.25 " "$2,298.40 " "$3,033.45 " N/A $609.46 $507.89 "$2,889.00 " "$3,852.00 " "$7,104.15 " "$2,407.50 " $507.89 "$2,089.46 " "$2,507.35 " $711.04 "$3,852.00 " $507.89 $507.89 $609.46 "$2,925.24 " $507.89 "$2,089.46 " "$2,089.46 " "$2,277.51 " "$3,852.00 " "$4,092.75 " $507.89 "$3,883.00 " "$1,041.17 " $507.89 "$2,407.50 " "$5,620.63 " "$3,250.12 " "$3,250.12 " "$3,250.12 " "$3,250.12 " N/A "$2,193.93 " "$2,089.46 " "$3,211.61 " $507.89 $507.89 "$1,776.04 " "$1,776.04 " "$2,089.46 " $507.89 "$7,104.15 " 330104 67715 5503 258 510 HC INCISION OF EYELID FOLD O "$8,426.25 " "$2,536.51 " "$2,536.51 " "$1,205.26 " "$1,878.00 " "$5,224.27 " "$5,224.27 " "$2,511.15 " "$1,205.26 " "$4,819.38 " "$1,205.26 " "$2,536.51 " "$6,319.69 " "$2,790.17 " "$5,308.54 " N/A "$1,446.31 " "$1,205.26 " "$5,055.75 " "$6,741.00 " "$8,624.15 " "$4,213.12 " "$1,205.26 " "$2,536.51 " "$3,043.82 " "$1,687.36 " "$6,741.00 " "$1,205.26 " "$1,205.26 " "$1,446.31 " "$3,551.12 " "$1,205.26 " "$2,536.51 " "$2,536.51 " "$2,764.80 " "$6,741.00 " "$7,162.31 " "$1,205.26 " "$6,319.69 " "$2,470.78 " "$1,205.26 " "$4,213.12 " "$6,823.22 " "$5,687.72 " "$5,687.72 " "$5,687.72 " "$5,687.72 " N/A "$2,663.34 " "$2,536.51 " "$5,620.31 " "$1,205.26 " "$1,205.26 " "$2,156.04 " "$2,156.04 " "$2,536.51 " "$1,205.26 " "$8,624.15 " 330104 51701 5734 159 510 HC INSERT BLADDER CATHETER O $485.78 $139.30 $139.30 $395.93 $482.00 $301.18 $301.18 $137.91 $395.93 $264.67 $395.93 $139.30 $364.33 $153.23 $306.04 N/A $475.12 $395.93 $291.47 $388.62 $473.63 $242.89 $395.93 $139.30 $167.16 $554.30 $388.62 $395.93 $395.93 $475.12 $195.02 $395.93 $139.30 $139.30 $151.84 $388.62 $412.91 $395.93 $364.33 $811.66 $395.93 $242.89 $374.72 $327.90 $327.90 $327.90 $327.90 N/A $146.27 $139.30 $324.02 $395.93 $395.93 $118.41 $118.41 $139.30 $118.41 $811.66 330104 99204 491 510 HC OFFICE CONSULTATION 40 MINS O $544.63 $156.61 $156.61 N/A N/A $337.67 $337.67 $155.04 N/A $297.56 N/A $156.61 $408.47 $172.27 $343.12 N/A N/A N/A $326.78 $435.70 $532.48 $272.31 N/A $156.61 $354.01 N/A $435.70 N/A N/A N/A $219.25 N/A $156.61 $156.61 $170.71 $435.70 $462.94 N/A $408.47 N/A N/A $272.31 $354.01 $367.63 $367.63 $367.63 $367.63 N/A $164.44 $156.61 $363.27 N/A N/A $133.12 $133.12 $156.61 $133.12 $532.48 330104 99203 491 510 HC OFFICE CONSULTATION 30 MINS O $419.44 $98.47 $98.47 N/A N/A $260.05 $260.05 $97.49 N/A $187.10 N/A $98.47 $314.58 $108.32 $264.25 N/A N/A N/A $251.66 $335.55 $334.81 $209.72 N/A $98.47 $272.64 N/A $335.55 N/A N/A N/A $137.86 N/A $98.47 $98.47 $107.34 $335.55 $356.52 N/A $314.58 N/A N/A $209.72 $272.64 $283.12 $283.12 $283.12 $283.12 N/A $103.40 $98.47 $279.77 N/A N/A $83.70 $83.70 $98.47 $83.70 $356.52 330104 99202 491 510 HC OFFICE CONSULTATION;EXPANDED PROBLEM FOCUS O $374.50 $56.37 $56.37 N/A N/A $232.19 $232.19 $55.81 N/A $107.11 N/A $56.37 $280.88 $62.01 $235.94 N/A N/A N/A $224.70 $299.60 $191.67 $187.25 N/A $56.37 $243.43 N/A $299.60 N/A N/A N/A $78.92 N/A $56.37 $56.37 $61.45 $299.60 $318.32 N/A $280.88 N/A N/A $187.25 $243.43 $252.79 $252.79 $252.79 $252.79 N/A $59.19 $56.37 $249.79 N/A N/A $47.92 $47.92 $56.37 $47.92 $318.32 330104 99202 491 510 HC OFFICE CONSULTATION 15 MINS O $283.55 $56.37 $56.37 N/A N/A $175.80 $175.80 $55.81 N/A $107.11 N/A $56.37 $212.66 $62.01 $178.64 N/A N/A N/A $170.13 $226.84 $191.67 $141.78 N/A $56.37 $184.31 N/A $226.84 N/A N/A N/A $78.92 N/A $56.37 $56.37 $61.45 $226.84 $241.02 N/A $212.66 N/A N/A $141.78 $184.31 $191.40 $191.40 $191.40 $191.40 N/A $59.19 $56.37 $189.13 N/A N/A $47.92 $47.92 $56.37 $47.92 $241.02 330104 99215 491 510 HC OFFICE VISIT EST PAT- HIGH COMPLX-LVL5 - 40-54 MINUTES O "$1,298.98 " $166.35 $166.35 N/A N/A $805.37 $805.37 $164.69 N/A $316.07 N/A $166.35 $974.24 $182.99 $818.36 N/A N/A N/A $779.39 "$1,039.18 " $565.59 $649.49 N/A $166.35 $844.34 N/A "$1,039.18 " N/A N/A N/A $232.89 N/A $166.35 $166.35 $181.32 "$1,039.18 " "$1,104.13 " N/A $974.24 N/A N/A $649.49 $844.34 $876.81 $876.81 $876.81 $876.81 N/A $174.67 $166.35 $866.42 N/A N/A $141.40 $141.40 $166.35 $141.40 "$1,104.13 " 330104 99214 491 510 HC OFFICE VISIT EST PAT- MOD COMPLX-LVL4 - 20-29 MINUTES O "$1,009.01 " $113.33 $113.33 N/A N/A $625.59 $625.59 $112.20 N/A $215.33 N/A $113.33 $756.76 $124.66 $635.68 N/A N/A N/A $605.41 $807.21 $385.32 $504.50 N/A $113.33 $655.86 N/A $807.21 N/A N/A N/A $158.66 N/A $113.33 $113.33 $123.53 $807.21 $857.66 N/A $756.76 N/A N/A $504.50 $655.86 $681.08 $681.08 $681.08 $681.08 N/A $119.00 $113.33 $673.01 N/A N/A $96.33 $96.33 $113.33 $96.33 $857.66 330104 99213 491 510 HC OFFICE VISIT EST PAT- EXPANDED PROB FOCUS-LVL3 - 20-29 MINUTES O $896.66 $76.93 $76.93 N/A N/A $555.93 $555.93 $76.16 N/A $146.16 N/A $76.93 $672.50 $84.62 $564.90 N/A N/A N/A $538.00 $717.33 $261.55 $448.33 N/A $76.93 $582.83 N/A $717.33 N/A N/A N/A $107.70 N/A $76.93 $76.93 $83.85 $717.33 $762.16 N/A $672.50 N/A N/A $448.33 $582.83 $605.25 $605.25 $605.25 $605.25 N/A $80.77 $76.93 $598.07 N/A N/A $65.39 $65.39 $76.93 $65.39 $762.16 330104 99212 491 510 HC OFFICE VISIT EST PAT- PROB FOCUS-LVL2 - 10 TO 19 MINS O $786.45 $41.65 $41.65 N/A N/A $174.00 $160.00 $41.23 N/A $79.14 N/A $41.65 $589.84 $45.82 $495.46 N/A N/A N/A $471.87 $629.16 $141.61 $393.23 N/A $41.65 $511.19 N/A $629.16 N/A N/A N/A $58.31 N/A $41.65 $41.65 $45.40 $629.16 $668.48 N/A $589.84 N/A N/A $393.23 $511.19 $530.85 $530.85 $530.85 $530.85 N/A $43.73 $41.65 $524.56 N/A N/A $35.40 $35.40 $41.65 $35.40 $668.48 330104 99211 491 510 HC OFFICE VISIT EST PAT- MINIMAL-LVL1 O $677.31 $10.10 $10.10 N/A N/A $419.93 $419.93 $10.00 N/A $19.19 N/A $10.10 $507.98 $11.11 $426.71 N/A N/A N/A $406.39 $541.85 $34.33 $338.65 N/A $10.10 $440.25 N/A $541.85 N/A N/A N/A $14.14 N/A $10.10 $10.10 $11.01 $541.85 $575.71 N/A $507.98 N/A N/A $338.65 $440.25 $457.18 $457.18 $457.18 $457.18 N/A $10.60 $10.10 $451.77 N/A N/A $8.58 $8.58 $10.10 $8.58 $575.71 330104 99205 491 510 HC OFFICE VISIT NEW PAT- COMPREHENSIVE-LVL5 - 50 TO 74 MINS O "$1,707.72 " $212.73 $212.73 N/A N/A "$1,058.79 " "$1,058.79 " $210.60 N/A $404.19 N/A $212.73 "$1,280.79 " $234.01 "$1,075.86 " N/A N/A N/A "$1,024.63 " "$1,366.18 " $723.29 $853.86 N/A $212.73 "$1,110.02 " N/A "$1,366.18 " N/A N/A N/A $297.82 N/A $212.73 $212.73 $231.88 "$1,366.18 " "$1,451.56 " N/A "$1,280.79 " N/A N/A $853.86 "$1,110.02 " "$1,152.71 " "$1,152.71 " "$1,152.71 " "$1,152.71 " N/A $223.37 $212.73 "$1,139.05 " N/A N/A $180.82 $180.82 $212.73 $180.82 "$1,451.56 " 330104 99204 491 510 HC OFFICE VISIT NEW PAT- MOD COMPLEXITY-LVL4 - 45 TO 59 MINS O "$1,298.98 " $156.61 $156.61 N/A N/A $805.37 $805.37 $155.04 N/A $297.56 N/A $156.61 $974.24 $172.27 $818.36 N/A N/A N/A $779.39 "$1,039.18 " $532.48 $649.49 N/A $156.61 $844.34 N/A "$1,039.18 " N/A N/A N/A $219.25 N/A $156.61 $156.61 $170.71 "$1,039.18 " "$1,104.13 " N/A $974.24 N/A N/A $649.49 $844.34 $876.81 $876.81 $876.81 $876.81 N/A $164.44 $156.61 $866.42 N/A N/A $133.12 $133.12 $156.61 $133.12 "$1,104.13 " 330104 99203 491 510 HC OFFICE VISIT NEW PAT- DETAILED EXAM- LVL3 - 33-44 MINS O "$1,007.94 " $98.47 $98.47 N/A N/A $624.92 $624.92 $97.49 N/A $187.10 N/A $98.47 $755.96 $108.32 $635.00 N/A N/A N/A $604.76 $806.35 $334.81 $503.97 N/A $98.47 $655.16 N/A $806.35 N/A N/A N/A $137.86 N/A $98.47 $98.47 $107.34 $806.35 $856.75 N/A $755.96 N/A N/A $503.97 $655.16 $680.36 $680.36 $680.36 $680.36 N/A $103.40 $98.47 $672.30 N/A N/A $83.70 $83.70 $98.47 $83.70 $856.75 330104 99202 491 510 HC OFFICE VISIT NEW PAT-EXPANDED PRBLM FOCUS- LVL2 15- 29 MINS O $760.77 $56.37 $56.37 N/A N/A $471.68 $471.68 $55.81 N/A $107.11 N/A $56.37 $570.58 $62.01 $479.29 N/A N/A N/A $456.46 $608.62 $191.67 $380.38 N/A $56.37 $494.50 N/A $608.62 N/A N/A N/A $78.92 N/A $56.37 $56.37 $61.45 $608.62 $646.65 N/A $570.58 N/A N/A $380.38 $494.50 $513.52 $513.52 $513.52 $513.52 N/A $59.19 $56.37 $507.43 N/A N/A $47.92 $47.92 $56.37 $47.92 $646.65 330104 99201 491 510 HC OFFICE VISIT NEW PAT-PROBLEM FOCUSED-LVL 1 O $636.65 N/A N/A N/A N/A $394.72 $394.72 $416.37 N/A N/A N/A N/A $477.49 N/A $401.09 N/A N/A N/A $381.99 $509.32 N/A $318.32 N/A N/A N/A N/A $509.32 N/A N/A N/A N/A N/A N/A N/A N/A $509.32 $541.15 N/A $477.49 N/A N/A $318.32 $413.82 $429.74 $429.74 $429.74 $429.74 N/A N/A N/A $424.65 N/A N/A N/A N/A N/A $318.32 $541.15 330104 99024 2005 510 HC POSTOP FOLLOW-UP VISIT O N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 330104 99205 491 510 HC OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN O $828.18 $212.73 $212.73 N/A N/A $513.47 $513.47 $210.60 N/A $404.19 N/A $212.73 $621.14 $234.01 $521.75 N/A N/A N/A $496.91 $662.54 $723.29 $414.09 N/A $212.73 $538.32 N/A $662.54 N/A N/A N/A $297.82 N/A $212.73 $212.73 $231.88 $662.54 $703.95 N/A $621.14 N/A N/A $414.09 $538.32 $559.02 $559.02 $559.02 $559.02 N/A $223.37 $212.73 $552.40 N/A N/A $180.82 $180.82 $212.73 $180.82 $723.29 330104 98967 491 510 HC NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN O $102.72 $24.80 $24.80 N/A N/A $63.69 $63.69 $24.55 N/A $47.11 N/A $24.80 $77.04 $27.27 $64.71 N/A N/A N/A $61.63 $82.18 $84.30 $51.36 N/A $24.80 $66.77 N/A $82.18 N/A N/A N/A $34.71 N/A $24.80 $24.80 $27.03 $82.18 $87.31 N/A $77.04 N/A N/A $51.36 $66.77 $69.34 $69.34 $69.34 $69.34 N/A $26.04 $24.80 $68.51 N/A N/A $21.08 $21.08 $24.80 $21.08 $87.31 330104 99201 491 510 HC OFFICE VISIT CBE AND/OR PAP O $69.55 N/A N/A N/A N/A $43.12 $43.12 $45.49 N/A N/A N/A N/A $52.16 N/A $43.82 N/A N/A N/A $41.73 $55.64 N/A $34.77 N/A N/A N/A N/A $55.64 N/A N/A N/A N/A N/A N/A N/A N/A $55.64 $59.12 N/A $52.16 N/A N/A $34.77 $45.21 $46.95 $46.95 $46.95 $46.95 N/A N/A N/A $46.39 N/A N/A N/A N/A N/A $34.77 $59.12 330104 99385 491 510 HC PREV VISIT NEW AGE 18-39 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $107.40 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 N/A $177.62 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $107.40 $301.95 330104 99499 491 510 HC UNLISTED EVALUATION AND MANAGEMENT SERV O $79.18 N/A N/A N/A N/A $49.09 $49.09 N/A N/A N/A N/A N/A $59.39 N/A $49.88 N/A N/A N/A $47.51 $63.34 N/A $39.59 N/A N/A $51.47 N/A $63.34 N/A N/A N/A N/A N/A N/A N/A N/A $63.34 $67.30 N/A $59.39 N/A N/A $39.59 $51.47 $53.45 $53.45 $53.45 $53.45 N/A N/A N/A $52.81 N/A N/A N/A N/A N/A $39.59 $67.30 330104 99439 260 510 HC CHRONIC CARE MANAGEMENT SERVICES EA ADDL 20 MIN O $281.41 N/A N/A N/A N/A $174.47 $174.47 $39.69 N/A N/A N/A N/A $211.06 N/A $177.29 N/A N/A N/A $168.85 $225.13 N/A $140.71 N/A N/A $182.92 N/A $225.13 N/A N/A N/A N/A N/A N/A N/A N/A $225.13 $239.20 N/A $211.06 N/A N/A $140.71 $182.92 $189.95 $189.95 $189.95 $189.95 N/A N/A N/A $187.70 N/A N/A N/A N/A N/A $39.69 $239.20 330104 99427 260 510 HC PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MNTH O $140.17 N/A N/A N/A N/A $86.91 $86.91 $40.37 N/A N/A N/A N/A $105.13 N/A $88.31 N/A N/A N/A $84.10 $112.14 N/A $70.09 N/A N/A $91.11 N/A $112.14 N/A N/A N/A N/A N/A N/A N/A N/A $112.14 $119.14 N/A $105.13 N/A N/A $70.09 $91.11 $94.61 $94.61 $94.61 $94.61 N/A N/A N/A $93.49 N/A N/A N/A N/A N/A $40.37 $119.14 330104 99426 5822 260 510 HC PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO O $197.95 $91.00 $91.00 N/A N/A $122.73 $122.73 $90.09 N/A $172.90 N/A $91.00 $148.46 $100.10 $124.71 N/A N/A N/A $118.77 $158.36 $309.40 $98.97 N/A $91.00 $109.20 N/A $158.36 N/A N/A N/A $127.40 N/A $91.00 $91.00 $99.19 $158.36 $168.26 N/A $148.46 N/A N/A $98.97 $244.79 $133.62 $133.62 $133.62 $133.62 N/A $95.55 $91.00 $132.03 N/A N/A $77.35 $77.35 $91.00 $77.35 $309.40 330104 99417 2005 510 HC PROLONGED OFFICE/OUTPATIENT E/M SVC EA 15 MIN O $281.41 N/A N/A N/A N/A $174.47 $174.47 $34.46 N/A N/A N/A N/A $211.06 N/A $177.29 N/A N/A N/A $168.85 $225.13 N/A $140.71 N/A N/A $182.92 N/A $225.13 N/A N/A N/A N/A N/A N/A N/A N/A $225.13 $239.20 N/A $211.06 N/A N/A $140.71 $182.92 $189.95 $189.95 $189.95 $189.95 N/A N/A N/A $187.70 N/A N/A N/A N/A N/A $34.46 $239.20 330104 99407 5821 324 510 HC BEHAV CHNG SMOKING > 10 MIN O $194.74 $35.61 $35.61 $51.96 N/A $120.74 $120.74 $35.25 $51.96 $67.66 $51.96 $35.61 $146.06 $39.17 $122.69 N/A $62.35 $51.96 $116.84 $155.79 $121.07 $97.37 $51.96 $35.61 $42.73 $72.74 $155.79 $51.96 $51.96 $62.35 $49.85 $51.96 $35.61 $35.61 $38.81 $155.79 $165.53 $51.96 $146.06 $106.52 $51.96 $97.37 $95.79 $131.45 $131.45 $131.45 $131.45 N/A $37.39 $35.61 $129.89 $51.96 $51.96 $30.27 $30.27 $35.61 $30.27 $165.53 330104 99406 5821 324 510 HC BEHAV CHNG SMOKING 3-10 MIN O $146.59 $35.61 $35.61 $51.96 N/A $90.89 $90.89 $35.25 $51.96 $67.66 $51.96 $35.61 $109.94 $39.17 $92.35 N/A $62.35 $51.96 $87.95 $117.27 $121.07 $73.30 $51.96 $35.61 $42.73 $72.74 $117.27 $51.96 $51.96 $62.35 $49.85 $51.96 $35.61 $35.61 $38.81 $117.27 $124.60 $51.96 $109.94 $106.52 $51.96 $73.30 $95.79 $98.95 $98.95 $98.95 $98.95 N/A $37.39 $35.61 $97.78 $51.96 $51.96 $30.27 $30.27 $35.61 $30.27 $124.60 330104 99404 325 510 HC PREVENTIVE COUNSELING INDIV-60 MIN O $791.80 N/A N/A N/A N/A $490.92 $490.92 $109.27 N/A N/A N/A N/A $593.85 N/A $498.83 N/A N/A N/A $475.08 $633.44 N/A $395.90 N/A N/A $514.67 N/A $633.44 N/A N/A N/A N/A N/A N/A N/A N/A $633.44 $673.03 N/A $593.85 N/A N/A $395.90 $514.67 $534.47 $534.47 $534.47 $534.47 N/A N/A N/A $528.13 N/A N/A N/A N/A N/A $109.27 $673.03 330104 99403 325 510 HC PREVENTIVE COUNSELING INDIV-45MIN O $767.19 N/A N/A N/A N/A $475.66 $475.66 $82.64 N/A N/A N/A N/A $575.39 N/A $483.33 N/A N/A N/A $460.31 $613.75 N/A $383.60 N/A N/A $498.67 N/A $613.75 N/A N/A N/A N/A N/A N/A N/A N/A $613.75 $652.11 N/A $575.39 N/A N/A $383.60 $498.67 $517.85 $517.85 $517.85 $517.85 N/A N/A N/A $511.72 N/A N/A N/A N/A N/A $82.64 $652.11 330104 99402 325 510 HC PREVENTIVE COUNSELING INDIV-30MIN O $760.77 N/A N/A N/A N/A $471.68 $471.68 $54.81 N/A N/A N/A N/A $570.58 N/A $479.29 N/A N/A N/A $456.46 $608.62 N/A $380.38 N/A N/A $494.50 N/A $608.62 N/A N/A N/A N/A N/A N/A N/A N/A $608.62 $646.65 N/A $570.58 N/A N/A $380.38 $494.50 $513.52 $513.52 $513.52 $513.52 N/A N/A N/A $507.43 N/A N/A N/A N/A N/A $54.81 $646.65 330104 99401 325 510 HC PREVENTIVE COUNSELING INDIV-15 MIN O $636.65 N/A N/A N/A N/A $394.72 $394.72 $27.83 N/A N/A N/A N/A $477.49 N/A $401.09 N/A N/A N/A $381.99 $509.32 N/A $318.32 N/A N/A $413.82 N/A $509.32 N/A N/A N/A N/A N/A N/A N/A N/A $509.32 $541.15 N/A $477.49 N/A N/A $318.32 $413.82 $429.74 $429.74 $429.74 $429.74 N/A N/A N/A $424.65 N/A N/A N/A N/A N/A $27.83 $541.15 330104 99396 491 510 HC PREV VISIT EST AGE 40-64 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $105.91 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 $360.00 $611.00 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $105.91 $611.00 330104 99395 491 510 HC PREV VISIT EST AGE 18-39 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $98.16 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 $331.00 $561.00 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $98.16 $561.00 330104 99394 491 510 HC PREV VISIT EST AGE 12-17 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $94.80 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 $321.00 $546.00 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $94.80 $546.00 330104 99386 491 510 HC PREV VISIT NEW AGE 40-64 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $129.97 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 N/A $177.62 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $129.97 $301.95 330104 99384 491 510 HC PREV VISIT NEW AGE 12-17 O $355.24 N/A N/A N/A N/A $220.25 $220.25 $111.45 N/A N/A N/A N/A $266.43 N/A $223.80 N/A N/A N/A $213.14 $284.19 N/A $177.62 N/A N/A $230.91 N/A $284.19 N/A N/A N/A N/A N/A N/A N/A N/A $284.19 $301.95 N/A $266.43 N/A N/A $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 N/A N/A N/A N/A N/A $111.45 $301.95 330104 98966 491 510 HC NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN O $79.18 $12.60 $12.60 N/A N/A $49.09 $49.09 $12.48 N/A $23.95 N/A $12.60 $59.39 $13.86 $49.88 N/A N/A N/A $47.51 $63.34 $42.85 $39.59 N/A $12.60 $51.47 N/A $63.34 N/A N/A N/A $17.64 N/A $12.60 $12.60 $13.74 $63.34 $67.30 N/A $59.39 N/A N/A $39.59 $51.47 $53.45 $53.45 $53.45 $53.45 N/A $13.23 $12.60 $52.81 N/A N/A $10.71 $10.71 $12.60 $10.71 $67.30 330104 97606 5052 17 510 HC NEG PRESS WOUND TX >50 CM O "$1,474.46 " $447.59 $447.59 $705.44 N/A $914.17 $914.17 $443.11 $705.44 $850.42 $705.44 $447.59 "$1,105.85 " $492.35 $928.91 N/A $846.53 $705.44 $884.68 "$1,179.57 " "$1,521.80 " $737.23 $705.44 $447.59 $537.10 $987.62 "$1,179.57 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,179.57 " "$1,253.29 " $705.44 "$1,105.85 " "$1,446.16 " $705.44 $737.23 "$1,204.01 " $995.26 $995.26 $995.26 $995.26 N/A $469.97 $447.59 $983.46 $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$1,521.80 " 330104 97605 5051 16 510 HC NEG PRESS WOUND TX 4.0 CM O "$8,659.51 " "$1,799.07 " "$1,799.07 " "$2,097.00 " "$2,523.00 " "$5,368.90 " "$5,368.90 " "$1,781.08 " "$2,097.00 " "$3,418.23 " "$2,097.00 " "$1,799.07 " "$6,494.63 " "$1,978.98 " "$5,455.49 " N/A "$2,516.40 " "$2,097.00 " "$5,195.71 " "$6,927.61 " "$6,116.84 " "$4,329.76 " "$2,097.00 " "$1,799.07 " "$2,158.88 " "$2,935.80 " "$6,927.61 " "$2,097.00 " "$2,097.00 " "$2,516.40 " "$2,518.70 " "$2,097.00 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$6,927.61 " "$7,360.58 " "$2,097.00 " "$3,883.00 " "$4,298.85 " "$2,097.00 " "$4,329.76 " "$4,839.50 " "$5,845.17 " "$5,845.17 " "$5,845.17 " "$5,845.17 " N/A "$1,889.02 " "$1,799.07 " "$5,775.89 " "$2,097.00 " "$2,097.00 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,529.21 " "$7,360.58 " 330104 11042 5052 17 510 HC DEB SUBQ TISSUE 20 SQ CM/< O "$1,989.13 " $447.59 $447.59 $705.44 "$2,523.00 " "$1,233.26 " "$1,233.26 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,491.85 " $492.35 "$1,253.15 " N/A $846.53 $705.44 "$1,193.48 " "$1,591.30 " "$1,521.80 " $994.57 $705.44 $447.59 $537.10 $987.62 "$1,591.30 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,591.30 " "$1,690.76 " $705.44 "$1,491.85 " "$1,446.16 " $705.44 $994.57 "$1,204.01 " "$1,342.66 " "$1,342.66 " "$1,342.66 " "$1,342.66 " N/A $469.97 $447.59 "$1,326.75 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$2,523.00 " 330104 11420 5072 10 510 HC EXC H-F-NK-SP B9+MARG 0.5/< O "$1,707.72 " "$1,799.07 " "$1,799.07 " "$1,250.80 " "$1,099.00 " "$1,296.00 " "$1,180.00 " "$1,781.08 " "$1,250.80 " "$3,418.23 " "$1,250.80 " "$1,799.07 " "$1,280.79 " "$1,978.98 " "$1,075.86 " N/A "$1,500.96 " "$1,250.80 " "$1,024.63 " "$1,366.18 " "$6,116.84 " $853.86 "$1,250.80 " "$1,799.07 " "$2,158.88 " "$1,751.12 " "$1,366.18 " "$1,250.80 " "$1,250.80 " "$1,500.96 " "$2,518.70 " "$1,250.80 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$1,366.18 " "$1,451.56 " "$1,250.80 " "$1,280.79 " "$2,564.14 " "$1,250.80 " $853.86 "$4,839.50 " "$1,152.71 " "$1,152.71 " "$1,152.71 " "$1,152.71 " N/A "$1,889.02 " "$1,799.07 " "$1,139.05 " "$1,250.80 " "$1,250.80 " "$1,529.21 " "$1,529.21 " "$1,799.07 " $853.86 "$6,116.84 " 330104 11440 5071 9 510 HC EXC FACE-MM B9+MARG 0.5 CM/< O "$3,143.66 " $778.60 $778.60 $636.95 "$1,878.00 " "$1,296.00 " "$1,180.00 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,672.11 " 330104 11441 5071 9 510 HC EXC FACE-MM B9+MARG 0.6-1 CM O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,296.00 " "$1,180.00 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,672.11 " 330104 11600 5071 9 510 HC EXC TR-EXT MAL+MARG 0.5 CM/< O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,949.07 " "$1,949.07 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,672.11 " 330104 11601 5071 9 510 HC EXC TR-EXT MAL+MARG 0.6-1 CM O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,949.07 " "$1,949.07 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 11603 5071 9 510 HC EXC TR-EXT MAL+MARG 2.1-3 CM O "$4,651.29 " $778.60 $778.60 $636.95 "$1,099.00 " "$2,883.80 " "$2,883.80 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$3,488.47 " $856.45 "$2,930.31 " N/A $764.34 $636.95 "$2,790.77 " "$3,721.03 " "$2,647.22 " "$2,325.64 " $636.95 $778.60 $934.31 $891.73 "$3,721.03 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$3,721.03 " "$3,953.60 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$2,325.64 " "$2,094.42 " "$3,139.62 " "$3,139.62 " "$3,139.62 " "$3,139.62 " N/A $817.53 $778.60 "$3,102.41 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,953.60 " 330104 11620 5072 10 510 HC EXC H-F-NK-SP MAL+MARG 0.5/< O "$3,143.66 " "$1,799.07 " "$1,799.07 " "$1,250.80 " "$1,099.00 " "$1,949.07 " "$1,949.07 " "$1,781.08 " "$1,250.80 " "$3,418.23 " "$1,250.80 " "$1,799.07 " "$2,357.74 " "$1,978.98 " "$1,980.51 " N/A "$1,500.96 " "$1,250.80 " "$1,886.20 " "$2,514.93 " "$6,116.84 " "$1,571.83 " "$1,250.80 " "$1,799.07 " "$2,158.88 " "$1,751.12 " "$2,514.93 " "$1,250.80 " "$1,250.80 " "$1,500.96 " "$2,518.70 " "$1,250.80 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$2,514.93 " "$2,672.11 " "$1,250.80 " "$2,357.74 " "$2,564.14 " "$1,250.80 " "$1,571.83 " "$4,839.50 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A "$1,889.02 " "$1,799.07 " "$2,096.82 " "$1,250.80 " "$1,250.80 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,099.00 " "$6,116.84 " 330104 11621 5071 9 510 HC EXC S/N/H/F/G MAL+MRG 0.6-1 O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,949.07 " "$1,949.07 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 11640 5071 9 510 HC EXC F/E/E/N/L MAL+MRG 0.5CM< O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,296.00 " "$1,180.00 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,672.11 " 330104 11641 5071 9 510 HC EXC F/E/E/N/L MAL+MRG 0.6-1 O "$3,143.66 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,296.00 " "$1,180.00 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 11719 5733 5 510 HC TRIM NAIL(S) ANY NUMBER O $254.66 $68.96 $68.96 $92.85 $482.00 $157.89 $157.89 $68.27 $92.85 $131.03 $92.85 $68.96 $191.00 $75.86 $160.44 N/A $111.41 $92.85 $152.80 $203.73 $234.47 $127.33 $92.85 $68.96 $82.75 $129.98 $203.73 $92.85 $92.85 $111.41 $96.55 $92.85 $68.96 $68.96 $75.17 $203.73 $216.46 $92.85 $191.00 $190.33 $92.85 $127.33 $185.51 $171.90 $171.90 $171.90 $171.90 N/A $72.41 $68.96 $169.86 $92.85 $92.85 $58.62 $58.62 $68.96 $58.62 $482.00 330104 11720 5733 5 510 HC DEBRIDE NAIL 1-5 O $589.57 $68.96 $68.96 $92.85 $482.00 $365.53 $365.53 $68.27 $92.85 $131.03 $92.85 $68.96 $442.18 $75.86 $371.43 N/A $111.41 $92.85 $353.74 $471.66 $234.47 $294.79 $92.85 $68.96 $82.75 $129.98 $471.66 $92.85 $92.85 $111.41 $96.55 $92.85 $68.96 $68.96 $75.17 $471.66 $501.13 $92.85 $442.18 $190.33 $92.85 $294.79 $185.51 $397.96 $397.96 $397.96 $397.96 N/A $72.41 $68.96 $393.24 $92.85 $92.85 $58.62 $58.62 $68.96 $58.62 $501.13 330104 11721 5733 5 510 HC DEBRIDE NAIL 6 OR MORE O $589.57 $68.96 $68.96 $92.85 $482.00 $365.53 $365.53 $68.27 $92.85 $131.03 $92.85 $68.96 $442.18 $75.86 $371.43 N/A $111.41 $92.85 $353.74 $471.66 $234.47 $294.79 $92.85 $68.96 $82.75 $129.98 $471.66 $92.85 $92.85 $111.41 $96.55 $92.85 $68.96 $68.96 $75.17 $471.66 $501.13 $92.85 $442.18 $190.33 $92.85 $294.79 $185.51 $397.96 $397.96 $397.96 $397.96 N/A $72.41 $68.96 $393.24 $92.85 $92.85 $58.62 $58.62 $68.96 $58.62 $501.13 330104 11730 5051 5 510 HC AVULSION NAIL PLATE PARTIAL/COMPLETE-SIMPLE/SINGLE O $806.78 $216.65 $216.65 $92.85 $482.00 $500.20 $500.20 $214.48 $92.85 $411.63 $92.85 $216.65 $605.09 $238.31 $508.27 N/A $111.41 $92.85 $484.07 $645.42 $736.61 $403.39 $92.85 $216.65 $259.98 $129.98 $645.42 $92.85 $92.85 $111.41 $303.31 $92.85 $216.65 $216.65 $236.15 $645.42 $685.76 $92.85 $605.09 $190.33 $92.85 $403.39 $582.79 $544.58 $544.58 $544.58 $544.58 N/A $227.48 $216.65 $538.12 $92.85 $92.85 $184.15 $184.15 $216.65 $92.85 $736.61 330104 11421 5071 9 510 HC EXC H-F-NK-SP B9+MARG 0.6-1 O "$3,143.66 " $778.60 $778.60 $636.95 "$2,886.00 " "$1,949.07 " "$1,949.07 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $764.34 $636.95 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $636.95 $778.60 $934.31 $891.73 "$2,514.93 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $636.95 "$2,357.74 " "$1,305.74 " $636.95 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$2,886.00 " 330104 11732 5 510 HC AVULSION NAIL PLATE PRT/COMPL-SIMPLE EA. ADDL NAIL O $636.65 N/A N/A $92.85 $482.00 $394.72 $394.72 $20.22 $92.85 N/A $92.85 N/A $477.49 N/A $401.09 N/A $111.41 $92.85 $381.99 $509.32 N/A $318.32 $92.85 N/A $413.82 $129.98 $509.32 $92.85 $92.85 $111.41 N/A $92.85 N/A N/A N/A $509.32 $541.15 $125.34 $477.49 $190.33 $125.34 $318.32 $413.82 $429.74 $429.74 $429.74 $429.74 N/A N/A N/A $424.65 $92.85 $92.85 N/A N/A N/A $20.22 $541.15 330104 10180 5073 18 510 HC I&D COMPLEX POSTOPERATIVE WOUND INFECTION O "$9,630.00 " "$3,099.23 " "$3,099.23 " "$1,404.72 " "$2,523.00 " "$5,970.60 " "$5,970.60 " "$3,068.24 " "$1,404.72 " "$5,888.53 " "$1,404.72 " "$3,099.23 " "$7,222.50 " "$3,409.15 " "$6,066.90 " N/A "$1,685.66 " "$1,404.72 " "$5,778.00 " "$7,704.00 " "$10,537.38 " "$4,815.00 " "$1,404.72 " "$3,099.23 " "$3,719.07 " "$1,966.60 " "$7,704.00 " "$1,404.72 " "$1,404.72 " "$1,685.66 " "$4,338.92 " "$1,404.72 " "$3,099.23 " "$3,099.23 " "$3,378.16 " "$7,704.00 " "$8,185.50 " "$1,404.72 " "$3,883.00 " "$2,879.67 " "$1,404.72 " "$4,815.00 " "$8,336.92 " "$6,500.25 " "$6,500.25 " "$6,500.25 " "$6,500.25 " N/A "$3,254.19 " "$3,099.23 " "$6,423.21 " "$1,404.72 " "$1,404.72 " "$2,634.34 " "$2,634.34 " "$3,099.23 " "$1,404.72 " "$10,537.38 " 330104 10140 5072 4 510 HC I&D HEMATOMA/ SEROMA OR FLUID COLLECTION O "$6,324.77 " "$1,799.07 " "$1,799.07 " $616.26 "$1,878.00 " "$3,921.36 " "$3,921.36 " "$1,781.08 " $616.26 "$3,418.23 " $616.26 "$1,799.07 " "$4,743.58 " "$1,978.98 " "$3,984.61 " N/A $739.52 $616.26 "$3,794.86 " "$5,059.82 " "$6,116.84 " "$3,162.39 " $616.26 "$1,799.07 " "$2,158.88 " $862.77 "$5,059.82 " $616.26 $616.26 $739.52 "$2,518.70 " $616.26 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " $616.26 "$4,743.58 " "$1,263.34 " $616.26 "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " N/A "$1,889.02 " "$1,799.07 " "$4,218.62 " $616.26 $616.26 "$1,529.21 " "$1,529.21 " "$1,799.07 " $616.26 "$6,116.84 " 330104 20245 5073 51 510 HC BONE BIOPSY OPEN DEEP O "$15,221.82 " "$3,099.23 " "$3,099.23 " "$1,085.97 " "$2,886.00 " "$9,437.53 " "$9,437.53 " "$3,068.24 " "$1,085.97 " "$5,888.53 " "$1,085.97 " "$3,099.23 " "$11,416.36 " "$3,409.15 " "$9,589.75 " N/A "$1,303.17 " "$1,085.97 " "$9,133.09 " "$12,177.46 " "$10,537.38 " "$7,610.91 " "$1,085.97 " "$3,099.23 " "$3,719.07 " "$1,520.36 " "$12,177.46 " "$1,085.97 " "$1,085.97 " "$1,303.17 " "$4,338.92 " "$1,085.97 " "$3,099.23 " "$3,099.23 " "$3,378.16 " "$12,177.46 " "$12,938.55 " "$1,085.97 " "$4,965.00 " "$2,226.24 " "$1,085.97 " "$7,610.91 " "$8,336.92 " "$10,274.73 " "$10,274.73 " "$10,274.73 " "$10,274.73 " N/A "$3,254.19 " "$3,099.23 " "$10,152.95 " "$1,085.97 " "$1,085.97 " "$2,634.34 " "$2,634.34 " "$3,099.23 " "$1,085.97 " "$12,938.55 " 330104 G0246 5012 491 510 HC FOLLOWUP EVAL OF FOOT PT LOP O $678.38 $145.00 $145.00 N/A N/A $420.60 $420.60 $143.55 N/A $275.50 N/A $145.00 $508.78 $159.50 $427.38 N/A N/A N/A $407.03 $542.70 $493.00 $339.19 N/A $145.00 $174.00 N/A $542.70 N/A N/A N/A $203.00 N/A $145.00 $145.00 $158.05 $542.70 $576.62 N/A $508.78 N/A N/A $339.19 $390.05 $457.91 $457.91 $457.91 $457.91 N/A $152.25 $145.00 $452.48 N/A N/A $123.25 $123.25 $145.00 $123.25 $576.62 330104 G0247 5051 491 510 HC ROUTINE FOOTCARE PT W LOPS O $806.78 $216.65 $216.65 N/A N/A $500.20 $500.20 $214.48 N/A $411.63 N/A $216.65 $605.09 $238.31 $508.27 N/A N/A N/A $484.07 $645.42 $736.61 $403.39 N/A $216.65 $259.98 N/A $645.42 N/A N/A N/A $303.31 N/A $216.65 $216.65 $236.15 $645.42 $685.76 N/A $605.09 N/A N/A $403.39 $582.79 $544.58 $544.58 $544.58 $544.58 N/A $227.48 $216.65 $538.12 N/A N/A $184.15 $184.15 $216.65 $184.15 $736.61 330104 G0463 5012 491 510 HC HOSPITAL OUTPT CLINIC VISIT O $621.67 $145.00 $145.00 N/A N/A $385.44 $385.44 $143.55 N/A $275.50 N/A $145.00 $466.25 $159.50 $391.65 N/A N/A N/A $373.00 $497.34 $493.00 $310.83 N/A $145.00 $174.00 N/A $497.34 N/A N/A N/A $203.00 N/A $145.00 $145.00 $158.05 $497.34 $528.42 N/A $466.25 N/A N/A $310.83 $390.05 $419.63 $419.63 $419.63 $419.63 N/A $152.25 $145.00 $414.65 N/A N/A $123.25 $123.25 $145.00 $123.25 $528.42 330104 T1013 2005 510 HC SIGN LANG/ORAL INTERPRETIVE SERV/15 MIN O $49.22 N/A N/A N/A N/A $30.52 $30.52 N/A N/A N/A N/A N/A $36.91 N/A $31.01 N/A N/A N/A $29.53 $39.38 N/A $24.61 N/A N/A $31.99 N/A $39.38 N/A N/A N/A N/A N/A N/A N/A N/A $39.38 $41.84 N/A $36.91 N/A N/A $24.61 $31.99 $33.22 $33.22 $33.22 $33.22 N/A N/A N/A $32.83 N/A N/A N/A N/A N/A $24.61 $41.84 330104 C5271 5053 56 510 HC LOWCOST-SKIN SUBST APP TR/AR/LG<=25SQCM O "$2,672.86 " $696.99 $696.99 "$1,466.46 " "$1,099.00 " "$1,657.17 " "$1,657.17 " $690.02 "$1,466.46 " "$1,324.28 " "$1,466.46 " $696.99 "$2,004.64 " $766.69 "$1,683.90 " N/A "$1,759.75 " "$1,466.46 " "$1,603.72 " "$2,138.29 " "$2,369.76 " "$1,336.43 " "$1,466.46 " $696.99 $836.39 "$2,053.05 " "$2,138.29 " "$1,466.46 " "$1,466.46 " "$1,759.75 " $975.78 "$1,466.46 " $696.99 $696.99 $759.72 "$2,138.29 " "$2,271.93 " "$1,466.46 " "$2,004.64 " "$3,006.25 " "$1,466.46 " "$1,336.43 " "$1,874.90 " "$1,804.18 " "$1,804.18 " "$1,804.18 " "$1,804.18 " N/A $731.84 $696.99 "$1,782.80 " "$1,466.46 " "$1,466.46 " $592.44 $592.44 $696.99 $592.44 "$3,006.25 " 330104 C5272 56 510 HC LOWCOST-SKIN TR/AR/LG EA.ADDL<=25SQCM O "$1,337.50 " N/A N/A "$1,466.46 " $482.00 $829.25 $829.25 $874.73 "$1,466.46 " N/A "$1,466.46 " N/A "$1,003.12 " N/A $842.62 N/A "$1,759.75 " "$1,466.46 " $802.50 "$1,070.00 " N/A $668.75 "$1,466.46 " N/A N/A "$2,053.05 " "$1,070.00 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,070.00 " "$1,136.88 " "$1,979.72 " "$1,003.12 " "$3,006.25 " "$1,979.72 " $668.75 $869.38 $902.81 $902.81 $902.81 $902.81 N/A N/A N/A $892.11 "$1,466.46 " "$1,466.46 " N/A N/A N/A $482.00 "$3,006.25 " 330104 C5273 5054 56 510 HC LOWCOST-SKIN SUBSTAPP TR/AR/LG<=100SQCM O "$8,947.34 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,886.00 " "$5,547.35 " "$5,547.35 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$6,710.51 " "$2,277.64 " "$5,636.82 " N/A "$1,759.75 " "$1,466.46 " "$5,368.40 " "$7,157.87 " "$7,039.98 " "$4,473.67 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$7,157.87 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$7,157.87 " "$7,605.24 " "$1,466.46 " "$6,710.51 " "$3,006.25 " "$1,466.46 " "$4,473.67 " "$5,569.87 " "$6,039.45 " "$6,039.45 " "$6,039.45 " "$6,039.45 " N/A "$2,174.11 " "$2,070.58 " "$5,967.88 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$7,605.24 " 330104 C5274 56 510 HC LOWCOST-SKINSUB TR/AR/LGEA.ADD<=100SQCM O "$4,471.53 " N/A N/A "$1,466.46 " $482.00 "$2,772.35 " "$2,772.35 " "$2,924.38 " "$1,466.46 " N/A "$1,466.46 " N/A "$3,353.65 " N/A "$2,817.06 " N/A "$1,759.75 " "$1,466.46 " "$2,682.92 " "$3,577.22 " N/A "$2,235.76 " "$1,466.46 " N/A N/A "$2,053.05 " "$3,577.22 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$3,577.22 " "$3,800.80 " "$1,979.72 " "$3,353.65 " "$3,006.25 " "$1,979.72 " "$2,235.76 " "$2,906.49 " "$3,018.28 " "$3,018.28 " "$3,018.28 " "$3,018.28 " N/A N/A N/A "$2,982.51 " "$1,466.46 " "$1,466.46 " N/A N/A N/A $482.00 "$3,800.80 " 330104 C5275 5053 56 510 HC LOWCOST-SKNSUB HEAD/NK/HND/FEET<=25SQCM O "$2,672.86 " $696.99 $696.99 "$1,466.46 " "$1,099.00 " "$1,657.17 " "$1,657.17 " $690.02 "$1,466.46 " "$1,324.28 " "$1,466.46 " $696.99 "$2,004.64 " $766.69 "$1,683.90 " N/A "$1,759.75 " "$1,466.46 " "$1,603.72 " "$2,138.29 " "$2,369.76 " "$1,336.43 " "$1,466.46 " $696.99 $836.39 "$2,053.05 " "$2,138.29 " "$1,466.46 " "$1,466.46 " "$1,759.75 " $975.78 "$1,466.46 " $696.99 $696.99 $759.72 "$2,138.29 " "$2,271.93 " "$1,466.46 " "$2,004.64 " "$3,006.25 " "$1,466.46 " "$1,336.43 " "$1,874.90 " "$1,804.18 " "$1,804.18 " "$1,804.18 " "$1,804.18 " N/A $731.84 $696.99 "$1,782.80 " "$1,466.46 " "$1,466.46 " $592.44 $592.44 $696.99 $592.44 "$3,006.25 " 330104 C5276 56 510 HC LOWCOST-SKN HD/NK/HND/FT EA.ADD<=25SQCM O "$1,337.50 " N/A N/A "$1,466.46 " $482.00 $829.25 $829.25 $874.73 "$1,466.46 " N/A "$1,466.46 " N/A "$1,003.12 " N/A $842.62 N/A "$1,759.75 " "$1,466.46 " $802.50 "$1,070.00 " N/A $668.75 "$1,466.46 " N/A N/A "$2,053.05 " "$1,070.00 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,070.00 " "$1,136.88 " "$1,979.72 " "$1,003.12 " "$3,006.25 " "$1,979.72 " $668.75 $869.38 $902.81 $902.81 $902.81 $902.81 N/A N/A N/A $892.11 "$1,466.46 " "$1,466.46 " N/A N/A N/A $482.00 "$3,006.25 " 330104 C5277 5053 56 510 HC LOWCOST-SKNSUB HD/NK/HND/FEET<=100SQCM O "$2,672.86 " $696.99 $696.99 "$1,466.46 " "$2,523.00 " "$1,657.17 " "$1,657.17 " $690.02 "$1,466.46 " "$1,324.28 " "$1,466.46 " $696.99 "$2,004.64 " $766.69 "$1,683.90 " N/A "$1,759.75 " "$1,466.46 " "$1,603.72 " "$2,138.29 " "$2,369.76 " "$1,336.43 " "$1,466.46 " $696.99 $836.39 "$2,053.05 " "$2,138.29 " "$1,466.46 " "$1,466.46 " "$1,759.75 " $975.78 "$1,466.46 " $696.99 $696.99 $759.72 "$2,138.29 " "$2,271.93 " "$1,466.46 " "$2,004.64 " "$3,006.25 " "$1,466.46 " "$1,336.43 " "$1,874.90 " "$1,804.18 " "$1,804.18 " "$1,804.18 " "$1,804.18 " N/A $731.84 $696.99 "$1,782.80 " "$1,466.46 " "$1,466.46 " $592.44 $592.44 $696.99 $592.44 "$3,006.25 " 330104 C5278 56 510 HC LOWCOST-SKN HD/NK/HND/FTEA.ADD<=100SQCM O "$1,337.50 " N/A N/A "$1,466.46 " $482.00 $829.25 $829.25 $874.73 "$1,466.46 " N/A "$1,466.46 " N/A "$1,003.12 " N/A $842.62 N/A "$1,759.75 " "$1,466.46 " $802.50 "$1,070.00 " N/A $668.75 "$1,466.46 " N/A N/A "$2,053.05 " "$1,070.00 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,070.00 " "$1,136.88 " "$1,979.72 " "$1,003.12 " "$3,006.25 " "$1,979.72 " $668.75 $869.38 $902.81 $902.81 $902.81 $902.81 N/A N/A N/A $892.11 "$1,466.46 " "$1,466.46 " N/A N/A N/A $482.00 "$3,006.25 " 330104 10160 5052 3 510 HC PUNCTURE ASPIRATION ABSCESS/HEMATOMA/BULLA OR CYST O "$1,474.46 " $447.59 $447.59 $325.60 $482.00 "$1,296.00 " "$1,180.00 " $443.11 $325.60 $850.42 $325.60 $447.59 "$1,105.85 " $492.35 $928.91 N/A $390.72 $325.60 $884.68 "$1,179.57 " "$1,521.80 " $737.23 $325.60 $447.59 $537.10 $455.84 "$1,179.57 " $325.60 $325.60 $390.72 $626.62 $325.60 $447.59 $447.59 $487.87 "$1,179.57 " "$1,253.29 " $325.60 "$1,105.85 " $667.48 $325.60 $737.23 "$1,204.01 " $995.26 $995.26 $995.26 $995.26 N/A $469.97 $447.59 $983.46 $325.60 $325.60 $380.45 $380.45 $447.59 $325.60 "$1,521.80 " 330104 0687T 419 510 HC TX AMBLYOPIA DEV SUPLY EDUCATIONAL SETUP 1ST SES O $65.27 N/A N/A $91.80 N/A $40.47 $40.47 N/A $91.80 N/A $91.80 N/A $48.95 N/A $41.12 N/A $110.16 $91.80 $39.16 $52.22 N/A $32.63 $91.80 N/A $42.43 $128.52 $52.22 $91.80 $91.80 $110.16 N/A $91.80 N/A N/A N/A $52.22 $55.48 $123.93 $48.95 $188.19 $123.93 $32.63 $42.43 $44.06 $44.06 $44.06 $44.06 N/A N/A N/A $43.54 $91.80 $91.80 N/A N/A N/A $32.63 $188.19 330104 0702T 324 510 HC REM THER MNTR OL DIG COG BHV THER PRGRM SPLY TCH O $99.51 N/A N/A $51.96 N/A $61.70 $61.70 $65.08 $51.96 N/A $51.96 N/A $74.63 N/A $62.69 N/A $62.35 $51.96 $59.71 $79.61 N/A $49.76 $51.96 N/A N/A $72.74 $79.61 $51.96 $51.96 $62.35 N/A $51.96 N/A N/A N/A $79.61 $84.58 $70.15 $74.63 $106.52 $70.15 $49.76 $64.68 $67.17 $67.17 $67.17 $67.17 N/A N/A N/A $66.37 $51.96 $51.96 N/A N/A N/A $49.76 $106.52 330104 0704T 419 510 HC REM TX AMBLYOPIA DEV SUPPLY 1ST SETUP&PT EDUCAJ O $65.27 N/A N/A $91.80 N/A $40.47 $40.47 N/A $91.80 N/A $91.80 N/A $48.95 N/A $41.12 N/A $110.16 $91.80 $39.16 $52.22 N/A $32.63 $91.80 N/A $42.43 $128.52 $52.22 $91.80 $91.80 $110.16 N/A $91.80 N/A N/A N/A $52.22 $55.48 $123.93 $48.95 $188.19 $123.93 $32.63 $42.43 $44.06 $44.06 $44.06 $44.06 N/A N/A N/A $43.54 $91.80 $91.80 N/A N/A N/A $32.63 $188.19 330104 0705T 488 510 HC REM TX AMBLYOPIA TCH SPRT MIN 18 TRAING HR EA 30 O $208.65 N/A N/A $84.24 N/A $129.36 $129.36 N/A $84.24 N/A $84.24 N/A $156.49 N/A $131.45 N/A $101.09 $84.24 $125.19 $166.92 N/A $104.33 $84.24 N/A $135.62 $117.93 $166.92 $84.24 $84.24 $101.09 N/A $84.24 N/A N/A N/A $166.92 $177.35 $113.72 $156.49 $172.69 $113.72 $104.33 $135.62 $140.84 $140.84 $140.84 $140.84 N/A N/A N/A $139.17 $84.24 $84.24 N/A N/A N/A $84.24 $177.35 330104 0706T 419 510 HC REM TX AMBLYOPIA I&R PHYS/QHP PER CALENDAR MONTH O $208.65 N/A N/A $91.80 N/A $129.36 $129.36 N/A $91.80 N/A $91.80 N/A $156.49 N/A $131.45 N/A $110.16 $91.80 $125.19 $166.92 N/A $104.33 $91.80 N/A $135.62 $128.52 $166.92 $91.80 $91.80 $110.16 N/A $91.80 N/A N/A N/A $166.92 $177.35 $123.93 $156.49 $188.19 $123.93 $104.33 $135.62 $140.84 $140.84 $140.84 $140.84 N/A N/A N/A $139.17 $91.80 $91.80 N/A N/A N/A $91.80 $188.19 330104 S9442 428 510 HC CHILDBIRTH CLASS (NON-PHYSICIAN) O $155.15 N/A N/A N/A N/A $96.19 $96.19 N/A N/A N/A N/A N/A $116.36 N/A $97.74 N/A N/A N/A $93.09 $124.12 N/A $77.58 N/A N/A $100.85 N/A $124.12 N/A N/A N/A N/A N/A N/A N/A N/A $124.12 $131.88 N/A $116.36 N/A N/A $77.58 $100.85 $104.73 $104.73 $104.73 $104.73 N/A N/A N/A $103.49 N/A N/A N/A N/A N/A $77.58 $131.88 330104 S9445 428 510 HC PT EDUCATION NOC INDIVID O $284.62 N/A N/A $45.00 N/A $176.46 $176.46 N/A $45.00 N/A $45.00 N/A $213.47 N/A $179.31 N/A $54.00 $45.00 $170.77 $227.70 N/A $142.31 $45.00 N/A $185.00 $63.00 $227.70 $45.00 $45.00 $54.00 N/A $45.00 N/A N/A N/A $227.70 $241.93 $60.75 $213.47 $92.25 $60.75 $142.31 $185.00 $192.12 $192.12 $192.12 $192.12 N/A N/A N/A $189.84 $45.00 $45.00 N/A N/A N/A $45.00 $241.93 330104 S9446 429 510 HC PT EDUCATION NOC GROUP O $171.20 N/A N/A $15.00 N/A $106.14 $106.14 N/A $15.00 N/A $15.00 N/A $128.40 N/A $107.86 N/A $18.00 $15.00 $102.72 $136.96 N/A $85.60 $15.00 N/A $111.28 $21.00 $136.96 $15.00 $15.00 $18.00 N/A $15.00 N/A N/A N/A $136.96 $145.52 $20.25 $128.40 $30.75 $20.25 $85.60 $111.28 $115.56 $115.56 $115.56 $115.56 N/A N/A N/A $114.19 $15.00 $15.00 N/A N/A N/A $15.00 $145.52 330104 10021 5052 2 510 HC FNA W/O IMAGE O "$1,683.11 " $447.59 $447.59 $512.29 $482.00 "$1,043.53 " "$1,043.53 " $443.11 $512.29 $850.42 $512.29 $447.59 "$1,262.33 " $492.35 "$1,060.36 " N/A $614.75 $512.29 "$1,009.87 " "$1,346.49 " "$1,521.80 " $841.55 $512.29 $447.59 $537.10 $717.21 "$1,346.49 " $512.29 $512.29 $614.75 $626.62 $512.29 $447.59 $447.59 $487.87 "$1,346.49 " "$1,430.64 " $512.29 "$1,262.33 " "$1,050.20 " $512.29 $841.55 "$1,204.01 " "$1,136.10 " "$1,136.10 " "$1,136.10 " "$1,136.10 " N/A $469.97 $447.59 "$1,122.63 " $512.29 $512.29 $380.45 $380.45 $447.59 $380.45 "$1,521.80 " 330104 10060 5051 3 510 HC DRAINAGE OF SKIN ABSCESS SIMPLE/SINGLE O "$1,041.11 " $216.65 $216.65 $325.60 $482.00 "$1,296.00 " "$1,180.00 " $214.48 $325.60 $411.63 $325.60 $216.65 $780.83 $238.31 $655.90 N/A $390.72 $325.60 $624.67 $832.89 $736.61 $520.55 $325.60 $216.65 $259.98 $455.84 $832.89 $325.60 $325.60 $390.72 $303.31 $325.60 $216.65 $216.65 $236.15 $832.89 $884.94 $325.60 $780.83 $667.48 $325.60 $520.55 $582.79 $702.75 $702.75 $702.75 $702.75 N/A $227.48 $216.65 $694.42 $325.60 $325.60 $184.15 $184.15 $216.65 $184.15 "$1,296.00 " 330104 10061 5052 3 510 HC DRAINAGE OF SKIN ABSCESS COMPLICATED/MULTIPLE O "$1,474.46 " $447.59 $447.59 $325.60 $482.00 $914.17 $914.17 $443.11 $325.60 $850.42 $325.60 $447.59 "$1,105.85 " $492.35 $928.91 N/A $390.72 $325.60 $884.68 "$1,179.57 " "$1,521.80 " $737.23 $325.60 $447.59 $537.10 $455.84 "$1,179.57 " $325.60 $325.60 $390.72 $626.62 $325.60 $447.59 $447.59 $487.87 "$1,179.57 " "$1,253.29 " $325.60 "$3,883.00 " $667.48 $325.60 $737.23 "$1,204.01 " $995.26 $995.26 $995.26 $995.26 N/A $469.97 $447.59 $983.46 $325.60 $325.60 $380.45 $380.45 $447.59 $325.60 "$3,883.00 " 330104 10080 5071 3 510 HC I&D OF PILONIDAL CYST; SIMPLE O "$3,675.45 " $778.60 $778.60 $325.60 $482.00 "$2,278.78 " "$2,278.78 " $770.81 $325.60 "$1,479.33 " $325.60 $778.60 "$2,756.59 " $856.45 "$2,315.53 " N/A $390.72 $325.60 "$2,205.27 " "$2,940.36 " "$2,647.22 " "$1,837.72 " $325.60 $778.60 $934.31 $455.84 "$2,940.36 " $325.60 $325.60 $390.72 "$1,090.03 " $325.60 $778.60 $778.60 $848.67 "$2,940.36 " "$3,124.13 " $325.60 "$2,756.59 " $667.48 $325.60 "$1,837.72 " "$2,094.42 " "$2,480.93 " "$2,480.93 " "$2,480.93 " "$2,480.93 " N/A $817.53 $778.60 "$2,451.53 " $325.60 $325.60 $661.81 $661.81 $778.60 $325.60 "$3,124.13 " 330104 10081 5071 4 510 HC I&D OF PILONIDAL CYST; COMPLICATED O "$3,143.66 " $778.60 $778.60 $616.26 "$1,878.00 " "$1,949.07 " "$1,949.07 " $770.81 $616.26 "$1,479.33 " $616.26 $778.60 "$2,357.74 " $856.45 "$1,980.51 " N/A $739.52 $616.26 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $616.26 $778.60 $934.31 $862.77 "$2,514.93 " $616.26 $616.26 $739.52 "$1,090.03 " $616.26 $778.60 $778.60 $848.67 "$2,514.93 " "$2,672.11 " $616.26 "$3,883.00 " "$1,263.34 " $616.26 "$1,571.83 " "$2,094.42 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " N/A $817.53 $778.60 "$2,096.82 " $616.26 $616.26 $661.81 $661.81 $778.60 $616.26 "$3,883.00 " 330104 10120 5052 3 510 HC REMOVE FOREIGN BODY SIMPLE O "$2,346.51 " $447.59 $447.59 $325.60 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $325.60 $850.42 $325.60 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $390.72 $325.60 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $325.60 $447.59 $537.10 $455.84 "$1,877.21 " $325.60 $325.60 $390.72 $626.62 $325.60 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $325.60 "$1,759.88 " $667.48 $325.60 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $325.60 $325.60 $380.45 $380.45 $447.59 $325.60 "$1,994.53 " 330104 0688T 418 510 HC TX AMBLYOPIA ASSMT PERF PHYS/QHP W/REPORT CAL MO O $208.65 N/A N/A $187.76 N/A $129.36 $129.36 N/A $187.76 N/A $187.76 N/A $156.49 N/A $131.45 N/A $225.31 $187.76 $125.19 $166.92 N/A $104.33 $187.76 N/A $135.62 $262.86 $166.92 $187.76 $187.76 $225.31 N/A $187.76 N/A N/A N/A $166.92 $177.35 $253.47 $156.49 $384.90 $253.47 $104.33 $135.62 $140.84 $140.84 $140.84 $140.84 N/A N/A N/A $139.17 $187.76 $187.76 N/A N/A N/A $104.33 $384.90 330104 11740 5734 5 510 HC EVACUATION OF SUBUNGUAL HEMATOMA O "$1,060.37 " $139.30 $139.30 $92.85 $482.00 $657.43 $657.43 $137.91 $92.85 $264.67 $92.85 $139.30 $795.28 $153.23 $668.03 N/A $111.41 $92.85 $636.22 $848.30 $473.63 $530.18 $92.85 $139.30 $167.16 $129.98 $848.30 $92.85 $92.85 $111.41 $195.02 $92.85 $139.30 $139.30 $151.84 $848.30 $901.31 $92.85 $795.28 $190.33 $92.85 $530.18 $374.72 $715.75 $715.75 $715.75 $715.75 N/A $146.27 $139.30 $707.27 $92.85 $92.85 $118.41 $118.41 $139.30 $92.85 $901.31 330104 12051 5052 17 510 HC INTMD RPR FACE/MM 2.5 CM/< O $828.18 $447.59 $447.59 $705.44 $482.00 $513.47 $513.47 $443.11 $705.44 $850.42 $705.44 $447.59 $621.14 $492.35 $521.75 N/A $846.53 $705.44 $496.91 $662.54 "$1,521.80 " $414.09 $705.44 $447.59 $537.10 $987.62 $662.54 $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 $662.54 $703.95 $705.44 "$3,883.00 " "$1,446.16 " $705.44 $414.09 "$1,204.01 " $559.02 $559.02 $559.02 $559.02 N/A $469.97 $447.59 $552.40 $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 11765 5052 5 510 HC EXCISION OF NAIL FOLD TOE O "$2,346.51 " $447.59 $447.59 $92.85 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $92.85 $850.42 $92.85 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $111.41 $92.85 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $92.85 $447.59 $537.10 $129.98 "$1,877.21 " $92.85 $92.85 $111.41 $626.62 $92.85 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $92.85 "$1,759.88 " $190.33 $92.85 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $92.85 $92.85 $380.45 $380.45 $447.59 $92.85 "$1,994.53 " 330104 14040 5054 56 510 HC TIS TRNFR F/C/C/M/N/A/G/H/F 10 SQ CM/< O "$9,539.05 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,523.00 " "$5,914.21 " "$5,914.21 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$7,154.29 " "$2,277.64 " "$6,009.60 " N/A "$1,759.75 " "$1,466.46 " "$5,723.43 " "$7,631.24 " "$7,039.98 " "$4,769.52 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$7,631.24 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$7,631.24 " "$8,108.19 " "$1,466.46 " "$4,965.00 " "$3,006.25 " "$1,466.46 " "$4,769.52 " "$5,569.87 " "$6,438.86 " "$6,438.86 " "$6,438.86 " "$6,438.86 " N/A "$2,174.11 " "$2,070.58 " "$6,362.55 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$8,108.19 " 330104 14041 5054 56 510 HC TIS TRNFR F/C/C/M/N/A/G/H/F 10.1-30 SQCM O "$9,539.05 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,886.00 " "$5,914.21 " "$5,914.21 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$7,154.29 " "$2,277.64 " "$6,009.60 " N/A "$1,759.75 " "$1,466.46 " "$5,723.43 " "$7,631.24 " "$7,039.98 " "$4,769.52 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$7,631.24 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$7,631.24 " "$8,108.19 " "$1,466.46 " "$4,965.00 " "$3,006.25 " "$1,466.46 " "$4,769.52 " "$5,569.87 " "$6,438.86 " "$6,438.86 " "$6,438.86 " "$6,438.86 " N/A "$2,174.11 " "$2,070.58 " "$6,362.55 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$8,108.19 " 330104 14301 5055 56 510 HC PBB-ADJ TIS TRNFR ANY 30.1 -60SQCM O "$15,651.96 " "$3,902.80 " "$3,902.80 " "$1,466.46 " "$3,553.00 " "$9,704.22 " "$9,704.22 " "$3,863.77 " "$1,466.46 " "$7,415.32 " "$1,466.46 " "$3,902.80 " "$11,738.97 " "$4,293.08 " "$9,860.73 " N/A "$1,759.75 " "$1,466.46 " "$9,391.18 " "$12,521.57 " "$13,269.53 " "$7,825.98 " "$1,466.46 " "$3,902.80 " "$4,683.36 " "$2,053.05 " "$12,521.57 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$5,463.92 " "$1,466.46 " "$3,902.80 " "$3,902.80 " "$4,254.05 " "$12,521.57 " "$13,304.17 " "$1,466.46 " "$4,965.00 " "$3,006.25 " "$1,466.46 " "$7,825.98 " "$10,498.54 " "$10,565.07 " "$10,565.07 " "$10,565.07 " "$10,565.07 " N/A "$4,097.94 " "$3,902.80 " "$10,439.86 " "$1,466.46 " "$1,466.46 " "$3,317.38 " "$3,317.38 " "$3,902.80 " "$1,466.46 " "$13,304.17 " 330104 14302 56 510 HC TIS TRNFR ADDL 30 SQ CM O $767.19 N/A N/A "$1,466.46 " "$3,553.00 " $475.66 $475.66 $264.95 "$1,466.46 " N/A "$1,466.46 " N/A $575.39 N/A $483.33 N/A "$1,759.75 " "$1,466.46 " $460.31 $613.75 N/A $383.60 "$1,466.46 " N/A $498.67 "$2,053.05 " $613.75 "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A $613.75 $652.11 "$1,979.72 " "$3,883.00 " "$3,006.25 " "$1,979.72 " $383.60 $498.67 $517.85 $517.85 $517.85 $517.85 N/A N/A N/A $511.72 "$1,466.46 " "$1,466.46 " N/A N/A N/A $264.95 "$3,883.00 " 330104 15002 5054 18 510 HC WOUND PREP TRK/ARM/LEG 1ST 100SQCM/1% AREA CHILD O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,404.72 " "$1,099.00 " "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,404.72 " "$3,934.11 " "$1,404.72 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$4,710.61 " N/A "$1,685.66 " "$1,404.72 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,404.72 " "$2,070.58 " "$2,484.70 " "$1,966.60 " "$5,981.73 " "$1,404.72 " "$1,404.72 " "$1,685.66 " "$2,898.82 " "$1,404.72 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,404.72 " "$3,883.00 " "$2,879.67 " "$1,404.72 " "$3,738.58 " "$5,569.87 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " N/A "$2,174.11 " "$2,070.58 " "$4,987.27 " "$1,404.72 " "$1,404.72 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,099.00 " "$7,039.98 " 330104 15003 17 510 HC WOUND PREP PED TRK/ARM/LG ADDL 100 CM O "$3,481.78 " N/A N/A $705.44 "$1,099.00 " "$2,158.70 " "$2,158.70 " $56.91 $705.44 N/A $705.44 N/A "$2,611.34 " N/A "$2,193.52 " N/A $846.53 $705.44 "$2,089.07 " "$2,785.42 " N/A "$1,740.89 " $705.44 N/A "$2,263.16 " $987.62 "$2,785.42 " $705.44 $705.44 $846.53 N/A $705.44 N/A N/A N/A "$2,785.42 " "$2,959.51 " $952.35 "$2,611.34 " "$1,446.16 " $952.35 "$1,740.89 " "$2,263.16 " "$2,350.20 " "$2,350.20 " "$2,350.20 " "$2,350.20 " N/A N/A N/A "$2,322.35 " $705.44 $705.44 N/A N/A N/A $56.91 "$2,959.51 " 330104 15004 5053 18 510 HC WOUND PREP F/N/HF/G 1ST 100SQCM/1% AREA CHILD O "$3,481.78 " $696.99 $696.99 "$1,404.72 " "$1,099.00 " "$2,158.70 " "$2,158.70 " $690.02 "$1,404.72 " "$1,324.28 " "$1,404.72 " $696.99 "$2,611.34 " $766.69 "$2,193.52 " N/A "$1,685.66 " "$1,404.72 " "$2,089.07 " "$2,785.42 " "$2,369.76 " "$1,740.89 " "$1,404.72 " $696.99 $836.39 "$1,966.60 " "$2,785.42 " "$1,404.72 " "$1,404.72 " "$1,685.66 " $975.78 "$1,404.72 " $696.99 $696.99 $759.72 "$2,785.42 " "$2,959.51 " "$1,404.72 " "$3,883.00 " "$2,879.67 " "$1,404.72 " "$1,740.89 " "$1,874.90 " "$2,350.20 " "$2,350.20 " "$2,350.20 " "$2,350.20 " N/A $731.84 $696.99 "$2,322.35 " "$1,404.72 " "$1,404.72 " $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 15005 17 510 HC WND PREP PED FACE/NCK/HND/FT/GEN ADD 100 CM O "$3,481.78 " N/A N/A $705.44 "$1,099.00 " "$2,158.70 " "$2,158.70 " $110.76 $705.44 N/A $705.44 N/A "$2,611.34 " N/A "$2,193.52 " N/A $846.53 $705.44 "$2,089.07 " "$2,785.42 " N/A "$1,740.89 " $705.44 N/A "$2,263.16 " $987.62 "$2,785.42 " $705.44 $705.44 $846.53 N/A $705.44 N/A N/A N/A "$2,785.42 " "$2,959.51 " $952.35 "$2,611.34 " "$1,446.16 " $952.35 "$1,740.89 " "$2,263.16 " "$2,350.20 " "$2,350.20 " "$2,350.20 " "$2,350.20 " N/A N/A N/A "$2,322.35 " $705.44 $705.44 N/A N/A N/A $110.76 "$2,959.51 " 330104 15271 5054 56 510 HC SKIN SUB GRAFT TRNK/ARM/LEG 1ST 25SQCM OR LESS O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,523.00 " "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$4,710.61 " N/A "$1,759.75 " "$1,466.46 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$5,981.73 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,466.46 " "$5,607.87 " "$3,006.25 " "$1,466.46 " "$3,738.58 " "$5,569.87 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " N/A "$2,174.11 " "$2,070.58 " "$4,987.27 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$7,039.98 " 330104 15272 56 510 HC SKIN SUB GRAFT T/A/L ADD-ON EA. ADDL 25CM O $814.27 N/A N/A "$1,466.46 " "$1,878.00 " $504.85 $504.85 $19.67 "$1,466.46 " N/A "$1,466.46 " N/A $610.70 N/A $512.99 N/A "$1,759.75 " "$1,466.46 " $488.56 $651.42 N/A $407.13 "$1,466.46 " N/A $529.28 "$2,053.05 " $651.42 "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A $651.42 $692.13 "$1,979.72 " $610.70 "$3,006.25 " "$1,979.72 " $407.13 $529.28 $549.63 $549.63 $549.63 $549.63 N/A N/A N/A $543.12 "$1,466.46 " "$1,466.46 " N/A N/A N/A $19.67 "$3,006.25 " 330104 15273 5055 56 510 HC SKIN SUB GRFT T/ARM/LG 1ST 100SQCM OR 1%AREACHILD O "$13,717.40 " "$3,902.80 " "$3,902.80 " "$1,466.46 " "$2,523.00 " "$8,504.79 " "$8,504.79 " "$3,863.77 " "$1,466.46 " "$7,415.32 " "$1,466.46 " "$3,902.80 " "$10,288.05 " "$4,293.08 " "$8,641.96 " N/A "$1,759.75 " "$1,466.46 " "$8,230.44 " "$10,973.92 " "$13,269.53 " "$6,858.70 " "$1,466.46 " "$3,902.80 " "$4,683.36 " "$2,053.05 " "$10,973.92 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$5,463.92 " "$1,466.46 " "$3,902.80 " "$3,902.80 " "$4,254.05 " "$10,973.92 " "$11,659.79 " "$1,466.46 " "$3,883.00 " "$3,006.25 " "$1,466.46 " "$6,858.70 " "$10,498.54 " "$9,259.25 " "$9,259.25 " "$9,259.25 " "$9,259.25 " N/A "$4,097.94 " "$3,902.80 " "$9,149.51 " "$1,466.46 " "$1,466.46 " "$3,317.38 " "$3,317.38 " "$3,902.80 " "$1,466.46 " "$13,269.53 " 330104 15274 56 510 HC SKN SUB GRFT T/A/L EA ADDL 100SQCM OR 1%AREA CHILD O "$2,198.85 " N/A N/A "$1,466.46 " "$1,878.00 " "$1,363.29 " "$1,363.29 " $56.50 "$1,466.46 " N/A "$1,466.46 " N/A "$1,649.14 " N/A "$1,385.28 " N/A "$1,759.75 " "$1,466.46 " "$1,319.31 " "$1,759.08 " N/A "$1,099.42 " "$1,466.46 " N/A "$1,429.25 " "$2,053.05 " "$1,759.08 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,759.08 " "$1,869.02 " "$1,979.72 " "$1,649.14 " "$3,006.25 " "$1,979.72 " "$1,099.42 " "$1,429.25 " "$1,484.22 " "$1,484.22 " "$1,484.22 " "$1,484.22 " N/A N/A N/A "$1,466.63 " "$1,466.46 " "$1,466.46 " N/A N/A N/A $56.50 "$3,006.25 " 330104 15275 5054 56 510 HC SKIN SUB GRAFT FACE/NK/HF/G 1ST 25 SQCM O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,523.00 " "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$4,710.61 " N/A "$1,759.75 " "$1,466.46 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$5,981.73 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,466.46 " "$3,883.00 " "$3,006.25 " "$1,466.46 " "$3,738.58 " "$5,569.87 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " N/A "$2,174.11 " "$2,070.58 " "$4,987.27 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$7,039.98 " 330104 15276 56 510 HC SKIN SUB GRAFT F/N/HF/G ADDL EA ADDL 25 SQCM O $814.27 N/A N/A "$1,466.46 " "$1,878.00 " $504.85 $504.85 $30.04 "$1,466.46 " N/A "$1,466.46 " N/A $610.70 N/A $512.99 N/A "$1,759.75 " "$1,466.46 " $488.56 $651.42 N/A $407.13 "$1,466.46 " N/A $529.28 "$2,053.05 " $651.42 "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A $651.42 $692.13 "$1,979.72 " $610.70 "$3,006.25 " "$1,979.72 " $407.13 $529.28 $549.63 $549.63 $549.63 $549.63 N/A N/A N/A $543.12 "$1,466.46 " "$1,466.46 " N/A N/A N/A $30.04 "$3,006.25 " 330104 15277 5054 56 510 HC SKN SUB GRFT F/N/HF/G 1ST 100SQCM OR 1%AREACHILD O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,466.46 " "$2,523.00 " "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$4,710.61 " N/A "$1,759.75 " "$1,466.46 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$5,981.73 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,070.58 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,466.46 " "$3,883.00 " "$3,006.25 " "$1,466.46 " "$3,738.58 " "$5,569.87 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " N/A "$2,174.11 " "$2,070.58 " "$4,987.27 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " "$1,466.46 " "$7,039.98 " 330104 15278 56 510 HC SKN SUB GRFT F/N/HF/G EA ADDL 100SQCM/1%AREA CHILD O "$2,198.85 " N/A N/A "$1,466.46 " "$1,878.00 " "$1,363.29 " "$1,363.29 " $68.84 "$1,466.46 " N/A "$1,466.46 " N/A "$1,649.14 " N/A "$1,385.28 " N/A "$1,759.75 " "$1,466.46 " "$1,319.31 " "$1,759.08 " N/A "$1,099.42 " "$1,466.46 " N/A "$1,429.25 " "$2,053.05 " "$1,759.08 " "$1,466.46 " "$1,466.46 " "$1,759.75 " N/A "$1,466.46 " N/A N/A N/A "$1,759.08 " "$1,869.02 " "$1,979.72 " "$1,649.14 " "$3,006.25 " "$1,979.72 " "$1,099.42 " "$1,429.25 " "$1,484.22 " "$1,484.22 " "$1,484.22 " "$1,484.22 " N/A N/A N/A "$1,466.63 " "$1,466.46 " "$1,466.46 " N/A N/A N/A $68.84 "$3,006.25 " 330104 16000 5051 16 510 HC INITIAL TREATMENT OF BURN(S) O $485.78 $216.65 $216.65 $463.33 $482.00 $301.18 $301.18 $214.48 $463.33 $411.63 $463.33 $216.65 $364.33 $238.31 $306.04 N/A $556.00 $463.33 $291.47 $388.62 $736.61 $242.89 $463.33 $216.65 $259.98 $648.67 $388.62 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $388.62 $412.91 $463.33 $364.33 $949.83 $463.33 $242.89 $582.79 $327.90 $327.90 $327.90 $327.90 N/A $227.48 $216.65 $324.02 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 16020 5051 16 510 HC DRESS/DEBRID P-THICK BURN S O $921.27 $216.65 $216.65 $463.33 $482.00 $571.19 $571.19 $214.48 $463.33 $411.63 $463.33 $216.65 $690.95 $238.31 $580.40 N/A $556.00 $463.33 $552.76 $737.02 $736.61 $460.63 $463.33 $216.65 $259.98 $648.67 $737.02 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $737.02 $783.08 $463.33 $690.95 $949.83 $463.33 $460.63 $582.79 $621.86 $621.86 $621.86 $621.86 N/A $227.48 $216.65 $614.49 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 16025 5051 16 510 HC DRESS/DEBRID P-THICK BURN M O $921.27 $216.65 $216.65 $463.33 "$2,523.00 " $571.19 $571.19 $214.48 $463.33 $411.63 $463.33 $216.65 $690.95 $238.31 $580.40 N/A $556.00 $463.33 $552.76 $737.02 $736.61 $460.63 $463.33 $216.65 $259.98 $648.67 $737.02 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $737.02 $783.08 $463.33 "$3,883.00 " $949.83 $463.33 $460.63 $582.79 $621.86 $621.86 $621.86 $621.86 N/A $227.48 $216.65 $614.49 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 "$3,883.00 " 330104 16030 5052 17 510 HC DRESS/DEBRID P-THICK BURN L O "$1,474.46 " $447.59 $447.59 $705.44 "$2,523.00 " $914.17 $914.17 $443.11 $705.44 $850.42 $705.44 $447.59 "$1,105.85 " $492.35 $928.91 N/A $846.53 $705.44 $884.68 "$1,179.57 " "$1,521.80 " $737.23 $705.44 $447.59 $537.10 $987.62 "$1,179.57 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,179.57 " "$1,253.29 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 $737.23 "$1,204.01 " $995.26 $995.26 $995.26 $995.26 N/A $469.97 $447.59 $983.46 $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 17000 5051 3 510 HC DESTRUCT PREMALG LESION O $806.78 $216.65 $216.65 $325.60 $482.00 "$1,296.00 " "$1,180.00 " $214.48 $325.60 $411.63 $325.60 $216.65 $605.09 $238.31 $508.27 N/A $390.72 $325.60 $484.07 $645.42 $736.61 $403.39 $325.60 $216.65 $259.98 $455.84 $645.42 $325.60 $325.60 $390.72 $303.31 $325.60 $216.65 $216.65 $236.15 $645.42 $685.76 $325.60 $605.09 $667.48 $325.60 $403.39 $582.79 $544.58 $544.58 $544.58 $544.58 N/A $227.48 $216.65 $538.12 $325.60 $325.60 $184.15 $184.15 $216.65 $184.15 "$1,296.00 " 330104 17250 5051 3 510 HC CHEMICAL CAUTERY TISSUE O "$1,043.25 " $216.65 $216.65 $325.60 $482.00 $646.81 $646.81 $214.48 $325.60 $411.63 $325.60 $216.65 $782.44 $238.31 $657.25 N/A $390.72 $325.60 $625.95 $834.60 $736.61 $521.62 $325.60 $216.65 $259.98 $455.84 $834.60 $325.60 $325.60 $390.72 $303.31 $325.60 $216.65 $216.65 $236.15 $834.60 $886.76 $325.60 $782.44 $667.48 $325.60 $521.62 $582.79 $704.19 $704.19 $704.19 $704.19 N/A $227.48 $216.65 $695.85 $325.60 $325.60 $184.15 $184.15 $216.65 $184.15 $886.76 330104 19000 5071 2 510 HC DRAINAGE OF BREAST LESION O "$2,813.03 " $778.60 $778.60 $512.29 "$1,878.00 " "$1,296.00 " "$1,180.00 " $770.81 $512.29 "$1,479.33 " $512.29 $778.60 "$2,109.77 " $856.45 "$1,772.21 " N/A $614.75 $512.29 "$1,687.82 " "$2,250.42 " "$2,647.22 " "$1,406.52 " $512.29 $778.60 $934.31 $717.21 "$2,250.42 " $512.29 $512.29 $614.75 "$1,090.03 " $512.29 $778.60 $778.60 $848.67 "$2,250.42 " "$2,391.08 " $512.29 "$2,109.77 " "$1,050.20 " $512.29 "$1,406.52 " "$2,094.42 " "$1,898.80 " "$1,898.80 " "$1,898.80 " "$1,898.80 " N/A $817.53 $778.60 "$1,876.29 " $512.29 $512.29 $661.81 $661.81 $778.60 $512.29 "$2,647.22 " 330104 19001 2 510 HC DRAIN BREAST LESION ADD-ON O $717.97 N/A N/A $512.29 $482.00 $445.14 $445.14 $24.07 $512.29 N/A $512.29 N/A $538.48 N/A $452.32 N/A $614.75 $512.29 $430.78 $574.38 N/A $358.99 $512.29 N/A $466.68 $717.21 $574.38 $512.29 $512.29 $614.75 N/A $512.29 N/A N/A N/A $574.38 $610.27 $691.59 $538.48 "$1,050.20 " $691.59 $358.99 $466.68 $484.63 $484.63 $484.63 $484.63 N/A N/A N/A $478.89 $512.29 $512.29 N/A N/A N/A $24.07 "$1,050.20 " 330104 19020 5072 20 510 HC INCISION OF BREAST LESION O "$5,564.00 " "$1,799.07 " "$1,799.07 " "$1,589.01 " "$2,523.00 " "$3,449.68 " "$3,449.68 " "$1,781.08 " "$1,589.01 " "$3,418.23 " "$1,589.01 " "$1,799.07 " "$4,173.00 " "$1,978.98 " "$3,505.32 " N/A "$1,906.82 " "$1,589.01 " "$3,338.40 " "$4,451.20 " "$6,116.84 " "$2,782.00 " "$1,589.01 " "$1,799.07 " "$2,158.88 " "$2,224.62 " "$4,451.20 " "$1,589.01 " "$1,589.01 " "$1,906.82 " "$2,518.70 " "$1,589.01 " "$1,799.07 " "$1,799.07 " "$1,960.99 " "$4,451.20 " "$4,729.40 " "$1,589.01 " "$3,883.00 " "$3,257.48 " "$1,589.01 " "$2,782.00 " "$4,839.50 " "$3,755.70 " "$3,755.70 " "$3,755.70 " "$3,755.70 " N/A "$1,889.02 " "$1,799.07 " "$3,711.19 " "$1,589.01 " "$1,589.01 " "$1,529.21 " "$1,529.21 " "$1,799.07 " "$1,529.21 " "$6,116.84 " 330104 20206 5072 2 510 HC NEEDLE BIOPSY MUSCLE O "$5,885.00 " "$1,799.07 " "$1,799.07 " $512.29 "$1,878.00 " "$3,648.70 " "$3,648.70 " "$1,781.08 " $512.29 "$3,418.23 " $512.29 "$1,799.07 " "$4,413.75 " "$1,978.98 " "$3,707.55 " N/A $614.75 $512.29 "$3,531.00 " "$4,708.00 " "$6,116.84 " "$2,942.50 " $512.29 "$1,799.07 " "$2,158.88 " $717.21 "$4,708.00 " $512.29 $512.29 $614.75 "$2,518.70 " $512.29 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$4,708.00 " "$5,002.25 " $512.29 "$4,413.75 " "$1,050.20 " $512.29 "$2,942.50 " "$4,839.50 " "$3,972.38 " "$3,972.38 " "$3,972.38 " "$3,972.38 " N/A "$1,889.02 " "$1,799.07 " "$3,925.30 " $512.29 $512.29 "$1,529.21 " "$1,529.21 " "$1,799.07 " $512.29 "$6,116.84 " 330104 20220 5072 2 510 HC BONE BIOPSY TROCAR/NEEDLE SUPERFICIAL O "$6,324.77 " "$1,799.07 " "$1,799.07 " $512.29 "$1,878.00 " "$3,921.36 " "$3,921.36 " "$1,781.08 " $512.29 "$3,418.23 " $512.29 "$1,799.07 " "$4,743.58 " "$1,978.98 " "$3,984.61 " N/A $614.75 $512.29 "$3,794.86 " "$5,059.82 " "$6,116.84 " "$3,162.39 " $512.29 "$1,799.07 " "$2,158.88 " $717.21 "$5,059.82 " $512.29 $512.29 $614.75 "$2,518.70 " $512.29 "$1,799.07 " "$1,799.07 " "$1,960.99 " "$5,059.82 " "$5,376.05 " $512.29 "$4,743.58 " "$1,050.20 " $512.29 "$3,162.39 " "$4,839.50 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " N/A "$1,889.02 " "$1,799.07 " "$4,218.62 " $512.29 $512.29 "$1,529.21 " "$1,529.21 " "$1,799.07 " $512.29 "$6,116.84 " 330104 13152 5053 9 510 HC CMPLX RPR E/N/E/L 2.6-7.5 CM O "$3,210.00 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,990.20 " "$1,990.20 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $764.34 $636.95 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $636.95 $696.99 $836.39 $891.73 "$2,568.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 13151 5053 9 510 HC CMPLX RPR E/N/E/L 1.1-2.5 CM O "$3,210.00 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,990.20 " "$1,990.20 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $764.34 $636.95 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $636.95 $696.99 $836.39 $891.73 "$2,568.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 17003 3 510 HC DESTRUCT PREMALG LES 2-14 O $434.42 N/A N/A $325.60 $482.00 $269.34 $269.34 $2.23 $325.60 N/A $325.60 N/A $325.81 N/A $273.68 N/A $390.72 $325.60 $260.65 $347.54 N/A $217.21 $325.60 N/A $282.37 $455.84 $347.54 $325.60 $325.60 $390.72 N/A $325.60 N/A N/A N/A $347.54 $369.26 $439.56 $325.81 $667.48 $439.56 $217.21 $282.37 $293.23 $293.23 $293.23 $293.23 N/A N/A N/A $289.76 $325.60 $325.60 N/A N/A N/A $2.23 $667.48 330104 13132 5053 9 510 HC CMPLX RPR F/C/C/M/N/AX/G/H/F 2.6-7.5CM O "$3,210.00 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,990.20 " "$1,990.20 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $764.34 $636.95 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $636.95 $696.99 $836.39 $891.73 "$2,568.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 13133 9 510 HC CMPLX RPR F/C/C/M/N/AX/G/H/F EA. ADDL 5CM OR LESS O $561.75 N/A N/A $636.95 "$1,878.00 " $348.29 $348.29 $148.49 $636.95 N/A $636.95 N/A $421.31 N/A $353.90 N/A $764.34 $636.95 $337.05 $449.40 N/A $280.88 $636.95 N/A $365.14 $891.73 $449.40 $636.95 $636.95 $764.34 N/A $636.95 N/A N/A N/A $449.40 $477.49 $859.88 "$3,883.00 " "$1,305.74 " $859.88 $280.88 $365.14 $379.18 $379.18 $379.18 $379.18 N/A N/A N/A $374.69 $636.95 $636.95 N/A N/A N/A $148.49 "$3,883.00 " 330104 11976 5071 9 510 HC REMOVE CONTRACEPTIVE CAPSULE O "$2,461.00 " $778.60 $778.60 $636.95 "$1,099.00 " "$1,525.82 " "$1,525.82 " $770.81 $636.95 "$1,479.33 " $636.95 $778.60 "$1,845.75 " $856.45 "$1,550.43 " N/A $764.34 $636.95 "$1,476.60 " "$1,968.80 " "$2,647.22 " "$1,230.50 " $636.95 $778.60 $934.31 $891.73 "$1,968.80 " $636.95 $636.95 $764.34 "$1,090.03 " $636.95 $778.60 $778.60 $848.67 "$1,968.80 " "$2,091.85 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,230.50 " "$2,094.42 " "$1,661.18 " "$1,661.18 " "$1,661.18 " "$1,661.18 " N/A $817.53 $778.60 "$1,641.49 " $636.95 $636.95 $661.81 $661.81 $778.60 $636.95 "$3,883.00 " 330104 11981 5734 3 510 HC INSERT DRUG IMPLANT DEVICE O $503.97 $139.30 $139.30 $325.60 $482.00 $312.46 $312.46 $137.91 $325.60 $264.67 $325.60 $139.30 $377.98 $153.23 $317.50 N/A $390.72 $325.60 $302.38 $403.18 $473.63 $251.99 $325.60 $139.30 $167.16 $455.84 $403.18 $325.60 $325.60 $390.72 $195.02 $325.60 $139.30 $139.30 $151.84 $403.18 $428.37 $325.60 $377.98 $667.48 $325.60 $251.99 $374.72 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $325.60 $325.60 $118.41 $118.41 $139.30 $118.41 $667.48 330104 11982 5735 3 510 HC REMOVE DRUG IMPLANT DEVICE O "$1,676.69 " $452.99 $452.99 $325.60 $482.00 "$1,039.55 " "$1,039.55 " $448.46 $325.60 $860.67 $325.60 $452.99 "$1,257.52 " $498.28 "$1,056.31 " N/A $390.72 $325.60 "$1,006.01 " "$1,341.35 " "$1,540.15 " $838.35 $325.60 $452.99 $543.58 $455.84 "$1,341.35 " $325.60 $325.60 $390.72 $634.18 $325.60 $452.99 $452.99 $493.75 "$1,341.35 " "$1,425.19 " $325.60 "$3,883.00 " $667.48 $325.60 $838.35 "$1,218.53 " "$1,131.77 " "$1,131.77 " "$1,131.77 " "$1,131.77 " N/A $475.64 $452.99 "$1,118.35 " $325.60 $325.60 $385.04 $385.04 $452.99 $325.60 "$3,883.00 " 330104 12001 5051 16 510 HC SIMPLE RPR S/N/AX/GEN/TRNK 2.5CM/< O $789.66 $216.65 $216.65 $463.33 $482.00 $489.59 $489.59 $214.48 $463.33 $411.63 $463.33 $216.65 $592.25 $238.31 $497.49 N/A $556.00 $463.33 $473.80 $631.73 $736.61 $394.83 $463.33 $216.65 $259.98 $648.67 $631.73 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $631.73 $671.21 $463.33 $592.25 $949.83 $463.33 $394.83 $582.79 $533.02 $533.02 $533.02 $533.02 N/A $227.48 $216.65 $526.70 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12002 5051 16 510 HC SIMPLE RPR S/N/AX/GEN/TRNK2.6-7.5CM O $789.66 $216.65 $216.65 $463.33 $482.00 $489.59 $489.59 $214.48 $463.33 $411.63 $463.33 $216.65 $592.25 $238.31 $497.49 N/A $556.00 $463.33 $473.80 $631.73 $736.61 $394.83 $463.33 $216.65 $259.98 $648.67 $631.73 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $631.73 $671.21 $463.33 $592.25 $949.83 $463.33 $394.83 $582.79 $533.02 $533.02 $533.02 $533.02 N/A $227.48 $216.65 $526.70 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12004 5051 16 510 HC SIMPLE RPR S/N/AX/GEN/TRK7.6-12.5CM O "$1,592.16 " $216.65 $216.65 $463.33 $482.00 $987.14 $987.14 $214.48 $463.33 $411.63 $463.33 $216.65 "$1,194.12 " $238.31 "$1,003.06 " N/A $556.00 $463.33 $955.30 "$1,273.73 " $736.61 $796.08 $463.33 $216.65 $259.98 $648.67 "$1,273.73 " $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 "$1,273.73 " "$1,353.34 " $463.33 "$1,194.12 " $949.83 $463.33 $796.08 $582.79 "$1,074.71 " "$1,074.71 " "$1,074.71 " "$1,074.71 " N/A $227.48 $216.65 "$1,061.97 " $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 "$1,353.34 " 330104 12011 5051 16 510 HC SIMPLE SIMPLE RPR F/E/E/N/L/M 2.5 CM/< O $852.79 $216.65 $216.65 $463.33 $482.00 $528.73 $528.73 $214.48 $463.33 $411.63 $463.33 $216.65 $639.59 $238.31 $537.26 N/A $556.00 $463.33 $511.67 $682.23 $736.61 $426.39 $463.33 $216.65 $259.98 $648.67 $682.23 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $682.23 $724.87 $463.33 $639.59 $949.83 $463.33 $426.39 $582.79 $575.63 $575.63 $575.63 $575.63 N/A $227.48 $216.65 $568.81 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12013 5051 16 510 HC SIMPLE RPR F/E/E/N/L/M 2.6-5.0 CM O $789.66 $216.65 $216.65 $463.33 $482.00 $489.59 $489.59 $214.48 $463.33 $411.63 $463.33 $216.65 $592.25 $238.31 $497.49 N/A $556.00 $463.33 $473.80 $631.73 $736.61 $394.83 $463.33 $216.65 $259.98 $648.67 $631.73 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $631.73 $671.21 $463.33 $592.25 $949.83 $463.33 $394.83 $582.79 $533.02 $533.02 $533.02 $533.02 N/A $227.48 $216.65 $526.70 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12014 5051 16 510 HC SIMPLE RPR F/E/E/N/L/M 5.1-7.5 CM O $789.66 $216.65 $216.65 $463.33 $482.00 $489.59 $489.59 $214.48 $463.33 $411.63 $463.33 $216.65 $592.25 $238.31 $497.49 N/A $556.00 $463.33 $473.80 $631.73 $736.61 $394.83 $463.33 $216.65 $259.98 $648.67 $631.73 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $631.73 $671.21 $463.33 $592.25 $949.83 $463.33 $394.83 $582.79 $533.02 $533.02 $533.02 $533.02 N/A $227.48 $216.65 $526.70 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 $949.83 330104 12015 5051 16 510 HC SIMPLE RPR F/E/E/N/L/M 7.6-12.5 CM O $828.18 $216.65 $216.65 $463.33 $482.00 $513.47 $513.47 $214.48 $463.33 $411.63 $463.33 $216.65 $621.14 $238.31 $521.75 N/A $556.00 $463.33 $496.91 $662.54 $736.61 $414.09 $463.33 $216.65 $259.98 $648.67 $662.54 $463.33 $463.33 $556.00 $303.31 $463.33 $216.65 $216.65 $236.15 $662.54 $703.95 $463.33 "$3,883.00 " $949.83 $463.33 $414.09 $582.79 $559.02 $559.02 $559.02 $559.02 N/A $227.48 $216.65 $552.40 $463.33 $463.33 $184.15 $184.15 $216.65 $184.15 "$3,883.00 " 330104 12020 5053 17 510 HC CLOSURE OF SPLIT WOUND SIMPLE O "$2,140.00 " $696.99 $696.99 $705.44 "$1,878.00 " "$1,326.80 " "$1,326.80 " $690.02 $705.44 "$1,324.28 " $705.44 $696.99 "$1,605.00 " $766.69 "$1,348.20 " N/A $846.53 $705.44 "$1,284.00 " "$1,712.00 " "$2,369.76 " "$1,070.00 " $705.44 $696.99 $836.39 $987.62 "$1,712.00 " $705.44 $705.44 $846.53 $975.78 $705.44 $696.99 $696.99 $759.72 "$1,712.00 " "$1,819.00 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,070.00 " "$1,874.90 " "$1,444.50 " "$1,444.50 " "$1,444.50 " "$1,444.50 " N/A $731.84 $696.99 "$1,427.38 " $705.44 $705.44 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 12031 5052 17 510 HC INTMD RPR S/A/T/EXT 2.5 CM/< O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12032 5052 17 510 HC INTMD RPR S/A/T/EXT 2.6-7.5CM O "$2,346.51 " $447.59 $447.59 $705.44 "$1,099.00 " "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 11983 5735 3 510 HC REMOVE W/RE-INSERT DRUG IMPLANT O "$1,676.69 " $452.99 $452.99 $325.60 $482.00 "$1,039.55 " "$1,039.55 " $448.46 $325.60 $860.67 $325.60 $452.99 "$1,257.52 " $498.28 "$1,056.31 " N/A $390.72 $325.60 "$1,006.01 " "$1,341.35 " "$1,540.15 " $838.35 $325.60 $452.99 $543.58 $455.84 "$1,341.35 " $325.60 $325.60 $390.72 $634.18 $325.60 $452.99 $452.99 $493.75 "$1,341.35 " "$1,425.19 " $325.60 "$3,883.00 " $667.48 $325.60 $838.35 "$1,218.53 " "$1,131.77 " "$1,131.77 " "$1,131.77 " "$1,131.77 " N/A $475.64 $452.99 "$1,118.35 " $325.60 $325.60 $385.04 $385.04 $452.99 $325.60 "$3,883.00 " 330104 12035 5052 17 510 HC INTMD RPR S/A/T/EXT 12.6-20CM O "$1,582.53 " $447.59 $447.59 $705.44 "$2,523.00 " $981.17 $981.17 $443.11 $705.44 $850.42 $705.44 $447.59 "$1,186.90 " $492.35 $996.99 N/A $846.53 $705.44 $949.52 "$1,266.02 " "$1,521.80 " $791.26 $705.44 $447.59 $537.10 $987.62 "$1,266.02 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,266.02 " "$1,345.15 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 $791.26 "$1,204.01 " "$1,068.21 " "$1,068.21 " "$1,068.21 " "$1,068.21 " N/A $469.97 $447.59 "$1,055.55 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12034 5052 17 510 HC INTMD RPR S/TR/EXT 7.6-12.5CM O "$1,582.53 " $447.59 $447.59 $705.44 "$2,523.00 " $981.17 $981.17 $443.11 $705.44 $850.42 $705.44 $447.59 "$1,186.90 " $492.35 $996.99 N/A $846.53 $705.44 $949.52 "$1,266.02 " "$1,521.80 " $791.26 $705.44 $447.59 $537.10 $987.62 "$1,266.02 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,266.02 " "$1,345.15 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 $791.26 "$1,204.01 " "$1,068.21 " "$1,068.21 " "$1,068.21 " "$1,068.21 " N/A $469.97 $447.59 "$1,055.55 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 13122 9 510 HC CMPLX RPR S/A/L EA. ADDL 5 CM OR LESS O $767.19 N/A N/A $636.95 "$1,878.00 " $475.66 $475.66 $100.16 $636.95 N/A $636.95 N/A $575.39 N/A $483.33 N/A $764.34 $636.95 $460.31 $613.75 N/A $383.60 $636.95 N/A $498.67 $891.73 $613.75 $636.95 $636.95 $764.34 N/A $636.95 N/A N/A N/A $613.75 $652.11 $859.88 $575.39 "$1,305.74 " $859.88 $383.60 $498.67 $517.85 $517.85 $517.85 $517.85 N/A N/A N/A $511.72 $636.95 $636.95 N/A N/A N/A $100.16 "$1,878.00 " 330104 13121 5053 9 510 HC CMPLX RPR S/A/L 2.6-7.5 CM O "$2,184.94 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,354.66 " "$1,354.66 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$1,638.70 " $766.69 "$1,376.51 " N/A $764.34 $636.95 "$1,310.96 " "$1,747.95 " "$2,369.76 " "$1,092.47 " $636.95 $696.99 $836.39 $891.73 "$1,747.95 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$1,747.95 " "$1,857.20 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,092.47 " "$1,874.90 " "$1,474.83 " "$1,474.83 " "$1,474.83 " "$1,474.83 " N/A $731.84 $696.99 "$1,457.35 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 13131 5052 9 510 HC CMPLX RPR F/C/C/M/N/AX/G/H/F 1.1-2.5CM O "$2,346.51 " $447.59 $447.59 $636.95 "$2,523.00 " "$1,454.84 " "$1,454.84 " $443.11 $636.95 $850.42 $636.95 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $764.34 $636.95 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $636.95 $447.59 $537.10 $891.73 "$1,877.21 " $636.95 $636.95 $764.34 $626.62 $636.95 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $636.95 $636.95 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 13100 5053 9 510 HC CMPLX RPR TRUNK 1.1-2.5 CM O "$2,134.65 " $696.99 $696.99 $636.95 "$2,523.00 " "$1,323.48 " "$1,323.48 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$1,600.99 " $766.69 "$1,344.83 " N/A $764.34 $636.95 "$1,280.79 " "$1,707.72 " "$2,369.76 " "$1,067.33 " $636.95 $696.99 $836.39 $891.73 "$1,707.72 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$1,707.72 " "$1,814.45 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,067.33 " "$1,874.90 " "$1,440.89 " "$1,440.89 " "$1,440.89 " "$1,440.89 " N/A $731.84 $696.99 "$1,423.81 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 12054 5052 17 510 HC INTMD RPR FACE/MM 7.6-12.5CM O "$1,685.25 " $447.59 $447.59 $705.44 "$2,523.00 " "$1,044.86 " "$1,044.86 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,263.94 " $492.35 "$1,061.71 " N/A $846.53 $705.44 "$1,011.15 " "$1,348.20 " "$1,521.80 " $842.62 $705.44 $447.59 $537.10 $987.62 "$1,348.20 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,348.20 " "$1,432.46 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 $842.62 "$1,204.01 " "$1,137.54 " "$1,137.54 " "$1,137.54 " "$1,137.54 " N/A $469.97 $447.59 "$1,124.06 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 13101 5053 9 510 HC CMPLX RPR TRUNK 2.6-7.5 CM O "$3,210.00 " $696.99 $696.99 $636.95 "$2,886.00 " "$1,990.20 " "$1,990.20 " $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $764.34 $636.95 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $636.95 $696.99 $836.39 $891.73 "$2,568.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $636.95 $636.95 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 12053 5052 17 510 HC INTMD RPR FACE/MM 5.1-7.5 CM O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12052 5052 17 510 HC INTMD RPR FACE/MM 2.6-5.0 CM O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 11750 5052 9 510 HC EXCISION NAIL/NAIL MATRIX PART/COMPL-PERMANENT O "$3,275.27 " $447.59 $447.59 $636.95 "$1,099.00 " "$2,030.67 " "$2,030.67 " $443.11 $636.95 $850.42 $636.95 $447.59 "$2,456.45 " $492.35 "$2,063.42 " N/A $764.34 $636.95 "$1,965.16 " "$2,620.22 " "$1,521.80 " "$1,637.63 " $636.95 $447.59 $537.10 $891.73 "$2,620.22 " $636.95 $636.95 $764.34 $626.62 $636.95 $447.59 $447.59 $487.87 "$2,620.22 " "$2,783.98 " $636.95 "$3,883.00 " "$1,305.74 " $636.95 "$1,637.63 " "$1,204.01 " "$2,210.81 " "$2,210.81 " "$2,210.81 " "$2,210.81 " N/A $469.97 $447.59 "$2,184.61 " $636.95 $636.95 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12044 5053 17 510 HC INTMD RPR N-HF/GENIT 7.6-12.5CM O "$3,210.00 " $696.99 $696.99 $705.44 "$2,523.00 " "$1,990.20 " "$1,990.20 " $690.02 $705.44 "$1,324.28 " $705.44 $696.99 "$2,407.50 " $766.69 "$2,022.30 " N/A $846.53 $705.44 "$1,926.00 " "$2,568.00 " "$2,369.76 " "$1,605.00 " $705.44 $696.99 $836.39 $987.62 "$2,568.00 " $705.44 $705.44 $846.53 $975.78 $705.44 $696.99 $696.99 $759.72 "$2,568.00 " "$2,728.50 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,605.00 " "$1,874.90 " "$2,166.75 " "$2,166.75 " "$2,166.75 " "$2,166.75 " N/A $731.84 $696.99 "$2,141.07 " $705.44 $705.44 $592.44 $592.44 $696.99 $592.44 "$3,883.00 " 330104 12042 5052 17 510 HC INTMD RPR N-HF/GENIT 2.6-7.5CM O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 12041 5052 17 510 HC INTMD RPR N-HF/GENIT 2.5CM/< O "$2,346.51 " $447.59 $447.59 $705.44 $482.00 "$1,454.84 " "$1,454.84 " $443.11 $705.44 $850.42 $705.44 $447.59 "$1,759.88 " $492.35 "$1,478.30 " N/A $846.53 $705.44 "$1,407.91 " "$1,877.21 " "$1,521.80 " "$1,173.26 " $705.44 $447.59 $537.10 $987.62 "$1,877.21 " $705.44 $705.44 $846.53 $626.62 $705.44 $447.59 $447.59 $487.87 "$1,877.21 " "$1,994.53 " $705.44 "$3,883.00 " "$1,446.16 " $705.44 "$1,173.26 " "$1,204.01 " "$1,583.89 " "$1,583.89 " "$1,583.89 " "$1,583.89 " N/A $469.97 $447.59 "$1,565.12 " $705.44 $705.44 $380.45 $380.45 $447.59 $380.45 "$3,883.00 " 330104 98968 491 521 HC TELEPHONE ASSESS & MGNT EST PT PARENT OR GUARD PROVIDED WITHIN THE PREVIOUS 7 DAYS -- 21-30 MINS O $117.70 $34.56 $34.56 N/A $58.85 $72.97 $72.97 $34.22 N/A $65.67 N/A $34.56 $88.28 $38.02 $76.51 $86.04 N/A N/A $70.62 $94.16 $117.51 $58.85 N/A $34.56 $76.51 N/A $94.16 N/A N/A N/A $48.39 N/A $34.56 $34.56 $37.67 $94.16 $100.05 N/A $88.28 N/A N/A $58.85 $76.51 $79.45 $79.45 $79.45 $79.45 N/A $36.29 $34.56 $78.51 N/A N/A $29.38 $29.38 $34.56 $29.38 $117.51 330104 73218 5523 293 610 HC MRI UPPER EXTREMITY W/O DYE O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,226.13 " $308.18 "$1,869.95 " "$2,169.74 " $600.00 $500.00 "$1,780.91 " "$2,374.54 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,374.54 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,374.54 " "$2,522.95 " $500.00 "$2,226.13 " "$1,025.00 " $500.00 "$1,484.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,522.95 " 330104 0697T 5523 386 610 HC QUAN MR ALYS TIS COMPJ WO MRI SAME SESS MLT ORGN - W/I&R O $606.69 $280.16 $280.16 N/A $303.35 "$1,575.00 " "$1,434.00 " $277.36 N/A $532.31 N/A $280.16 $455.02 $308.18 $382.21 $443.49 N/A N/A $364.01 $485.35 $952.56 "$1,596.93 " N/A $280.16 $336.20 N/A $485.35 N/A N/A N/A $392.23 N/A $280.16 $280.16 $305.38 $485.35 $515.69 N/A $455.02 N/A N/A $303.35 $753.64 $441.26 $441.26 $441.26 $441.26 N/A $294.17 $280.16 $404.66 N/A N/A $238.14 $238.14 $280.16 $238.14 "$1,596.93 " 330104 0698T 386 610 HC QUAN MR ALYS TISS COMPOSITION W/MRI MLT ORGANS - I&R O $606.69 N/A N/A N/A $303.35 "$1,575.00 " "$1,434.00 " N/A N/A N/A N/A N/A $455.02 N/A $382.21 $443.49 N/A N/A $364.01 $485.35 N/A N/A N/A N/A $394.35 N/A $485.35 N/A N/A N/A N/A N/A N/A N/A N/A $485.35 $515.69 N/A $455.02 N/A N/A $303.35 $394.35 N/A N/A N/A N/A N/A N/A N/A $404.66 N/A N/A N/A N/A N/A $303.35 "$1,575.00 " 330104 74185 282 610 HC MRA W/O CONT ABD O "$7,545.64 " $428.98 $428.98 $500.00 "$3,772.82 " "$1,575.00 " "$1,434.00 " $424.69 $500.00 $815.06 $500.00 $428.98 "$5,659.23 " $471.88 "$4,753.75 " "$5,515.86 " $600.00 $500.00 "$4,527.38 " "$6,036.51 " "$1,458.54 " "$2,445.19 " $500.00 $428.98 "$4,904.67 " $700.00 "$6,036.51 " $500.00 $500.00 $600.00 $600.57 $500.00 $428.98 $428.98 $467.59 "$6,036.51 " "$6,413.79 " $675.00 "$5,659.23 " "$1,025.00 " $675.00 "$3,772.82 " "$4,904.67 " $675.65 $675.65 $675.65 $675.65 $590.37 $450.43 $428.98 $590.37 $500.00 $500.00 $364.63 $364.63 $428.98 $364.63 "$6,413.79 " 330104 71555 282 610 HC MRA W/O CONT CHEST O "$8,123.44 " $424.41 $424.41 $500.00 "$4,061.72 " "$1,575.00 " "$1,434.00 " $420.17 $500.00 $806.38 $500.00 $424.41 "$6,092.58 " $466.85 "$5,117.77 " "$5,938.23 " $600.00 $500.00 "$4,874.06 " "$6,498.75 " "$1,443.00 " "$2,419.14 " $500.00 $424.41 "$5,280.24 " $700.00 "$6,498.75 " $500.00 $500.00 $600.00 $594.18 $500.00 $424.41 $424.41 $462.61 "$6,498.75 " "$6,904.92 " $675.00 "$6,092.58 " "$1,025.00 " $675.00 "$4,061.72 " "$5,280.24 " $668.45 $668.45 $668.45 $668.45 $590.91 $445.63 $424.41 $590.91 $500.00 $500.00 $360.75 $360.75 $424.41 $360.75 "$6,904.92 " 330104 73725 282 610 HC MRA W/O CONT LWR EXT O "$7,545.64 " $426.41 $426.41 $500.00 "$3,772.82 " "$1,575.00 " "$1,434.00 " $422.15 $500.00 $810.18 $500.00 $426.41 "$5,659.23 " $469.05 "$4,753.75 " "$5,515.86 " $600.00 $500.00 "$4,527.38 " "$6,036.51 " "$1,449.80 " "$2,430.55 " $500.00 $426.41 "$4,904.67 " $700.00 "$6,036.51 " $500.00 $500.00 $600.00 $596.98 $500.00 $426.41 $426.41 $464.79 "$6,036.51 " "$6,413.79 " $675.00 "$5,659.23 " "$1,025.00 " $675.00 "$3,772.82 " "$4,904.67 " $671.60 $671.60 $671.60 $671.60 $592.54 $447.73 $426.41 $592.54 $500.00 $500.00 $362.45 $362.45 $426.41 $362.45 "$6,413.79 " 330104 C8937 2002 610 HC CAD BREAST MRI O $107.00 N/A N/A N/A $53.50 "$1,575.00 " "$1,434.00 " $69.98 N/A N/A N/A N/A $80.25 N/A $67.41 $78.22 N/A N/A $64.20 $85.60 N/A N/A N/A N/A N/A N/A $85.60 N/A N/A N/A N/A N/A N/A N/A N/A $85.60 $90.95 N/A $80.25 N/A N/A $53.50 $69.55 N/A N/A N/A N/A N/A N/A N/A $71.37 N/A N/A N/A N/A N/A $53.50 "$1,575.00 " 330104 73219 5572 295 610 HC MRI UPPER EXTREMITY W/DYE O "$4,559.27 " $442.02 $442.02 $500.00 "$2,279.64 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,419.45 " $486.22 "$2,872.34 " "$3,332.83 " $600.00 $500.00 "$2,735.56 " "$3,647.42 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,647.42 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,647.42 " "$3,875.38 " $500.00 "$3,419.45 " "$1,025.00 " $500.00 "$2,279.64 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,875.38 " 330104 70336 5523 293 610 HC MAGNETIC IMAGE JAW JOINT O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,226.13 " $308.18 "$1,869.95 " "$2,169.74 " $600.00 $500.00 "$1,780.91 " "$2,374.54 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,374.54 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,374.54 " "$2,522.95 " $500.00 "$2,226.13 " "$1,025.00 " $500.00 "$1,484.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,522.95 " 330104 70546 5572 282 610 HC MR ANGIOGRAPH HEAD W/O&W/DYE O "$4,346.34 " $442.02 $442.02 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,259.76 " $486.22 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,694.39 " 330104 70542 5572 295 610 HC MRI ORBIT/FACE/NECK W/DYE O "$6,560.17 " $442.02 $442.02 $500.00 "$3,280.09 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$4,920.13 " $486.22 "$4,132.91 " "$4,795.48 " $600.00 $500.00 "$3,936.10 " "$5,248.14 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$5,248.14 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$5,248.14 " "$5,576.14 " $500.00 "$4,920.13 " "$1,025.00 " $500.00 "$3,280.09 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$5,576.14 " 330104 70543 5572 295 610 HC MRI ORBT/FAC/NCK W/O &W/DYE O "$6,560.17 " $442.02 $442.02 $500.00 "$3,280.09 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$4,920.13 " $486.22 "$4,132.91 " "$4,795.48 " $600.00 $500.00 "$3,936.10 " "$5,248.14 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$5,248.14 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$5,248.14 " "$5,576.14 " $500.00 "$4,920.13 " "$1,025.00 " $500.00 "$3,280.09 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$5,576.14 " 330104 70544 5523 282 610 HC MR ANGIOGRAPHY HEAD W/O DYE O "$4,419.10 " $280.16 $280.16 $500.00 "$2,209.55 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$3,314.33 " $308.18 "$2,784.03 " "$3,230.36 " $600.00 $500.00 "$2,651.46 " "$3,535.28 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$3,535.28 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$3,535.28 " "$3,756.24 " $500.00 "$3,314.33 " "$1,025.00 " $500.00 "$2,209.55 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$3,756.24 " 330104 70545 5572 282 610 HC MR ANGIOGRAPHY HEAD W/DYE O "$4,346.34 " $442.02 $442.02 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,259.76 " $486.22 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,694.39 " 330104 70547 5523 282 610 HC MR ANGIOGRAPHY NECK W/O DYE O "$4,346.34 " $280.16 $280.16 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$3,259.76 " $308.18 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$3,694.39 " 330104 70548 5572 282 610 HC MR ANGIOGRAPHY NECK W/DYE O "$4,346.34 " $442.02 $442.02 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,259.76 " $486.22 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,694.39 " 330104 70549 5572 282 610 HC MR ANGIOGRAPH NECK W/O&W/DYE O "$4,346.34 " $442.02 $442.02 $500.00 "$2,173.17 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,259.76 " $486.22 "$2,738.19 " "$3,177.17 " $600.00 $500.00 "$2,607.80 " "$3,477.07 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,477.07 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,477.07 " "$3,694.39 " $500.00 "$3,259.76 " "$1,025.00 " $500.00 "$2,173.17 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,694.39 " 330104 71550 5523 293 610 HC MRI CHEST W/O DYE O "$7,521.03 " $280.16 $280.16 $500.00 "$3,760.51 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$5,640.77 " $308.18 "$4,738.25 " "$5,497.87 " $600.00 $500.00 "$4,512.62 " "$6,016.82 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,016.82 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,016.82 " "$6,392.88 " $500.00 "$5,640.77 " "$1,025.00 " $500.00 "$3,760.51 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$6,392.88 " 330104 73220 5572 295 610 HC MRI UPPR EXTREMITY W/O&W/DYE O "$4,559.27 " $442.02 $442.02 $500.00 "$2,279.64 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,419.45 " $486.22 "$2,872.34 " "$3,332.83 " $600.00 $500.00 "$2,735.56 " "$3,647.42 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,647.42 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,647.42 " "$3,875.38 " $500.00 "$3,419.45 " "$1,025.00 " $500.00 "$2,279.64 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,875.38 " 330104 71551 5573 295 610 HC MRI CHEST W/DYE O "$7,521.03 " $888.71 $888.71 $500.00 "$3,760.51 " "$1,575.00 " "$1,434.00 " $879.82 $500.00 "$1,688.54 " $500.00 $888.71 "$5,640.77 " $977.58 "$4,738.25 " "$5,497.87 " $600.00 $500.00 "$4,512.62 " "$6,016.82 " "$3,021.61 " "$5,065.63 " $500.00 $888.71 "$1,066.45 " $700.00 "$6,016.82 " $500.00 $500.00 $600.00 "$1,244.19 " $500.00 $888.71 $888.71 $968.69 "$6,016.82 " "$6,392.88 " $500.00 "$5,640.77 " "$1,025.00 " $500.00 "$3,760.51 " "$2,390.62 " "$1,399.71 " "$1,399.71 " "$1,399.71 " "$1,399.71 " $699.17 $933.14 $888.71 $699.17 $500.00 $500.00 $755.40 $755.40 $888.71 $500.00 "$6,392.88 " 330104 70540 5523 293 610 HC MRI ORBIT/FACE/NECK W/O DYE O "$2,698.54 " $280.16 $280.16 $500.00 "$1,349.27 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,023.90 " $308.18 "$1,700.08 " "$1,972.63 " $600.00 $500.00 "$1,619.12 " "$2,158.83 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,158.83 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,158.83 " "$2,293.76 " $500.00 "$2,023.90 " "$1,025.00 " $500.00 "$1,349.27 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,293.76 " 330104 73221 5523 293 610 HC MRI JOINT UPR EXTREM W/O DYE O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,226.13 " $308.18 "$1,869.95 " "$2,169.74 " $600.00 $500.00 "$1,780.91 " "$2,374.54 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,374.54 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,374.54 " "$2,522.95 " $500.00 "$2,226.13 " "$1,025.00 " $500.00 "$1,484.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,522.95 " 330104 75565 293 610 HC CARD MRI VELOC FLOW MAPPING O $856.00 N/A N/A $57.80 $428.00 "$1,575.00 " "$1,434.00 " $56.80 $57.80 N/A $57.80 N/A $642.00 N/A $539.28 $625.74 $69.36 $57.80 $513.60 $684.80 N/A N/A $57.80 N/A $556.40 $80.92 $684.80 $57.80 $57.80 $69.36 N/A $57.80 N/A N/A N/A $684.80 $727.60 $78.03 $642.00 $118.49 $78.03 $428.00 $556.40 N/A N/A N/A N/A N/A N/A N/A $570.95 $57.80 $57.80 N/A N/A N/A $56.80 "$1,575.00 " 330104 73223 5572 295 610 HC MRI JOINT UPR EXTR W/O&W/DYE O "$3,768.54 " $442.02 $442.02 $500.00 "$1,884.27 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$2,826.40 " $486.22 "$2,374.18 " "$2,754.80 " $600.00 $500.00 "$2,261.12 " "$3,014.83 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,014.83 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,014.83 " "$3,203.26 " $500.00 "$2,826.40 " "$1,025.00 " $500.00 "$1,884.27 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$3,203.26 " 330104 71552 5572 295 610 HC MRI CHEST W/O & W/DYE O "$8,210.11 " $442.02 $442.02 $500.00 "$4,105.06 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$6,157.58 " $486.22 "$5,172.37 " "$6,001.59 " $600.00 $500.00 "$4,926.07 " "$6,568.09 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$6,568.09 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$6,568.09 " "$6,978.59 " $500.00 "$6,157.58 " "$1,025.00 " $500.00 "$4,105.06 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$6,978.59 " 330104 77049 295 610 HC MRI BREAST BI LAT W/WITH CONTRAST O "$11,063.80 " $435.71 $435.71 $500.00 "$5,531.90 " "$1,575.00 " "$1,434.00 " $431.35 $500.00 $827.84 $500.00 $435.71 "$8,297.85 " $479.28 "$6,970.19 " "$8,087.64 " $600.00 $500.00 "$6,638.28 " "$8,851.04 " "$1,481.40 " "$2,483.52 " $500.00 $435.71 "$7,191.47 " $700.00 "$8,851.04 " $500.00 $500.00 $600.00 $609.99 $500.00 $435.71 $435.71 $474.92 "$8,851.04 " "$9,404.23 " $675.00 "$8,297.85 " "$1,025.00 " $675.00 "$5,531.90 " "$7,191.47 " $686.24 $686.24 $686.24 $686.24 $468.80 $457.49 $435.71 $468.80 $500.00 $500.00 $370.35 $370.35 $435.71 $370.35 "$9,404.23 " 330104 77048 295 610 HC MRI BREAST C-+ W/CAD UNI O "$8,381.31 " $427.36 $427.36 $500.00 "$4,190.65 " "$1,575.00 " "$1,434.00 " $423.08 $500.00 $811.98 $500.00 $427.36 "$6,285.98 " $470.09 "$5,280.23 " "$6,126.74 " $600.00 $500.00 "$5,028.79 " "$6,705.05 " "$1,453.01 " "$2,435.93 " $500.00 $427.36 "$5,447.85 " $700.00 "$6,705.05 " $500.00 $500.00 $600.00 $598.30 $500.00 $427.36 $427.36 $465.82 "$6,705.05 " "$7,124.11 " $675.00 "$6,285.98 " "$1,025.00 " $675.00 "$4,190.65 " "$5,447.85 " $673.09 $673.09 $673.09 $673.09 $471.10 $448.72 $427.36 $471.10 $500.00 $500.00 $363.25 $363.25 $427.36 $363.25 "$7,124.11 " 330104 77047 5523 293 610 HC MRI BREAST C- BILATERAL O "$8,380.24 " $280.16 $280.16 $500.00 "$4,190.12 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$6,285.18 " $308.18 "$5,279.55 " "$6,125.96 " $600.00 $500.00 "$5,028.14 " "$6,704.19 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,704.19 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,704.19 " "$7,123.20 " $500.00 "$6,285.18 " "$1,025.00 " $500.00 "$4,190.12 " $753.64 $441.26 $441.26 $441.26 $441.26 $368.90 $294.17 $280.16 $368.90 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$7,123.20 " 330104 77046 5523 293 610 HC MRI BREAST C- UNILATERAL O "$7,760.71 " $280.16 $280.16 $500.00 "$3,880.36 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$5,820.53 " $308.18 "$4,889.25 " "$5,673.08 " $600.00 $500.00 "$4,656.43 " "$6,208.57 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,208.57 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,208.57 " "$6,596.60 " $500.00 "$5,820.53 " "$1,025.00 " $500.00 "$3,880.36 " $753.64 $441.26 $441.26 $441.26 $441.26 $368.90 $294.17 $280.16 $368.90 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$6,596.60 " 330104 76390 5521 293 610 HC MR SPECTROSCOPY O "$3,815.62 " $104.23 $104.23 N/A "$1,907.81 " "$1,575.00 " "$1,434.00 " $103.19 N/A $198.04 N/A $104.23 "$2,861.72 " $114.66 "$2,403.84 " "$2,789.22 " N/A N/A "$2,289.37 " "$3,052.50 " $354.39 $594.13 N/A $104.23 $125.08 N/A "$3,052.50 " N/A N/A N/A $145.93 N/A $104.23 $104.23 $113.61 "$3,052.50 " "$3,243.28 " N/A "$2,861.72 " N/A N/A "$1,907.81 " $280.39 $164.17 $164.17 $164.17 $164.17 $613.74 $109.45 $104.23 $613.74 N/A N/A $88.60 $88.60 $104.23 $88.60 "$3,243.28 " 330104 75561 5572 295 610 HC CARDIAC MRI W/WO CONTRAST FOR MORPH- FUNCTION & FURTHER SEQ W/DYE O "$3,482.85 " $442.02 $442.02 $500.00 "$1,741.42 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$2,612.14 " $486.22 "$2,194.20 " "$2,545.96 " $600.00 $500.00 "$2,089.71 " "$2,786.28 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$2,786.28 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$2,786.28 " "$2,960.42 " $500.00 "$2,612.14 " "$1,025.00 " $500.00 "$1,741.42 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$2,960.42 " 330104 73222 5573 295 610 HC MRI JOINT UPR EXTREM W/DYE O "$3,205.72 " $888.71 $888.71 $500.00 "$1,602.86 " "$1,575.00 " "$1,434.00 " $879.82 $500.00 "$1,688.54 " $500.00 $888.71 "$2,404.29 " $977.58 "$2,019.60 " "$2,343.38 " $600.00 $500.00 "$1,923.43 " "$2,564.58 " "$3,021.61 " "$5,065.63 " $500.00 $888.71 "$1,066.45 " $700.00 "$2,564.58 " $500.00 $500.00 $600.00 "$1,244.19 " $500.00 $888.71 $888.71 $968.69 "$2,564.58 " "$2,724.86 " $500.00 "$2,404.29 " "$1,025.00 " $500.00 "$1,602.86 " "$2,390.62 " "$1,399.71 " "$1,399.71 " "$1,399.71 " "$1,399.71 " $699.17 $933.14 $888.71 $699.17 $500.00 $500.00 $755.40 $755.40 $888.71 $500.00 "$5,065.63 " 330104 74713 293 610 HC MRI FETAL EA ADDL GESTATION O "$1,213.38 " N/A N/A $69.88 $606.69 "$1,575.00 " "$1,434.00 " $247.27 $69.88 N/A $69.88 N/A $910.04 N/A $764.43 $886.98 $83.86 $69.88 $728.03 $970.70 N/A N/A $69.88 N/A $788.70 $97.83 $970.70 $69.88 $69.88 $83.86 N/A $69.88 N/A N/A N/A $970.70 "$1,031.37 " $94.34 $910.04 $143.25 $94.34 $606.69 $788.70 N/A N/A N/A N/A N/A N/A N/A $809.32 $69.88 $69.88 N/A N/A N/A $69.88 "$1,575.00 " 330104 75557 5523 293 610 HC CARDIAC MRI FOR MORPHOLOGY & FUNCTION W/O CONTRAST O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,226.13 " $308.18 "$1,869.95 " "$2,169.74 " $600.00 $500.00 "$1,780.91 " "$2,374.54 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,374.54 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,374.54 " "$2,522.95 " $500.00 "$2,226.13 " "$1,025.00 " $500.00 "$1,484.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,522.95 " 330104 74183 5572 295 610 HC MRI ABDOMEN W/O & W/DYE O "$7,890.18 " $442.02 $442.02 $500.00 "$3,945.09 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$5,917.64 " $486.22 "$4,970.81 " "$5,767.72 " $600.00 $500.00 "$4,734.11 " "$6,312.14 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$6,312.14 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$6,312.14 " "$6,706.65 " $500.00 "$5,917.64 " "$1,025.00 " $500.00 "$3,945.09 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$6,706.65 " 330104 74182 5572 295 610 HC MRI ABDOMEN W/DYE O "$7,890.18 " $442.02 $442.02 $500.00 "$3,945.09 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$5,917.64 " $486.22 "$4,970.81 " "$5,767.72 " $600.00 $500.00 "$4,734.11 " "$6,312.14 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$6,312.14 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$6,312.14 " "$6,706.65 " $500.00 "$5,917.64 " "$1,025.00 " $500.00 "$3,945.09 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$6,706.65 " 330104 74181 5523 293 610 HC MRI ABDOMEN W/O DYE O "$7,890.18 " $280.16 $280.16 $500.00 "$3,945.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$5,917.64 " $308.18 "$4,970.81 " "$5,767.72 " $600.00 $500.00 "$4,734.11 " "$6,312.14 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,312.14 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,312.14 " "$6,706.65 " $500.00 "$5,917.64 " "$1,025.00 " $500.00 "$3,945.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$6,706.65 " 330104 73723 5572 295 610 HC MRI JOINT LWR EXTR W/O&W/DYE O "$4,883.48 " $442.02 $442.02 $500.00 "$2,441.74 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,662.61 " $486.22 "$3,076.59 " "$3,569.82 " $600.00 $500.00 "$2,930.09 " "$3,906.78 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,906.78 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,906.78 " "$4,150.96 " $500.00 "$3,662.61 " "$1,025.00 " $500.00 "$2,441.74 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$4,150.96 " 330104 73722 5573 295 610 HC MRI JOINT OF LWR EXTR W/DYE O "$5,274.03 " $888.71 $888.71 $500.00 "$2,637.01 " "$1,575.00 " "$1,434.00 " $879.82 $500.00 "$1,688.54 " $500.00 $888.71 "$3,955.52 " $977.58 "$3,322.64 " "$3,855.32 " $600.00 $500.00 "$3,164.42 " "$4,219.22 " "$3,021.61 " "$5,065.63 " $500.00 $888.71 "$1,066.45 " $700.00 "$4,219.22 " $500.00 $500.00 $600.00 "$1,244.19 " $500.00 $888.71 $888.71 $968.69 "$4,219.22 " "$4,482.93 " $500.00 "$3,955.52 " "$1,025.00 " $500.00 "$2,637.01 " "$2,390.62 " "$1,399.71 " "$1,399.71 " "$1,399.71 " "$1,399.71 " $699.17 $933.14 $888.71 $699.17 $500.00 $500.00 $755.40 $755.40 $888.71 $500.00 "$5,065.63 " 330104 73721 5523 293 610 HC MRI JNT OF LWR EXTRE W/O DYE O "$4,883.48 " $280.16 $280.16 $500.00 "$2,441.74 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$3,662.61 " $308.18 "$3,076.59 " "$3,569.82 " $600.00 $500.00 "$2,930.09 " "$3,906.78 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$3,906.78 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$3,906.78 " "$4,150.96 " $500.00 "$3,662.61 " "$1,025.00 " $500.00 "$2,441.74 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$4,150.96 " 330104 73720 5572 295 610 HC MRI LWR EXTREMITY W/O&W/DYE O "$4,883.48 " $442.02 $442.02 $500.00 "$2,441.74 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$3,662.61 " $486.22 "$3,076.59 " "$3,569.82 " $600.00 $500.00 "$2,930.09 " "$3,906.78 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$3,906.78 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$3,906.78 " "$4,150.96 " $500.00 "$3,662.61 " "$1,025.00 " $500.00 "$2,441.74 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$4,150.96 " 330104 73718 5523 293 610 HC MRI LOWER EXTREMITY W/O DYE O "$4,883.48 " $280.16 $280.16 $500.00 "$2,441.74 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$3,662.61 " $308.18 "$3,076.59 " "$3,569.82 " $600.00 $500.00 "$2,930.09 " "$3,906.78 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$3,906.78 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$3,906.78 " "$4,150.96 " $500.00 "$3,662.61 " "$1,025.00 " $500.00 "$2,441.74 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$4,150.96 " 330104 74712 5523 293 610 HC MRI FETAL SNGL/1ST GESTATION O "$2,808.75 " $280.16 $280.16 $145.13 "$1,404.38 " "$1,575.00 " "$1,434.00 " $277.36 $145.13 $532.31 $145.13 $280.16 "$2,106.56 " $308.18 "$1,769.51 " "$2,053.20 " $174.16 $145.13 "$1,685.25 " "$2,247.00 " $952.56 "$1,596.93 " $145.13 $280.16 $336.20 $203.18 "$2,247.00 " $145.13 $145.13 $174.16 $392.23 $145.13 $280.16 $280.16 $305.38 "$2,247.00 " "$2,387.44 " $145.13 "$2,106.56 " $297.52 $145.13 "$1,404.38 " $753.64 $441.26 $441.26 $441.26 $441.26 $437.66 $294.17 $280.16 $437.66 $145.13 $145.13 $238.14 $238.14 $280.16 $145.13 "$2,387.44 " 330104 72196 5572 295 610 HC MRI PELVIS W/DYE O "$6,717.46 " $442.02 $442.02 $500.00 "$3,358.73 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$5,038.10 " $486.22 "$4,232.00 " "$4,910.46 " $600.00 $500.00 "$4,030.48 " "$5,373.97 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$5,373.97 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$5,373.97 " "$5,709.84 " $500.00 "$5,038.10 " "$1,025.00 " $500.00 "$3,358.73 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$5,709.84 " 330104 70552 5572 295 611 HC MRI BRAIN STEM W/DYE O "$6,122.54 " $442.02 $442.02 $500.00 "$3,061.27 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$4,591.90 " $486.22 "$3,857.20 " "$4,475.58 " $600.00 $500.00 "$3,673.52 " "$4,898.03 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$4,898.03 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$4,898.03 " "$5,204.16 " $500.00 "$4,591.90 " "$1,025.00 " $500.00 "$3,061.27 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$5,204.16 " 330104 70551 5523 293 611 HC MRI BRAIN STEM W/O DYE O "$6,122.54 " $280.16 $280.16 $500.00 "$3,061.27 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$4,591.90 " $308.18 "$3,857.20 " "$4,475.58 " $600.00 $500.00 "$3,673.52 " "$4,898.03 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$4,898.03 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$4,898.03 " "$5,204.16 " $500.00 "$4,591.90 " "$1,025.00 " $500.00 "$3,061.27 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$5,204.16 " 330104 70555 5523 293 611 HC FMRI BRAIN BY PHYS/PSYCH O $921.27 $280.16 $280.16 N/A $460.63 "$1,575.00 " "$1,434.00 " $277.36 N/A $532.31 N/A $280.16 $690.95 $308.18 $580.40 $673.45 N/A N/A $552.76 $737.02 $952.56 "$1,596.93 " N/A $280.16 $336.20 N/A $737.02 N/A N/A N/A $392.23 N/A $280.16 $280.16 $305.38 $737.02 $783.08 N/A $690.95 N/A N/A $460.63 $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 N/A N/A $238.14 $238.14 $280.16 $238.14 "$1,596.93 " 330104 70553 5572 295 611 HC MRI BRAIN STEM W/O & W/DYE O "$6,122.54 " $442.02 $442.02 $500.00 "$3,061.27 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$4,591.90 " $486.22 "$3,857.20 " "$4,475.58 " $600.00 $500.00 "$3,673.52 " "$4,898.03 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$4,898.03 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$4,898.03 " "$5,204.16 " $500.00 "$4,591.90 " "$1,025.00 " $500.00 "$3,061.27 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$5,204.16 " 330104 72146 5523 293 612 HC MRI CHEST SPINE W/O DYE O "$8,228.30 " $280.16 $280.16 $500.00 "$4,114.15 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$6,171.22 " $308.18 "$5,183.83 " "$6,014.89 " $600.00 $500.00 "$4,936.98 " "$6,582.64 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,582.64 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,582.64 " "$6,994.05 " $500.00 "$6,171.22 " "$1,025.00 " $500.00 "$4,114.15 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$6,994.05 " 330104 72141 5523 293 612 HC MRI NECK SPINE W/O DYE O "$7,549.92 " $280.16 $280.16 $500.00 "$3,774.96 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$5,662.44 " $308.18 "$4,756.45 " "$5,518.99 " $600.00 $500.00 "$4,529.95 " "$6,039.94 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$6,039.94 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$6,039.94 " "$6,417.43 " $500.00 "$5,662.44 " "$1,025.00 " $500.00 "$3,774.96 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$6,417.43 " 330104 72142 5572 295 612 HC MRI NECK SPINE W/DYE O "$7,549.92 " $442.02 $442.02 $500.00 "$3,774.96 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$5,662.44 " $486.22 "$4,756.45 " "$5,518.99 " $600.00 $500.00 "$4,529.95 " "$6,039.94 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$6,039.94 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$6,039.94 " "$6,417.43 " $500.00 "$5,662.44 " "$1,025.00 " $500.00 "$3,774.96 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$6,417.43 " 330104 72147 5572 295 612 HC MRI CHEST SPINE W/DYE O "$8,228.30 " $442.02 $442.02 $500.00 "$4,114.15 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$6,171.22 " $486.22 "$5,183.83 " "$6,014.89 " $600.00 $500.00 "$4,936.98 " "$6,582.64 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$6,582.64 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$6,582.64 " "$6,994.05 " $500.00 "$6,171.22 " "$1,025.00 " $500.00 "$4,114.15 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$6,994.05 " 330104 72148 5523 293 612 HC MRI LUMBAR SPINE W/O DYE O "$2,968.18 " $280.16 $280.16 $500.00 "$1,484.09 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$2,226.13 " $308.18 "$1,869.95 " "$2,169.74 " $600.00 $500.00 "$1,780.91 " "$2,374.54 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$2,374.54 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$2,374.54 " "$2,522.95 " $500.00 "$2,226.13 " "$1,025.00 " $500.00 "$1,484.09 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$2,522.95 " 330104 72149 5572 295 612 HC MRI LUMBAR SPINE W/DYE O "$3,205.72 " $442.02 $442.02 $500.00 "$1,602.86 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$2,404.29 " $486.22 "$2,019.60 " "$2,343.38 " $600.00 $500.00 "$1,923.43 " "$2,564.58 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$2,564.58 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$2,564.58 " "$2,724.86 " $500.00 "$2,404.29 " "$1,025.00 " $500.00 "$1,602.86 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $699.17 $464.12 $442.02 $699.17 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$2,724.86 " 330104 72156 5572 295 612 HC MRI NECK SPINE W/O & W/DYE O "$7,549.92 " $442.02 $442.02 $500.00 "$3,774.96 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$5,662.44 " $486.22 "$4,756.45 " "$5,518.99 " $600.00 $500.00 "$4,529.95 " "$6,039.94 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$6,039.94 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$6,039.94 " "$6,417.43 " $500.00 "$5,662.44 " "$1,025.00 " $500.00 "$3,774.96 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$6,417.43 " 330104 72158 5572 295 612 HC MRI LUMBAR SPINE W/O & W/DYE O "$3,205.72 " $442.02 $442.02 $500.00 "$1,602.86 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$2,404.29 " $486.22 "$2,019.60 " "$2,343.38 " $600.00 $500.00 "$1,923.43 " "$2,564.58 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$2,564.58 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$2,564.58 " "$2,724.86 " $500.00 "$2,404.29 " "$1,025.00 " $500.00 "$1,602.86 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$2,724.86 " 330104 72157 5572 295 612 HC MRI CHEST SPINE W/O & W/DYE O "$8,228.30 " $442.02 $442.02 $500.00 "$4,114.15 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$6,171.22 " $486.22 "$5,183.83 " "$6,014.89 " $600.00 $500.00 "$4,936.98 " "$6,582.64 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$6,582.64 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$6,582.64 " "$6,994.05 " $500.00 "$6,171.22 " "$1,025.00 " $500.00 "$4,114.15 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$6,994.05 " 330104 72195 5523 293 614 HC MRI PELVIS W/O DYE O "$6,717.46 " $280.16 $280.16 $500.00 "$3,358.73 " "$1,575.00 " "$1,434.00 " $277.36 $500.00 $532.31 $500.00 $280.16 "$5,038.10 " $308.18 "$4,232.00 " "$4,910.46 " $600.00 $500.00 "$4,030.48 " "$5,373.97 " $952.56 "$1,596.93 " $500.00 $280.16 $336.20 $700.00 "$5,373.97 " $500.00 $500.00 $600.00 $392.23 $500.00 $280.16 $280.16 $305.38 "$5,373.97 " "$5,709.84 " $500.00 "$5,038.10 " "$1,025.00 " $500.00 "$3,358.73 " $753.64 $441.26 $441.26 $441.26 $441.26 $548.69 $294.17 $280.16 $548.69 $500.00 $500.00 $238.14 $238.14 $280.16 $238.14 "$5,709.84 " 330104 75561 5572 295 614 HC CARDIAC MRI W/WO CONTRAST FOR MORPH- FUNCTION & FURTHER SEQ O "$3,482.85 " $442.02 $442.02 $500.00 "$1,741.42 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$2,612.14 " $486.22 "$2,194.20 " "$2,545.96 " $600.00 $500.00 "$2,089.71 " "$2,786.28 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$2,786.28 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$2,786.28 " "$2,960.42 " $500.00 "$2,612.14 " "$1,025.00 " $500.00 "$1,741.42 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$2,960.42 " 330104 76391 5523 293 614 HC MR ELASTOGRAPHY O $921.27 $280.16 $280.16 N/A $460.63 "$1,575.00 " "$1,434.00 " $277.36 N/A $532.31 N/A $280.16 $690.95 $308.18 $580.40 $673.45 N/A N/A $552.76 $737.02 $952.56 "$1,596.93 " N/A $280.16 $336.20 N/A $737.02 N/A N/A N/A $392.23 N/A $280.16 $280.16 $305.38 $737.02 $783.08 N/A $690.95 N/A N/A $460.63 $753.64 $441.26 $441.26 $441.26 $441.26 $368.90 $294.17 $280.16 $368.90 N/A N/A $238.14 $238.14 $280.16 $238.14 "$1,596.93 " 330104 77048 295 614 HC MRI BREAST W/O & W CONTRAST W/CAD UNILATERAL O "$8,381.31 " $427.36 $427.36 $500.00 "$4,190.65 " "$1,575.00 " "$1,434.00 " $423.08 $500.00 $811.98 $500.00 $427.36 "$6,285.98 " $470.09 "$5,280.23 " "$6,126.74 " $600.00 $500.00 "$5,028.79 " "$6,705.05 " "$1,453.01 " "$2,435.93 " $500.00 $427.36 "$5,447.85 " $700.00 "$6,705.05 " $500.00 $500.00 $600.00 $598.30 $500.00 $427.36 $427.36 $465.82 "$6,705.05 " "$7,124.11 " $675.00 "$6,285.98 " "$1,025.00 " $675.00 "$4,190.65 " "$5,447.85 " $673.09 $673.09 $673.09 $673.09 $471.10 $448.72 $427.36 $471.10 $500.00 $500.00 $363.25 $363.25 $427.36 $363.25 "$7,124.11 " 330104 72197 5572 295 614 HC MRI PELVIS W/O & W/DYE O "$6,717.46 " $442.02 $442.02 $500.00 "$3,358.73 " "$1,575.00 " "$1,434.00 " $437.60 $500.00 $839.84 $500.00 $442.02 "$5,038.10 " $486.22 "$4,232.00 " "$4,910.46 " $600.00 $500.00 "$4,030.48 " "$5,373.97 " "$1,502.87 " "$2,519.52 " $500.00 $442.02 $530.42 $700.00 "$5,373.97 " $500.00 $500.00 $600.00 $618.83 $500.00 $442.02 $442.02 $481.80 "$5,373.97 " "$5,709.84 " $500.00 "$5,038.10 " "$1,025.00 " $500.00 "$3,358.73 " "$1,189.03 " $696.18 $696.18 $696.18 $696.18 $853.76 $464.12 $442.02 $853.76 $500.00 $500.00 $375.72 $375.72 $442.02 $375.72 "$5,709.84 " 330104 74185 282 618 HC MRA W/CONT ABD O "$7,545.64 " $428.98 $428.98 $500.00 "$3,772.82 " "$1,575.00 " "$1,434.00 " $424.69 $500.00 $815.06 $500.00 $428.98 "$5,659.23 " $471.88 "$4,753.75 " "$5,515.86 " $600.00 $500.00 "$4,527.38 " "$6,036.51 " "$1,458.54 " "$2,445.19 " $500.00 $428.98 "$4,904.67 " $700.00 "$6,036.51 " $500.00 $500.00 $600.00 $600.57 $500.00 $428.98 $428.98 $467.59 "$6,036.51 " "$6,413.79 " $675.00 "$5,659.23 " "$1,025.00 " $675.00 "$3,772.82 " "$4,904.67 " $675.65 $675.65 $675.65 $675.65 $590.37 $450.43 $428.98 $590.37 $500.00 $500.00 $364.63 $364.63 $428.98 $364.63 "$6,413.79 " 330104 72198 282 618 HC MRA W/O CONT PELVIS O "$7,545.64 " $429.80 $429.80 $500.00 "$3,772.82 " "$1,575.00 " "$1,434.00 " $425.50 $500.00 $816.63 $500.00 $429.80 "$5,659.23 " $472.78 "$4,753.75 " "$5,515.86 " $600.00 $500.00 "$4,527.38 " "$6,036.51 " "$1,461.33 " "$2,449.88 " $500.00 $429.80 "$4,904.67 " $700.00 "$6,036.51 " $500.00 $500.00 $600.00 $601.72 $500.00 $429.80 $429.80 $468.49 "$6,036.51 " "$6,413.79 " $675.00 "$5,659.23 " "$1,025.00 " $675.00 "$3,772.82 " "$4,904.67 " $676.94 $676.94 $676.94 $676.94 $590.91 $451.29 $429.80 $590.91 $500.00 $500.00 $365.33 $365.33 $429.80 $365.33 "$6,413.79 " 330104 72159 282 618 HC MRA W/DYE SPINAL CANAL O "$7,208.59 " $440.48 $440.48 $500.00 "$3,604.30 " "$1,575.00 " "$1,434.00 " $436.08 $500.00 $836.91 $500.00 $440.48 "$5,406.44 " $484.53 "$4,541.41 " "$5,269.48 " $600.00 $500.00 "$4,325.15 " "$5,766.87 " "$1,497.64 " "$2,510.74 " $500.00 $440.48 "$4,685.58 " $700.00 "$5,766.87 " $500.00 $500.00 $600.00 $616.67 $500.00 $440.48 $440.48 $480.12 "$5,766.87 " "$6,127.30 " $675.00 "$5,406.44 " "$1,025.00 " $675.00 "$3,604.30 " "$4,685.58 " $693.76 $693.76 $693.76 $693.76 $698.56 $462.51 $440.48 $698.56 $500.00 $500.00 $374.41 $374.41 $440.48 $374.41 "$6,127.30 " 330104 73225 282 618 HC MRA W/DYE UPPER EXTREMITY O "$7,208.59 " $436.74 $436.74 $500.00 "$3,604.30 " "$1,575.00 " "$1,434.00 " $432.38 $500.00 $829.81 $500.00 $436.74 "$5,406.44 " $480.42 "$4,541.41 " "$5,269.48 " $600.00 $500.00 "$4,325.15 " "$5,766.87 " "$1,484.93 " "$2,489.44 " $500.00 $436.74 "$4,685.58 " $700.00 "$5,766.87 " $500.00 $500.00 $600.00 $611.44 $500.00 $436.74 $436.74 $476.05 "$5,766.87 " "$6,127.30 " $675.00 "$5,406.44 " "$1,025.00 " $675.00 "$3,604.30 " "$4,685.58 " $687.87 $687.87 $687.87 $687.87 $698.56 $458.58 $436.74 $698.56 $500.00 $500.00 $371.23 $371.23 $436.74 $371.23 "$6,127.30 " 330104 Q4124 455 636 HC OASIS ULTRA 35 SQ CM O $49.00 N/A N/A N/A $24.50 $30.38 $30.38 N/A N/A N/A N/A N/A $36.75 $39.20 $24.50 $35.82 N/A N/A $29.40 $39.20 N/A $24.50 N/A N/A $31.85 $24.50 $39.20 $24.50 N/A N/A N/A N/A N/A N/A N/A $39.20 $41.65 N/A N/A N/A N/A $24.50 $31.85 $33.08 $33.08 $33.08 $33.08 N/A $24.50 N/A $32.68 N/A N/A N/A N/A N/A $24.50 $41.65 330104 J1642 496 636 HC INJ HEPARIN SODIUM PER 10 U O $1.00 N/A N/A N/A $0.50 $0.62 $0.62 N/A N/A N/A N/A N/A $0.75 $0.80 $0.50 $0.73 N/A N/A $0.60 $0.80 N/A $0.50 N/A N/A $0.65 $0.50 $0.80 $0.50 N/A N/A N/A N/A N/A N/A N/A $0.80 $0.85 N/A N/A N/A N/A $0.50 $0.65 $0.68 $0.68 $0.68 $0.68 N/A $0.50 N/A $0.67 N/A N/A N/A N/A N/A $0.50 $0.85 330104 Q4121 455 636 HC THERASKIN (103TSXL) 7.6X15.2 PER SQ CM O $93.00 N/A N/A N/A $46.50 $57.66 $57.66 N/A N/A N/A N/A N/A $69.75 $74.40 $46.50 $67.98 N/A N/A $55.80 $74.40 N/A $46.50 N/A N/A $60.45 $46.50 $74.40 $46.50 N/A N/A N/A N/A N/A N/A N/A $74.40 $79.05 N/A N/A N/A N/A $46.50 $60.45 $62.78 $62.78 $62.78 $62.78 N/A $46.50 N/A $62.03 N/A N/A N/A N/A N/A $46.50 $79.05 330104 J2790 436 636 HC RHO D IMMUNE GLOBULIN INJ O $585.00 N/A N/A N/A $292.50 $362.70 $362.70 N/A N/A N/A N/A N/A $438.75 $468.00 $292.50 $427.63 N/A N/A $351.00 $468.00 N/A $292.50 N/A N/A $380.25 $292.50 $468.00 $292.50 N/A N/A N/A N/A N/A N/A N/A $468.00 $497.25 N/A N/A N/A N/A $292.50 $380.25 $394.88 $394.88 $394.88 $394.88 N/A $292.50 N/A $390.20 N/A N/A N/A N/A N/A $292.50 $497.25 330104 Q4158 455 636 HC KERECIS OMEGA 8 CM O $248.00 N/A N/A N/A $124.00 $153.76 $153.76 N/A N/A N/A N/A N/A $186.00 $198.40 $124.00 $181.29 N/A N/A $148.80 $198.40 N/A $124.00 N/A N/A $161.20 $124.00 $198.40 $124.00 N/A N/A N/A N/A N/A N/A N/A $198.40 $210.80 N/A N/A N/A N/A $124.00 $161.20 $167.40 $167.40 $167.40 $167.40 N/A $124.00 N/A $165.42 N/A N/A N/A N/A N/A $124.00 $210.80 330104 Q4121 455 636 HC THERASKIN ( 101TSS) 2.5X5.1PER SQ CM O $260.00 N/A N/A N/A $130.00 $161.20 $161.20 N/A N/A N/A N/A N/A $195.00 $208.00 $130.00 $190.06 N/A N/A $156.00 $208.00 N/A $130.00 N/A N/A $169.00 $130.00 $208.00 $130.00 N/A N/A N/A N/A N/A N/A N/A $208.00 $221.00 N/A N/A N/A N/A $130.00 $169.00 $175.50 $175.50 $175.50 $175.50 N/A $130.00 N/A $173.42 N/A N/A N/A N/A N/A $130.00 $221.00 330104 J7183 1352 462 636 HC WILATE INJECTION O $1.00 $1.43 $1.43 N/A $0.50 $0.62 $0.62 $1.42 N/A $2.72 N/A $1.43 $0.75 $0.80 $0.50 $0.73 N/A N/A $0.60 $0.80 $4.87 $0.50 N/A $1.43 $1.72 $0.50 $0.80 $0.50 N/A N/A $2.01 N/A $1.43 $1.43 $1.56 $0.80 $0.85 N/A $2.95 N/A N/A $0.50 $2.37 $0.68 $0.68 $0.68 $0.68 N/A $0.50 $1.43 $0.67 $1.00 N/A $1.22 $1.22 $1.43 $0.50 $4.87 330104 Q4160 455 636 HC NUSHIELD (6X6) 36 SQ CM O $295.83 N/A N/A N/A $147.91 $183.41 $183.41 N/A N/A N/A N/A N/A $221.87 $236.66 $147.91 $216.25 N/A N/A $177.50 $236.66 N/A $147.91 N/A N/A $192.29 $147.91 $236.66 $147.91 N/A N/A N/A N/A N/A N/A N/A $236.66 $251.46 N/A N/A N/A N/A $147.91 $192.29 $199.69 $199.69 $199.69 $199.69 N/A $147.91 N/A $197.32 N/A N/A N/A N/A N/A $147.91 $251.46 330104 Q4121 455 636 HC THERASKIN (100TSXS) 2.5X2.5 PER SQ CM O $498.00 N/A N/A N/A $249.00 $308.76 $308.76 N/A N/A N/A N/A N/A $373.50 $398.40 $249.00 $364.04 N/A N/A $298.80 $398.40 N/A $249.00 N/A N/A $323.70 $249.00 $398.40 $249.00 N/A N/A N/A N/A N/A N/A N/A $398.40 $423.30 N/A N/A N/A N/A $249.00 $323.70 $336.15 $336.15 $336.15 $336.15 N/A $249.00 N/A $332.17 N/A N/A N/A N/A N/A $249.00 $423.30 330104 Q4160 455 636 HC NUSHIELD (4X6) 24 SQ CM O $325.00 N/A N/A N/A $162.50 $201.50 $201.50 N/A N/A N/A N/A N/A $243.75 $260.00 $162.50 $237.57 N/A N/A $195.00 $260.00 N/A $162.50 N/A N/A $211.25 $162.50 $260.00 $162.50 N/A N/A N/A N/A N/A N/A N/A $260.00 $276.25 N/A N/A N/A N/A $162.50 $211.25 $219.38 $219.38 $219.38 $219.38 N/A $162.50 N/A $216.78 N/A N/A N/A N/A N/A $162.50 $276.25 330104 Q4160 455 636 HC NUSHIELD 1.6 SQ CM O $740.63 N/A N/A N/A $370.31 $459.19 $459.19 N/A N/A N/A N/A N/A $555.47 $592.50 $370.31 $541.40 N/A N/A $444.38 $592.50 N/A $370.31 N/A N/A $481.41 $370.31 $592.50 $370.31 N/A N/A N/A N/A N/A N/A N/A $592.50 $629.54 N/A N/A N/A N/A $370.31 $481.41 $499.93 $499.93 $499.93 $499.93 N/A $370.31 N/A $494.00 N/A N/A N/A N/A N/A $370.31 $629.54 330104 Q4160 455 636 HC NUSHIELD (4X4) 16 SQ CM O $348.75 N/A N/A N/A $174.38 $216.22 $216.22 N/A N/A N/A N/A N/A $261.56 $279.00 $174.38 $254.94 N/A N/A $209.25 $279.00 N/A $174.38 N/A N/A $226.69 $174.38 $279.00 $174.38 N/A N/A N/A N/A N/A N/A N/A $279.00 $296.44 N/A N/A N/A N/A $174.38 $226.69 $235.41 $235.41 $235.41 $235.41 N/A $174.38 N/A $232.62 N/A N/A N/A N/A N/A $174.38 $296.44 330104 Q4121 455 636 HC THERASKIN (26TS) 4X6.5 PER SQ CM O $147.00 N/A N/A N/A $73.50 $91.14 $91.14 N/A N/A N/A N/A N/A $110.25 $117.60 $73.50 $107.46 N/A N/A $88.20 $117.60 N/A $73.50 N/A N/A $95.55 $73.50 $117.60 $73.50 N/A N/A N/A N/A N/A N/A N/A $117.60 $124.95 N/A N/A N/A N/A $73.50 $95.55 $99.23 $99.23 $99.23 $99.23 N/A $73.50 N/A $98.05 N/A N/A N/A N/A N/A $73.50 $124.95 330104 Q4160 455 636 HC NUSHIELD 12 SQ CM O $350.00 N/A N/A N/A $175.00 $217.00 $217.00 N/A N/A N/A N/A N/A $262.50 $280.00 $175.00 $255.85 N/A N/A $210.00 $280.00 N/A $175.00 N/A N/A $227.50 $175.00 $280.00 $175.00 N/A N/A N/A N/A N/A N/A N/A $280.00 $297.50 N/A N/A N/A N/A $175.00 $227.50 $236.25 $236.25 $236.25 $236.25 N/A $175.00 N/A $233.45 N/A N/A N/A N/A N/A $175.00 $297.50 330104 J7198 929 463 636 HC ANTI-INHIBITOR/FEIBA 1IU O $5.49 $2.70 $2.70 $5.49 $2.75 $3.40 $3.40 $2.68 $5.49 $5.14 $5.49 $2.70 $4.12 $4.39 $2.75 $4.01 $6.59 $5.49 $3.29 $4.39 $9.19 $2.75 $5.49 $2.70 $3.25 $2.75 $4.39 $2.75 $5.49 $6.59 $3.79 $5.49 $2.70 $2.70 $2.95 $4.39 $4.67 $5.49 $5.57 $11.25 $5.49 $2.75 $4.46 $3.71 $3.71 $3.71 $3.71 N/A $2.75 $2.70 $3.66 $5.49 $5.49 $2.30 $2.30 $2.70 $2.30 $11.25 330104 J7194 928 462 636 HC PROFILNINE SD FACTOR IX PER IU O $2.00 $1.90 $1.90 $2.00 $1.00 $1.24 $1.24 $1.88 $2.00 $3.60 $2.00 $1.90 $1.50 $1.60 $1.00 $1.46 $2.40 $2.00 $1.20 $1.60 $6.45 $1.00 $2.00 $1.90 $2.27 $1.00 $1.60 $1.00 $2.00 $2.40 $2.65 $2.00 $1.90 $1.90 $2.07 $1.60 $1.70 $2.00 $3.90 $4.10 $2.00 $1.00 $3.13 $1.35 $1.35 $1.35 $1.35 N/A $1.00 $1.90 $1.33 $2.00 $2.00 $1.61 $1.61 $1.90 $1.00 $6.45 330104 J7190 925 462 636 HC KOATE DVI FACTOR VIII PER IU O $1.00 $1.32 $1.32 $1.00 $0.50 $0.62 $0.62 $1.31 $1.00 $2.52 $1.00 $1.32 $0.75 $0.80 $0.50 $0.73 $1.20 $1.00 $0.60 $0.80 $4.50 $0.50 $1.00 $1.32 $1.59 $0.50 $0.80 $0.50 $1.00 $1.20 $1.85 $1.00 $1.32 $1.32 $1.44 $0.80 $0.85 $1.00 $2.73 $2.05 $1.00 $0.50 $2.19 $0.68 $0.68 $0.68 $0.68 N/A $0.50 $1.32 $0.67 $1.00 $1.00 $1.13 $1.13 $1.32 $0.50 $4.50 330104 Q4121 455 636 HC THERASKIN (3TS) 1.75X1.75 PER SQ CM O $895.00 N/A N/A N/A $447.50 $554.90 $554.90 N/A N/A N/A N/A N/A $671.25 $716.00 $447.50 $654.25 N/A N/A $537.00 $716.00 N/A $447.50 N/A N/A $581.75 $447.50 $716.00 $447.50 N/A N/A N/A N/A N/A N/A N/A $716.00 $760.75 N/A N/A N/A N/A $447.50 $581.75 $604.12 $604.12 $604.12 $604.12 N/A $447.50 N/A $596.97 N/A N/A N/A N/A N/A $447.50 $760.75 330104 J7192 927 463 636 HC ADVATE FVIII PER IU O $2.00 $1.73 $1.73 $2.00 $1.00 $1.24 $1.24 $1.71 $2.00 $3.28 $2.00 $1.73 $1.50 $1.60 $1.00 $1.46 $2.40 $2.00 $1.20 $1.60 $5.87 $1.00 $2.00 $1.73 $2.07 $1.00 $1.60 $1.00 $2.00 $2.40 $2.42 $2.00 $1.73 $1.73 $1.88 $1.60 $1.70 $2.00 $3.56 $4.10 $2.00 $1.00 $2.85 $1.35 $1.35 $1.35 $1.35 N/A $1.00 $1.73 $1.33 $2.00 $2.00 $1.47 $1.47 $1.73 $1.00 $5.87 330104 Q4160 455 636 HC NUSHIELD 6 SQ CM O $397.50 N/A N/A N/A $198.75 $246.45 $246.45 N/A N/A N/A N/A N/A $298.12 $318.00 $198.75 $290.57 N/A N/A $238.50 $318.00 N/A $198.75 N/A N/A $258.38 $198.75 $318.00 $198.75 N/A N/A N/A N/A N/A N/A N/A $318.00 $337.88 N/A N/A N/A N/A $198.75 $258.38 $268.31 $268.31 $268.31 $268.31 N/A $198.75 N/A $265.13 N/A N/A N/A N/A N/A $198.75 $337.88 330104 Q4121 455 636 HC THERASKIN (102TSL) 5.1X7.6 PER SQ CM O $103.00 N/A N/A N/A $51.50 $63.86 $63.86 N/A N/A N/A N/A N/A $77.25 $82.40 $51.50 $75.29 N/A N/A $61.80 $82.40 N/A $51.50 N/A N/A $66.95 $51.50 $82.40 $51.50 N/A N/A N/A N/A N/A N/A N/A $82.40 $87.55 N/A N/A N/A N/A $51.50 $66.95 $69.53 $69.53 $69.53 $69.53 N/A $51.50 N/A $68.70 N/A N/A N/A N/A N/A $51.50 $87.55 330104 Q4159 455 636 HC AFFINITY 2.25 SQ CM O "$1,800.00 " N/A N/A N/A $900.00 "$1,116.00 " "$1,116.00 " N/A N/A N/A N/A N/A "$1,350.00 " "$1,440.00 " $900.00 "$1,315.80 " N/A N/A "$1,080.00 " "$1,440.00 " N/A $900.00 N/A N/A "$1,170.00 " $900.00 "$1,440.00 " $900.00 N/A N/A N/A N/A N/A N/A N/A "$1,440.00 " "$1,530.00 " N/A N/A N/A N/A $900.00 "$1,170.00 " "$1,215.00 " "$1,215.00 " "$1,215.00 " "$1,215.00 " N/A $900.00 N/A "$1,200.60 " N/A N/A N/A N/A N/A $900.00 "$1,530.00 " 330104 J7198 929 463 636 HC ANTI-INHIBITOR PER I.U. O $2.00 $2.70 $2.70 $2.00 $1.00 $1.24 $1.24 $2.68 $2.00 $5.14 $2.00 $2.70 $1.50 $1.60 $1.00 $1.46 $2.40 $2.00 $1.20 $1.60 $9.19 $1.00 $2.00 $2.70 $3.25 $1.00 $1.60 $1.00 $2.00 $2.40 $3.79 $2.00 $2.70 $2.70 $2.95 $1.60 $1.70 $2.00 $5.57 $4.10 $2.00 $1.00 $4.46 $1.35 $1.35 $1.35 $1.35 N/A $1.00 $2.70 $1.33 $2.00 $2.00 $2.30 $2.30 $2.70 $1.00 $9.19 330104 J7195 932 463 636 HC BENEFIX RT RECOMBINANT FACTOR IX O $2.00 $1.97 $1.97 $2.00 $1.00 $1.24 $1.24 $1.96 $2.00 $3.75 $2.00 $1.97 $1.50 $1.60 $1.00 $1.46 $2.40 $2.00 $1.20 $1.60 $6.71 $1.00 $2.00 $1.97 $2.37 $1.00 $1.60 $1.00 $2.00 $2.40 $2.76 $2.00 $1.97 $1.97 $2.15 $1.60 $1.70 $2.00 $4.07 $4.10 $2.00 $1.00 $3.26 $1.35 $1.35 $1.35 $1.35 N/A $1.00 $1.97 $1.33 $2.00 $2.00 $1.68 $1.68 $1.97 $1.00 $6.71 330104 J7193 931 463 636 HC ALPHANINE SD-VF FACTOR IX O $1.00 $1.48 $1.48 $1.00 $0.50 $0.62 $0.62 $1.46 $1.00 $2.81 $1.00 $1.48 $0.75 $0.80 $0.50 $0.73 $1.20 $1.00 $0.60 $0.80 $5.03 $0.50 $1.00 $1.48 $1.77 $0.50 $0.80 $0.50 $1.00 $1.20 $2.07 $1.00 $1.48 $1.48 $1.61 $0.80 $0.85 $1.00 $3.04 $2.05 $1.00 $0.50 $2.44 $0.68 $0.68 $0.68 $0.68 N/A $0.50 $1.48 $0.67 $1.00 $1.00 $1.26 $1.26 $1.48 $0.50 $5.03 330104 J7189 1705 463 636 HC FACTOR VIIA O $3.00 $2.82 $2.82 $3.00 $1.50 $1.86 $1.86 $2.79 $3.00 $5.36 $3.00 $2.82 $2.25 $2.40 $1.50 $2.19 $3.60 $3.00 $1.80 $2.40 $9.59 $1.50 $3.00 $2.82 $3.38 $1.50 $2.40 $1.50 $3.00 $3.60 $3.95 $3.00 $2.82 $2.82 $3.07 $2.40 $2.55 $3.00 $5.81 $6.15 $3.00 $1.50 $4.65 $2.03 $2.03 $2.03 $2.03 N/A $1.50 $2.82 $2.00 $3.00 $3.00 $2.40 $2.40 $2.82 $1.50 $9.59 330104 J7186 1213 462 636 HC ANTIHEMPHILIC VII/VWF COMP O $1.00 $1.40 $1.40 $1.00 $0.50 $0.62 $0.62 $1.38 $1.00 $2.65 $1.00 $1.40 $0.75 $0.80 $0.50 $0.73 $1.20 $1.00 $0.60 $0.80 $4.74 $0.50 $1.00 $1.40 $1.67 $0.50 $0.80 $0.50 $1.00 $1.20 $1.95 $1.00 $1.40 $1.40 $1.52 $0.80 $0.85 $1.00 $2.87 $2.05 $1.00 $0.50 $2.30 $0.68 $0.68 $0.68 $0.68 N/A $0.50 $1.40 $0.67 $1.40 $1.00 $1.19 $1.19 $1.40 $0.50 $4.74 330104 Q4160 455 636 HC NUSHIELD 8 SQ CM O $356.25 N/A N/A N/A $178.12 $220.88 $220.88 N/A N/A N/A N/A N/A $267.19 $285.00 $178.12 $260.42 N/A N/A $213.75 $285.00 N/A $178.12 N/A N/A $231.56 $178.12 $285.00 $178.12 N/A N/A N/A N/A N/A N/A N/A $285.00 $302.81 N/A N/A N/A N/A $178.12 $231.56 $240.47 $240.47 $240.47 $240.47 N/A $178.12 N/A $237.62 N/A N/A N/A N/A N/A $178.12 $302.81 330104 G0390 5045 491 681 HC TRAUMA RESPONS W/HOSP LVL I O "$6,320.49 " "$1,381.55 " "$1,381.55 " N/A "$3,160.24 " "$3,918.70 " "$3,918.70 " "$1,367.73 " N/A "$2,624.94 " N/A "$1,381.55 " "$4,740.37 " "$1,519.70 " "$4,108.32 " "$4,620.28 " N/A N/A "$3,792.29 " "$5,056.39 " "$4,697.27 " "$3,160.24 " N/A "$1,381.55 " "$1,657.86 " N/A "$5,056.39 " N/A N/A N/A "$1,934.17 " N/A "$1,381.55 " "$1,381.55 " "$1,505.89 " "$5,056.39 " "$5,372.42 " N/A "$4,740.37 " N/A N/A "$3,160.24 " "$2,279.56 " "$4,266.33 " "$4,266.33 " "$4,266.33 " "$4,266.33 " N/A "$1,450.63 " "$1,381.55 " "$4,215.77 " N/A N/A "$1,174.32 " "$1,174.32 " "$1,381.55 " "$1,174.32 " "$5,372.42 " 330104 G0390 5045 491 682 HC TRAUMA RESPONS W/HOSP CRITI O "$4,955.17 " "$1,381.55 " "$1,381.55 " N/A "$2,477.59 " "$3,072.21 " "$3,072.21 " "$1,367.73 " N/A "$2,624.94 " N/A "$1,381.55 " "$3,716.38 " "$1,519.70 " "$3,220.86 " "$3,622.23 " N/A N/A "$2,973.10 " "$3,964.14 " "$4,697.27 " "$2,477.59 " N/A "$1,381.55 " "$1,657.86 " N/A "$3,964.14 " N/A N/A N/A "$1,934.17 " N/A "$1,381.55 " "$1,381.55 " "$1,505.89 " "$3,964.14 " "$4,211.89 " N/A "$3,716.38 " N/A N/A "$2,477.59 " "$2,279.56 " "$3,344.74 " "$3,344.74 " "$3,344.74 " "$3,344.74 " N/A "$1,450.63 " "$1,381.55 " "$3,305.10 " N/A N/A "$1,174.32 " "$1,174.32 " "$1,381.55 " "$1,174.32 " "$4,697.27 " 330104 710 HC L&D RECOVERY ROOM INITIAL 30 MIN O $505.04 N/A N/A N/A $252.52 $313.12 $313.12 $330.30 N/A N/A N/A N/A $378.78 $353.53 $328.28 $369.18 $176.76 $176.76 $303.02 $404.03 N/A $252.52 $176.76 N/A N/A N/A $404.03 N/A $404.03 N/A N/A $404.03 N/A N/A N/A $404.03 $429.28 $252.52 $378.78 $252.52 $252.52 N/A $328.28 $340.90 $340.90 $340.90 $340.90 N/A N/A N/A $336.86 $252.52 N/A N/A N/A N/A $176.76 $429.28 330104 710 HC RECOVERY ROOM 30 MIN O $507.18 N/A N/A N/A $253.59 $314.45 $314.45 $331.70 N/A N/A N/A N/A $380.38 $355.03 $329.67 $370.75 $177.51 $177.51 $304.31 $405.74 N/A $253.59 $177.51 N/A N/A N/A $405.74 N/A $405.74 N/A N/A $405.74 N/A N/A N/A $405.74 $431.10 $253.59 $380.38 $253.59 $253.59 N/A $329.67 $342.35 $342.35 $342.35 $342.35 N/A N/A N/A $338.29 $253.59 N/A N/A N/A N/A $177.51 $431.10 330104 710 HC RECOVERY ROOM EACH ADDL 30 MIN O $485.78 N/A N/A N/A $242.89 $301.18 $301.18 $317.70 N/A N/A N/A N/A $364.33 $340.05 $315.76 $355.11 $170.02 $170.02 $291.47 $388.62 N/A $242.89 $170.02 N/A N/A N/A $388.62 N/A $388.62 N/A N/A $388.62 N/A N/A N/A $388.62 $412.91 $242.89 $364.33 $242.89 $242.89 N/A $315.76 $327.90 $327.90 $327.90 $327.90 N/A N/A N/A $324.02 $242.89 N/A N/A N/A N/A $170.02 $412.91 330104 720 HC LABOR ROOM-VAGINAL DELIVERY O "$10,159.65 " N/A N/A N/A "$5,079.82 " "$6,298.98 " "$6,298.98 " "$6,644.41 " N/A N/A N/A N/A "$7,619.74 " "$7,111.75 " "$6,603.77 " "$7,426.70 " "$3,555.88 " "$3,555.88 " "$6,095.79 " "$8,127.72 " N/A "$5,079.82 " "$3,555.88 " N/A N/A N/A "$8,127.72 " N/A "$8,127.72 " N/A N/A "$8,127.72 " N/A N/A N/A "$8,127.72 " "$8,635.70 " "$5,079.82 " "$7,619.74 " "$5,079.82 " "$5,079.82 " N/A "$6,603.77 " "$6,857.76 " "$6,857.76 " "$6,857.76 " "$6,857.76 " N/A N/A N/A "$6,776.49 " "$5,079.82 " N/A N/A N/A N/A "$3,555.88 " "$8,635.70 " 330104 59050 191 720 HC FETAL MONITOR W/REPORT O $965.14 N/A N/A $240.40 $482.57 $598.39 $598.39 $65.88 $240.40 N/A $240.40 N/A $723.86 N/A $627.34 $705.52 $288.48 $240.40 $579.08 $772.11 N/A $482.57 $240.40 N/A $627.34 $336.56 $772.11 $240.40 $240.40 $288.48 N/A $240.40 N/A N/A N/A $772.11 $820.37 $324.54 $723.86 $492.83 $324.54 $482.57 $627.34 $651.47 $651.47 $651.47 $651.47 N/A N/A N/A $643.75 $240.40 $240.40 N/A N/A N/A $65.88 $820.37 330104 59070 5412 178 720 HC TRANSABDOM AMNIOINFUSION W/ULTRSND GUIDANCE O "$1,248.69 " $350.28 $350.28 $767.36 $624.35 $774.19 $774.19 $346.77 $767.36 $665.52 $767.36 $350.28 $936.52 $385.30 $811.65 $912.79 $920.83 $767.36 $749.21 $998.95 "$1,190.94 " $624.35 $767.36 $350.28 $420.33 "$1,074.30 " $998.95 $767.36 $767.36 $920.83 $490.39 $767.36 $350.28 $350.28 $381.80 $998.95 "$1,061.39 " $767.36 "$3,883.00 " "$1,573.08 " $767.36 $624.35 $577.96 $842.87 $842.87 $842.87 $842.87 N/A $367.79 $350.28 $832.88 $767.36 $767.36 $297.73 $297.73 $350.28 $297.73 "$3,883.00 " 330104 59412 5414 178 720 HC ANTEPARTUM MANIPULATION O "$11,509.99 " "$3,392.19 " "$3,392.19 " $767.36 "$5,754.99 " "$7,136.19 " "$7,136.19 " "$3,358.27 " $767.36 "$6,445.17 " $767.36 "$3,392.19 " "$8,632.49 " "$3,731.41 " "$7,481.49 " "$8,413.80 " $920.83 $767.36 "$6,905.99 " "$9,207.99 " "$11,533.46 " "$5,754.99 " $767.36 "$3,392.19 " "$4,070.63 " "$1,074.30 " "$9,207.99 " $767.36 $767.36 $920.83 "$4,749.07 " $767.36 "$3,392.19 " "$3,392.19 " "$3,697.49 " "$9,207.99 " "$9,783.49 " $767.36 "$8,632.49 " "$1,573.08 " $767.36 "$5,754.99 " "$5,597.12 " "$7,769.24 " "$7,769.24 " "$7,769.24 " "$7,769.24 " N/A "$3,561.80 " "$3,392.19 " "$7,677.16 " $767.36 $767.36 "$2,883.36 " "$2,883.36 " "$3,392.19 " $767.36 "$11,533.46 " 330104 93005 5733 413 730 HC ELECTROCARDIOGRAM TRACING O "$1,313.96 " $68.96 $68.96 $7.50 $656.98 $814.66 $814.66 $68.27 $7.50 $131.03 $7.50 $68.96 $985.47 $75.86 $854.07 $960.50 $9.00 $7.50 $788.38 "$1,051.17 " $234.47 $393.08 $7.50 $68.96 $82.75 $10.50 "$1,051.17 " $7.50 $7.50 $9.00 $96.55 $7.50 $68.96 $68.96 $75.17 "$1,051.17 " "$1,116.87 " $7.50 $985.47 $15.37 $7.50 $656.98 $113.79 $886.92 $886.92 $886.92 $886.92 N/A $72.41 $68.96 $876.41 $7.50 $7.50 $58.62 $58.62 $68.96 $7.50 "$1,116.87 " 330104 93248 418 731 HC EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION O $281.41 N/A N/A $187.76 $140.71 $174.47 $174.47 $28.76 $187.76 N/A $187.76 N/A $211.06 N/A $182.92 $205.71 $225.31 $187.76 $168.85 $225.13 N/A N/A $187.76 N/A $182.92 $262.86 $225.13 $187.76 $187.76 $225.31 N/A $187.76 N/A N/A N/A $225.13 $239.20 $253.47 $211.06 $384.90 $253.47 $140.71 $182.92 $189.95 $189.95 $189.95 $189.95 N/A N/A N/A $187.70 $187.76 $187.76 N/A N/A N/A $28.76 $384.90 330104 93247 5734 418 731 HC EXTERNAL ECG REC>7D<15D SCANNING ALYS W/REPORT O $561.75 $139.30 $139.30 $187.76 $280.88 $348.29 $348.29 $137.91 $187.76 $264.67 $187.76 $139.30 $421.31 $153.23 $365.14 $410.64 $225.31 $187.76 $337.05 $449.40 $473.63 $794.02 $187.76 $139.30 $167.16 $262.86 $449.40 $187.76 $187.76 $225.31 $195.02 $187.76 $139.30 $139.30 $151.84 $449.40 $477.49 $187.76 $421.31 $384.90 $187.76 $280.88 $229.85 $379.18 $379.18 $379.18 $379.18 N/A $146.27 $139.30 $374.69 $187.76 $187.76 $118.41 $118.41 $139.30 $118.41 $794.02 330104 93246 5733 418 731 HC EXTERNAL ECG REC>7D<15D RECORDING O $281.41 $68.96 $68.96 $4.73 $140.71 $174.47 $174.47 $68.27 $4.73 $131.03 $4.73 $68.96 $211.06 $75.86 $182.92 $205.71 $5.68 $4.73 $168.85 $225.13 $234.47 $393.08 $4.73 $68.96 $82.75 $6.62 $225.13 $4.73 $4.73 $5.68 $96.55 $4.73 $68.96 $68.96 $75.17 $225.13 $239.20 $4.73 $211.06 $9.70 $4.73 $140.71 $113.79 $189.95 $189.95 $189.95 $189.95 N/A $72.41 $68.96 $187.70 $4.73 $4.73 $58.62 $58.62 $68.96 $4.73 $393.08 330104 93241 418 731 HC EXTERNAL ECG REC>48HR<7D SCAN ALYS REPORT R&I O $281.41 N/A N/A $187.76 $140.71 $174.47 $174.47 $319.66 $187.76 N/A $187.76 N/A $211.06 N/A $182.92 $205.71 $225.31 $187.76 $168.85 $225.13 N/A N/A $187.76 N/A $182.92 $262.86 $225.13 $187.76 $187.76 $225.31 N/A $187.76 N/A N/A N/A $225.13 $239.20 $253.47 $211.06 $384.90 $253.47 $140.71 $182.92 $189.95 $189.95 $189.95 $189.95 N/A N/A N/A $187.70 $187.76 $187.76 N/A N/A N/A $140.71 $384.90 330104 93242 5732 418 731 HC EXTERNAL ECG REC>48HR<7D RECORDING O $169.06 $40.74 $40.74 $4.73 $84.53 $104.82 $104.82 $40.34 $4.73 $77.41 $4.73 $40.74 $126.80 $44.82 $109.89 $123.58 $5.68 $4.73 $101.44 $135.25 $138.53 $232.24 $4.73 $40.74 $48.89 $6.62 $135.25 $4.73 $4.73 $5.68 $57.04 $4.73 $40.74 $40.74 $44.41 $135.25 $143.70 $4.73 $126.80 $9.70 $4.73 $84.53 $67.23 $114.12 $114.12 $114.12 $114.12 N/A $42.78 $40.74 $112.76 $4.73 $4.73 $34.63 $34.63 $40.74 $4.73 $232.24 330104 93226 5734 418 731 HC ECG MONIT/REPRT UP TO 48 HRS;SCANNING ANALYSIS O $632.37 $139.30 $139.30 $187.76 $316.19 $392.07 $392.07 $137.91 $187.76 $264.67 $187.76 $139.30 $474.28 $153.23 $411.04 $462.26 $225.31 $187.76 $379.42 $505.90 $473.63 $794.02 $187.76 $139.30 $167.16 $262.86 $505.90 $187.76 $187.76 $225.31 $195.02 $187.76 $139.30 $139.30 $151.84 $505.90 $537.51 $187.76 $474.28 $384.90 $187.76 $316.19 $229.85 $426.85 $426.85 $426.85 $426.85 N/A $146.27 $139.30 $421.79 $187.76 $187.76 $118.41 $118.41 $139.30 $118.41 $794.02 330104 93225 5734 418 731 HC ECG MONIT/REPRT UP TO 48 HRS;RECORDING O "$3,580.22 " $139.30 $139.30 $18.00 "$1,790.11 " "$2,219.74 " "$2,219.74 " $137.91 $18.00 $264.67 $18.00 $139.30 "$2,685.17 " $153.23 "$2,327.14 " "$2,617.14 " $21.60 $18.00 "$2,148.13 " "$2,864.18 " $473.63 $794.02 $18.00 $139.30 $167.16 $25.20 "$2,864.18 " $18.00 $18.00 $21.60 $195.02 $18.00 $139.30 $139.30 $151.84 "$2,864.18 " "$3,043.19 " $18.00 "$2,685.17 " $36.90 $18.00 "$1,790.11 " $229.85 "$2,416.65 " "$2,416.65 " "$2,416.65 " "$2,416.65 " N/A $146.27 $139.30 "$2,388.01 " $18.00 $18.00 $118.41 $118.41 $139.30 $18.00 "$3,043.19 " 330104 93243 5734 418 731 HC XTERNAL ECG REC>48HR<7D SCANNING ALYS W/REPORT O $281.41 $139.30 $139.30 $187.76 $140.71 $174.47 $174.47 $137.91 $187.76 $264.67 $187.76 $139.30 $211.06 $153.23 $182.92 $205.71 $225.31 $187.76 $168.85 $225.13 $473.63 $794.02 $187.76 $139.30 $167.16 $262.86 $225.13 $187.76 $187.76 $225.31 $195.02 $187.76 $139.30 $139.30 $151.84 $225.13 $239.20 $187.76 $211.06 $384.90 $187.76 $140.71 $229.85 $189.95 $189.95 $189.95 $189.95 N/A $146.27 $139.30 $187.70 $187.76 $187.76 $118.41 $118.41 $139.30 $118.41 $794.02 330104 95812 5722 210 740 HC EEG 41-60 MINUTES O "$2,198.85 " $336.00 $336.00 $35.00 "$1,099.42 " "$1,363.29 " "$1,363.29 " $332.64 $35.00 $638.40 $35.00 $336.00 "$1,649.14 " $369.60 "$1,429.25 " "$1,607.36 " $42.00 $35.00 "$1,319.31 " "$1,759.08 " "$1,142.40 " "$1,915.20 " $35.00 $336.00 $403.20 $49.00 "$1,759.08 " $35.00 $35.00 $42.00 $470.40 $35.00 $336.00 $336.00 $366.24 "$1,759.08 " "$1,869.02 " $35.00 "$1,649.14 " $71.75 $35.00 "$1,099.42 " $554.40 "$1,484.22 " "$1,484.22 " "$1,484.22 " "$1,484.22 " N/A $352.80 $336.00 "$1,466.63 " $35.00 $35.00 $285.60 $285.60 $336.00 $35.00 "$1,915.20 " 330104 95813 5722 210 740 HC EEG OVER 1 HOUR O "$2,906.12 " $336.00 $336.00 $35.00 "$1,453.06 " "$1,801.79 " "$1,801.79 " $332.64 $35.00 $638.40 $35.00 $336.00 "$2,179.59 " $369.60 "$1,888.98 " "$2,124.37 " $42.00 $35.00 "$1,743.67 " "$2,324.90 " "$1,142.40 " "$1,915.20 " $35.00 $336.00 $403.20 $49.00 "$2,324.90 " $35.00 $35.00 $42.00 $470.40 $35.00 $336.00 $336.00 $366.24 "$2,324.90 " "$2,470.20 " $35.00 "$2,179.59 " $71.75 $35.00 "$1,453.06 " $554.40 "$1,961.63 " "$1,961.63 " "$1,961.63 " "$1,961.63 " N/A $352.80 $336.00 "$1,938.38 " $35.00 $35.00 $285.60 $285.60 $336.00 $35.00 "$2,470.20 " 330104 95816 5722 211 740 HC EEG AWAKE AND DROWSY O "$1,258.32 " $336.00 $336.00 $35.00 $629.16 $780.16 $780.16 $332.64 $35.00 $638.40 $35.00 $336.00 $943.74 $369.60 $817.91 $919.83 $42.00 $35.00 $754.99 "$1,006.66 " "$1,142.40 " "$1,915.20 " $35.00 $336.00 $403.20 $49.00 "$1,006.66 " $35.00 $35.00 $42.00 $470.40 $35.00 $336.00 $336.00 $366.24 "$1,006.66 " "$1,069.57 " $35.00 $943.74 $71.75 $35.00 $629.16 $554.40 $849.37 $849.37 $849.37 $849.37 N/A $352.80 $336.00 $839.30 $35.00 $35.00 $285.60 $285.60 $336.00 $35.00 "$1,915.20 " 330104 95819 5722 211 740 HC EEG AWAKE AND ASLEEP O "$1,653.15 " $336.00 $336.00 $35.00 $826.58 "$1,024.95 " "$1,024.95 " $332.64 $35.00 $638.40 $35.00 $336.00 "$1,239.86 " $369.60 "$1,074.55 " "$1,208.45 " $42.00 $35.00 $991.89 "$1,322.52 " "$1,142.40 " "$1,915.20 " $35.00 $336.00 $403.20 $49.00 "$1,322.52 " $35.00 $35.00 $42.00 $470.40 $35.00 $336.00 $336.00 $366.24 "$1,322.52 " "$1,405.18 " $35.00 "$1,239.86 " $71.75 $35.00 $826.58 $554.40 "$1,115.88 " "$1,115.88 " "$1,115.88 " "$1,115.88 " N/A $352.80 $336.00 "$1,102.65 " $35.00 $35.00 $285.60 $285.60 $336.00 $35.00 "$1,915.20 " 330104 95824 5723 211 740 HC EEG CEREBRAL DEATH ONLY O "$2,238.44 " $579.99 $579.99 $180.07 "$1,119.22 " "$1,387.83 " "$1,387.83 " $574.19 $180.07 "$1,101.98 " $180.07 $579.99 "$1,678.83 " $637.99 "$1,454.99 " "$1,636.30 " $216.09 $180.07 "$1,343.06 " "$1,790.75 " "$1,971.97 " "$3,305.94 " $180.07 $579.99 $695.99 $252.10 "$1,790.75 " $180.07 $180.07 $216.09 $811.99 $180.07 $579.99 $579.99 $632.19 "$1,790.75 " "$1,902.67 " $180.07 "$1,678.83 " $369.15 $180.07 "$1,119.22 " $956.98 "$1,510.95 " "$1,510.95 " "$1,510.95 " "$1,510.95 " N/A $608.99 $579.99 "$1,493.04 " $180.07 $180.07 $492.99 $492.99 $579.99 $180.07 "$3,305.94 " 330104 43497 5303 125 750 HC TRANSORL LWR ESOPHGL MYOTOMY O "$8,774.00 " "$3,911.98 " "$3,911.98 " "$1,812.20 " N/A "$2,432.00 " "$2,215.00 " "$3,872.86 " "$1,812.20 " "$7,432.76 " "$1,812.20 " "$3,911.98 " "$6,580.50 " "$4,303.18 " "$5,703.10 " "$5,834.71 " "$2,174.63 " "$1,812.20 " "$5,264.40 " "$14,074.00 " "$13,300.73 " "$9,788.00 " "$1,812.20 " "$3,911.98 " "$4,694.38 " "$2,537.07 " "$7,019.20 " "$1,812.20 " "$1,812.20 " "$2,174.63 " "$5,476.77 " "$1,812.20 " "$3,911.98 " "$3,911.98 " "$4,264.06 " "$7,019.20 " "$7,457.90 " "$1,812.20 " "$6,580.50 " "$3,715.00 " "$1,812.20 " "$4,387.00 " "$6,454.77 " "$5,922.45 " "$5,922.45 " "$5,922.45 " "$5,922.45 " "$5,375.00 " "$4,107.58 " "$3,911.98 " "$5,659.00 " "$1,812.20 " "$1,812.20 " "$3,325.18 " "$3,325.18 " "$3,911.98 " "$1,812.20 " "$14,074.00 " 330104 42975 5151 249 750 HC DISE EVAL SLP DO BRTH FLX DX O $642.00 $214.45 $214.45 $135.47 N/A "$2,432.00 " "$2,215.00 " $212.31 $135.47 $407.46 $135.47 $214.45 $481.50 $235.90 $417.30 $426.93 $162.56 $135.47 $385.20 "$14,074.00 " $729.14 "$9,788.00 " $135.47 $214.45 $257.34 $189.66 $513.60 $135.47 $135.47 $162.56 $300.23 $135.47 $214.45 $214.45 $233.75 $513.60 $545.70 $135.47 $481.50 $277.71 $135.47 $321.00 $353.85 $433.35 $433.35 $433.35 $433.35 "$2,688.00 " $225.18 $214.45 "$2,954.00 " $135.47 $135.47 $182.29 $182.29 $214.45 $135.47 "$14,074.00 " 330104 27648 278 761 HC ANKLE ARTHROGRAPHY INJ O "$1,480.88 " N/A N/A $468.99 $936.00 $918.15 $918.15 $60.78 $468.99 N/A $468.99 N/A "$1,110.66 " N/A "$2,217.33 " N/A $562.78 $468.99 $888.53 "$1,184.70 " N/A $740.44 $468.99 N/A $962.57 $656.58 "$2,467.00 " $468.99 $468.99 $562.78 N/A $468.99 N/A "$2,500.00 " N/A "$1,184.70 " "$1,258.75 " $633.13 "$3,777.00 " $961.42 $633.13 $740.44 $962.57 $999.59 $999.59 $999.59 $999.59 "$2,688.00 " N/A N/A "$3,440.00 " $468.99 $468.99 N/A N/A N/A $60.78 "$3,777.00 " 330104 31624 5153 64 761 HC DX BRONCHOSCOPE/LAVAGE INCL GUIDANCE O "$6,592.27 " "$1,917.86 " "$1,917.86 " "$1,185.37 " $936.00 "$1,792.00 " "$1,631.00 " "$1,898.68 " "$1,185.37 " "$3,643.93 " "$1,185.37 " "$1,917.86 " "$4,944.20 " "$2,109.64 " "$2,217.33 " N/A "$1,422.44 " "$1,185.37 " "$3,955.36 " "$5,273.82 " "$6,520.71 " "$3,296.14 " "$1,185.37 " "$1,917.86 " "$2,301.43 " "$1,659.51 " "$2,467.00 " "$1,185.37 " "$1,185.37 " "$1,422.44 " "$2,685.00 " "$1,185.37 " "$1,917.86 " "$2,500.00 " "$2,090.46 " "$5,273.82 " "$5,603.43 " "$1,185.37 " "$3,883.00 " $180.14 $163.76 "$3,296.14 " "$2,086.00 " "$4,449.78 " "$4,449.78 " "$4,449.78 " "$4,449.78 " "$2,688.00 " "$2,013.75 " "$1,917.86 " "$3,440.00 " "$1,185.37 " "$1,185.37 " "$1,630.18 " "$1,630.18 " "$1,917.86 " $163.76 "$6,520.71 " 330104 32408 5072 68 761 HC CORE NEEDLE BX LUNG/MEDIASTINUM PERQ W/IMG O "$5,457.00 " "$1,799.07 " "$1,799.07 " $609.85 $936.00 "$3,383.34 " "$3,383.34 " "$1,781.08 " $609.85 "$3,418.23 " $609.85 "$1,799.07 " "$4,092.75 " "$1,978.98 " "$2,217.33 " N/A $731.82 $609.85 "$3,274.20 " "$4,365.60 " "$6,116.84 " "$2,728.50 " $609.85 "$1,799.07 " "$2,158.88 " $853.79 "$2,467.00 " $609.85 $609.85 $731.82 "$2,518.70 " $609.85 "$1,799.07 " "$2,500.00 " "$1,960.99 " "$4,365.60 " "$4,638.45 " $609.85 "$3,777.00 " $205.49 $186.81 "$2,728.50 " "$2,086.00 " "$3,683.48 " "$3,683.48 " "$3,683.48 " "$3,683.48 " "$2,688.00 " "$1,889.02 " "$1,799.07 " "$3,440.00 " $609.85 $609.85 "$1,529.21 " "$1,529.21 " "$1,799.07 " $186.81 "$6,116.84 " 330104 32557 5182 68 761 HC TREATMENT ROOM INSERT CATH PLEURA W/ IMAGE O "$7,515.68 " "$1,785.03 " "$1,785.03 " $609.85 $936.00 "$4,659.72 " "$4,659.72 " "$1,767.18 " $609.85 "$3,391.56 " $609.85 "$1,785.03 " "$5,636.76 " "$1,963.54 " "$2,217.33 " N/A $731.82 $609.85 "$4,509.41 " "$6,012.54 " "$6,069.11 " "$3,757.84 " $609.85 "$1,785.03 " "$2,142.04 " $853.79 "$2,467.00 " $609.85 $609.85 $731.82 "$2,499.05 " $609.85 "$1,785.03 " "$2,500.00 " "$1,945.69 " "$6,012.54 " "$6,388.33 " $609.85 "$3,883.00 " $201.58 $183.26 "$3,757.84 " "$2,086.00 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$5,073.08 " "$2,688.00 " "$1,874.28 " "$1,785.03 " "$3,440.00 " $609.85 $609.85 "$1,517.28 " "$1,517.28 " "$1,785.03 " $183.26 "$6,388.33 " 330104 36573 5182 75 761 HC INSJ PICC RS&I 5 YR+ O "$6,959.28 " "$1,785.03 " "$1,785.03 " $235.81 $936.00 "$4,314.75 " "$4,314.75 " "$1,767.18 " $235.81 "$3,391.56 " $235.81 "$1,785.03 " "$5,219.46 " "$1,963.54 " "$2,217.33 " N/A $282.97 $235.81 "$4,175.57 " "$5,567.42 " "$6,069.11 " "$3,479.64 " $235.81 "$1,785.03 " "$2,142.04 " $330.13 "$2,467.00 " $235.81 $235.81 $282.97 "$2,499.05 " $235.81 "$1,785.03 " "$2,500.00 " "$1,945.69 " "$5,567.42 " "$5,915.39 " $235.81 "$3,777.00 " $114.50 $104.10 "$3,479.64 " "$2,086.00 " "$4,697.51 " "$4,697.51 " "$4,697.51 " "$4,697.51 " "$2,688.00 " "$1,874.28 " "$1,785.03 " "$3,440.00 " $235.81 $235.81 "$1,517.28 " "$1,517.28 " "$1,785.03 " $104.10 "$6,069.11 " 330104 38222 5073 124 761 HC DX BONE MARROW BX & ASPIR O "$10,685.02 " "$3,099.23 " "$3,099.23 " $512.29 $936.00 "$6,624.71 " "$6,624.71 " "$3,068.24 " $512.29 "$5,888.53 " $512.29 "$3,099.23 " "$8,013.77 " "$3,409.15 " "$2,217.33 " N/A $614.75 $512.29 "$6,411.01 " "$8,548.02 " "$10,537.38 " "$5,342.51 " $512.29 "$3,099.23 " "$3,719.07 " $717.20 "$2,467.00 " $512.29 $512.29 $614.75 "$4,338.92 " $512.29 "$3,099.23 " "$2,500.00 " "$3,378.16 " "$8,548.02 " "$9,082.27 " $512.29 "$3,777.00 " $102.14 $92.85 "$5,342.51 " "$2,086.00 " "$7,212.39 " "$7,212.39 " "$7,212.39 " "$7,212.39 " "$2,688.00 " "$3,254.19 " "$3,099.23 " "$3,440.00 " $512.29 $512.29 "$2,634.34 " "$2,634.34 " "$3,099.23 " $92.85 "$10,537.38 " 330104 38790 278 761 HC INJ PROCEDURE - LYMPHANGIOGRAPHY O "$5,825.08 " N/A N/A $468.99 $936.00 "$3,611.55 " "$3,611.55 " $99.40 $468.99 N/A $468.99 N/A "$4,368.81 " N/A "$2,217.33 " N/A $562.78 $468.99 "$3,495.05 " "$4,660.06 " N/A "$2,912.54 " $468.99 N/A "$3,786.30 " $656.58 "$2,467.00 " $468.99 $468.99 $562.78 N/A $468.99 N/A "$2,500.00 " N/A "$4,660.06 " "$4,951.32 " $633.13 "$3,777.00 " $961.42 $633.13 "$2,912.54 " "$3,786.30 " "$3,931.93 " "$3,931.93 " "$3,931.93 " "$3,931.93 " "$2,688.00 " N/A N/A "$3,440.00 " $468.99 $468.99 N/A N/A N/A $99.40 "$4,951.32 " 330104 43762 5371 130 761 HC REPLACEMENT GTUBE NO REVJ TRC O "$1,820.07 " $257.79 $257.79 $507.89 $936.00 "$1,128.44 " "$1,128.44 " $255.21 $507.89 $489.80 $507.89 $257.79 "$1,365.05 " $283.57 "$2,217.33 " N/A $609.46 $507.89 "$1,092.04 " "$1,456.06 " $876.48 $910.03 $507.89 $257.79 $309.35 $711.04 "$2,467.00 " $507.89 $507.89 $609.46 $360.90 $507.89 $257.79 "$2,500.00 " $280.99 "$1,456.06 " "$1,547.06 " $507.89 "$3,777.00 " $52.27 $47.52 $910.03 "$2,086.00 " "$1,228.55 " "$1,228.55 " "$1,228.55 " "$1,228.55 " "$2,688.00 " $270.68 $257.79 "$3,440.00 " $507.89 $507.89 $219.12 $219.12 $257.79 $47.52 "$3,777.00 " 330104 48102 5072 150 761 HC NEEDLE BIOPSY PANCREAS O "$5,350.00 " "$1,799.07 " "$1,799.07 " $609.85 $936.00 "$3,317.00 " "$3,317.00 " "$1,781.08 " $609.85 "$3,418.23 " $609.85 "$1,799.07 " "$4,012.50 " "$1,978.98 " "$2,217.33 " N/A $731.82 $609.85 "$3,210.00 " "$4,280.00 " "$6,116.84 " "$2,675.00 " $609.85 "$1,799.07 " "$2,158.88 " $853.79 "$2,467.00 " $609.85 $609.85 $731.82 "$2,518.70 " $609.85 "$1,799.07 " "$2,500.00 " "$1,960.99 " "$4,280.00 " "$4,547.50 " $609.85 "$3,883.00 " $319.28 $290.26 "$2,675.00 " "$2,086.00 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$3,611.25 " "$2,688.00 " "$1,889.02 " "$1,799.07 " "$3,440.00 " $609.85 $609.85 "$1,529.21 " "$1,529.21 " "$1,799.07 " $290.26 "$6,116.84 " 330104 50432 5373 170 761 HC PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I O "$8,164.10 " "$2,225.37 " "$2,225.37 " "$1,109.35 " $936.00 "$5,061.74 " "$5,061.74 " "$2,203.12 " "$1,109.35 " "$4,228.21 " "$1,109.35 " "$2,225.37 " "$6,123.08 " "$2,447.91 " "$2,217.33 " N/A "$1,331.22 " "$1,109.35 " "$4,898.46 " "$6,531.28 " "$7,566.27 " "$4,082.05 " "$1,109.35 " "$2,225.37 " "$2,670.45 " "$1,553.09 " "$2,467.00 " "$1,109.35 " "$1,109.35 " "$1,331.22 " "$3,115.52 " "$1,109.35 " "$2,225.37 " "$2,500.00 " "$2,425.66 " "$6,531.28 " "$6,939.49 " "$1,109.35 " "$3,777.00 " $276.40 $251.27 "$4,082.05 " "$2,086.00 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$5,510.77 " "$2,688.00 " "$2,336.64 " "$2,225.37 " "$3,440.00 " "$1,109.35 " "$1,109.35 " "$1,891.57 " "$1,891.57 " "$2,225.37 " $251.27 "$7,566.27 " 330104 49465 5523 389 761 HC FLUORO EXAM OF G/COLON TUBE O "$1,545.08 " $280.16 $280.16 $258.22 $936.00 $957.95 $957.95 $277.36 $258.22 $532.31 $258.22 $280.16 "$1,158.81 " $308.18 "$2,217.33 " N/A $309.86 $258.22 $927.05 "$1,236.06 " $952.56 $772.54 $258.22 $280.16 $336.20 $361.51 "$2,467.00 " $258.22 $258.22 $309.86 $392.23 $258.22 $280.16 "$2,500.00 " $305.38 "$1,236.06 " "$1,313.32 " $258.22 "$3,777.00 " $41.48 $37.71 $772.54 "$2,086.00 " "$1,042.93 " "$1,042.93 " "$1,042.93 " "$1,042.93 " "$2,688.00 " $294.17 $280.16 "$3,440.00 " $258.22 $258.22 $238.14 $238.14 $280.16 $37.71 "$3,777.00 " 330104 50200 5072 170 761 HC RENAL BIOPSY; PERCUTANEOUS O "$6,324.77 " "$1,799.07 " "$1,799.07 " "$1,109.35 " $936.00 "$3,921.36 " "$3,921.36 " "$1,781.08 " "$1,109.35 " "$3,418.23 " "$1,109.35 " "$1,799.07 " "$4,743.58 " "$1,978.98 " "$2,217.33 " N/A "$1,331.22 " "$1,109.35 " "$3,794.86 " "$5,059.82 " "$6,116.84 " "$3,162.39 " "$1,109.35 " "$1,799.07 " "$2,158.88 " "$1,553.09 " "$2,467.00 " "$1,109.35 " "$1,109.35 " "$1,331.22 " "$2,518.70 " "$1,109.35 " "$1,799.07 " "$2,500.00 " "$1,960.99 " "$5,059.82 " "$5,376.05 " "$1,109.35 " "$3,883.00 " $171.32 $155.74 "$3,162.39 " "$2,086.00 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$4,269.22 " "$2,688.00 " "$1,889.02 " "$1,799.07 " "$3,440.00 " "$1,109.35 " "$1,109.35 " "$1,529.21 " "$1,529.21 " "$1,799.07 " $155.74 "$6,116.84 " 330104 50431 5372 161 761 HC INJ ANTEGRADE NEPHROSTOGRAM AND/OR URETEROGRAM O "$2,840.85 " $750.25 $750.25 $430.05 $936.00 "$1,761.33 " "$1,761.33 " $742.74 $430.05 "$1,425.47 " $430.05 $750.25 "$2,130.64 " $825.27 "$2,217.33 " N/A $516.05 $430.05 "$1,704.51 " "$2,272.68 " "$2,550.83 " "$1,420.42 " $430.05 $750.25 $900.29 $602.06 "$2,467.00 " $430.05 $430.05 $516.05 "$1,050.34 " $430.05 $750.25 "$2,500.00 " $817.77 "$2,272.68 " "$2,414.72 " $430.05 "$3,777.00 " $89.55 $81.41 "$1,420.42 " "$2,086.00 " "$1,917.57 " "$1,917.57 " "$1,917.57 " "$1,917.57 " "$2,688.00 " $787.76 $750.25 "$3,440.00 " $430.05 $430.05 $637.71 $637.71 $750.25 $81.41 "$3,777.00 " 330104 25246 278 761 HC WRIST ARTHROGRAPHY INJ O "$1,570.76 " N/A N/A $468.99 $936.00 $973.87 $973.87 $84.97 $468.99 N/A $468.99 N/A "$1,178.07 " N/A "$2,217.33 " N/A $562.78 $468.99 $942.46 "$1,256.61 " N/A $785.38 $468.99 N/A "$1,020.99 " $656.58 "$2,467.00 " $468.99 $468.99 $562.78 N/A $468.99 N/A "$2,500.00 " N/A "$1,256.61 " "$1,335.15 " $633.13 "$3,777.00 " $961.42 $633.13 $785.38 "$1,020.99 " "$1,060.26 " "$1,060.26 " "$1,060.26 " "$1,060.26 " "$2,688.00 " N/A N/A "$3,440.00 " $468.99 $468.99 N/A N/A N/A $84.97 "$3,777.00 " 330104 50436 5374 170 761 HC DILAT XST TRC NDURLGC PX O "$8,560.00 " "$3,845.31 " "$3,845.31 " "$1,109.35 " $936.00 "$5,307.20 " "$5,307.20 " "$3,806.86 " "$1,109.35 " "$7,306.09 " "$1,109.35 " "$3,845.31 " "$6,420.00 " "$4,229.84 " "$2,217.33 " N/A "$1,331.22 " "$1,109.35 " "$5,136.00 " "$6,848.00 " "$13,074.06 " "$4,280.00 " "$1,109.35 " "$3,845.31 " "$4,614.37 " "$1,553.09 " "$2,467.00 " "$1,109.35 " "$1,109.35 " "$1,331.22 " "$5,383.43 " "$1,109.35 " "$3,845.31 " "$2,500.00 " "$4,191.39 " "$6,848.00 " "$7,276.00 " "$1,109.35 " "$3,777.00 " $202.28 $183.89 "$4,280.00 " "$2,086.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$2,688.00 " "$4,037.58 " "$3,845.31 " "$3,440.00 " "$1,109.35 " "$1,109.35 " "$3,268.51 " "$3,268.51 " "$3,845.31 " $183.89 "$13,074.06 " 330104 50437 5374 170 761 HC DILAT XST TRC NEW ACCESS RCS O "$8,560.00 " "$3,845.31 " "$3,845.31 " "$1,109.35 " $936.00 "$5,307.20 " "$5,307.20 " "$3,806.86 " "$1,109.35 " "$7,306.09 " "$1,109.35 " "$3,845.31 " "$6,420.00 " "$4,229.84 " "$2,217.33 " N/A "$1,331.22 " "$1,109.35 " "$5,136.00 " "$6,848.00 " "$13,074.06 " "$4,280.00 " "$1,109.35 " "$3,845.31 " "$4,614.37 " "$1,553.09 " "$2,467.00 " "$1,109.35 " "$1,109.35 " "$1,331.22 " "$5,383.43 " "$1,109.35 " "$3,845.31 " "$2,500.00 " "$4,191.39 " "$6,848.00 " "$7,276.00 " "$1,109.35 " "$3,777.00 " $335.40 $304.91 "$4,280.00 " "$2,086.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$5,778.00 " "$2,688.00 " "$4,037.58 " "$3,845.31 " "$3,440.00 " "$1,109.35 " "$1,109.35 " "$3,268.51 " "$3,268.51 " "$3,845.31 " $304.91 "$13,074.06 " 330104 62270 5442 53 761 HC SPINAL PUNCTURE LUMBAR DIAGNOSTIC O "$2,973.53 " $773.04 $773.04 $560.61 $936.00 "$1,843.59 " "$1,843.59 " $765.31 $560.61 "$1,468.78 " $560.61 $773.04 "$2,230.15 " $850.34 "$2,217.33 " N/A $672.74 $560.61 "$1,784.12 " "$2,378.82 " "$2,628.34 " "$1,486.77 " $560.61 $773.04 $927.65 $784.86 "$2,467.00 " $560.61 $560.61 $672.74 "$1,082.26 " $560.61 $773.04 "$2,500.00 " $842.61 "$2,378.82 " "$2,527.50 " $560.61 "$3,777.00 " $90.64 $82.40 "$1,486.77 " "$2,086.00 " "$2,007.13 " "$2,007.13 " "$2,007.13 " "$2,007.13 " "$2,688.00 " $811.69 $773.04 "$3,440.00 " $560.61 $560.61 $657.08 $657.08 $773.04 $82.40 "$3,777.00 " 330104 62328 5442 53 761 HC NJX INTERLAMINAR LMBR/SAC O "$3,033.45 " $773.04 $773.04 $560.61 $936.00 "$1,880.74 " "$1,880.74 " $765.31 $560.61 "$1,468.78 " $560.61 $773.04 "$2,275.09 " $850.34 "$2,217.33 " N/A $672.74 $560.61 "$1,820.07 " "$2,426.76 " "$2,628.34 " "$1,516.72 " $560.61 $773.04 $927.65 $784.86 "$2,467.00 " $560.61 $560.61 $672.74 "$1,082.26 " $560.61 $773.04 "$2,500.00 " $842.61 "$2,426.76 " "$2,578.43 " $560.61 "$3,777.00 " $118.55 $107.77 "$1,516.72 " "$2,086.00 " "$2,047.58 " "$2,047.58 " "$2,047.58 " "$2,047.58 " "$2,688.00 " $811.69 $773.04 "$3,440.00 " $560.61 $560.61 $657.08 $657.08 $773.04 $107.77 "$3,777.00 " 330104 49083 5301 150 761 HC TREATMENT ROOM ABD PARACENTESIS W/IMAGING O "$3,773.89 " $990.40 $990.40 $609.85 $936.00 "$2,339.81 " "$2,339.81 " $980.49 $609.85 "$1,881.75 " $609.85 $990.40 "$2,830.42 " "$1,089.44 " "$2,217.33 " N/A $731.82 $609.85 "$2,264.33 " "$3,019.11 " "$3,367.35 " "$1,886.94 " $609.85 $990.40 "$1,188.48 " $853.79 "$2,467.00 " $609.85 $609.85 $731.82 "$1,386.56 " $609.85 $990.40 "$2,500.00 " "$1,079.53 " "$3,019.11 " "$3,207.81 " $609.85 "$3,883.00 " $143.94 $130.85 "$1,886.94 " "$2,086.00 " "$2,547.38 " "$2,547.38 " "$2,547.38 " "$2,547.38 " "$2,688.00 " "$1,039.92 " $990.40 "$3,440.00 " $609.85 $609.85 $841.84 $841.84 $990.40 $130.85 "$3,883.00 " 330104 24220 278 761 HC ELBOW ARTHROGRAM INJ O "$1,555.78 " N/A N/A $468.99 $936.00 $964.58 $964.58 $78.39 $468.99 N/A $468.99 N/A "$1,166.84 " N/A "$2,217.33 " N/A $562.78 $468.99 $933.47 "$1,244.62 " N/A $777.89 $468.99 N/A "$1,011.26 " $656.58 "$2,467.00 " $468.99 $468.99 $562.78 N/A $468.99 N/A "$2,500.00 " N/A "$1,244.62 " "$1,322.41 " $633.13 "$3,777.00 " $961.42 $633.13 $777.89 "$1,011.26 " "$1,050.15 " "$1,050.15 " "$1,050.15 " "$1,050.15 " "$2,688.00 " N/A N/A "$3,440.00 " $468.99 $468.99 N/A N/A N/A $78.39 "$3,777.00 " 330104 62329 5442 53 761 HC THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT O "$2,669.65 " $773.04 $773.04 $560.61 $936.00 "$1,655.18 " "$1,655.18 " $765.31 $560.61 "$1,468.78 " $560.61 $773.04 "$2,002.24 " $850.34 "$2,217.33 " N/A $672.74 $560.61 "$1,601.79 " "$2,135.72 " "$2,628.34 " "$1,334.83 " $560.61 $773.04 $927.65 $784.86 "$2,467.00 " $560.61 $560.61 $672.74 "$1,082.26 " $560.61 $773.04 "$2,500.00 " $842.61 "$2,135.72 " "$2,269.20 " $560.61 "$3,777.00 " $156.17 $141.97 "$1,334.83 " "$2,086.00 " "$1,802.01 " "$1,802.01 " "$1,802.01 " "$1,802.01 " "$2,688.00 " $811.69 $773.04 "$3,440.00 " $560.61 $560.61 $657.08 $657.08 $773.04 $141.97 "$3,777.00 " 330104 20610 5441 49 761 HC TREATMENT ROOM DRAIN/INJECT MAJOR JOINT/BURSA O "$1,206.96 " $326.20 $326.20 $296.51 $936.00 "$1,296.00 " "$1,180.00 " $322.94 $296.51 $619.77 $296.51 $326.20 $905.22 $358.82 "$2,217.33 " N/A $355.81 $296.51 $724.18 $965.57 "$1,109.07 " $603.48 $296.51 $326.20 $391.44 $415.11 "$2,467.00 " $296.51 $296.51 $355.81 $456.68 $296.51 $326.20 "$2,500.00 " $355.56 $965.57 "$1,025.92 " $296.51 "$3,777.00 " $63.89 $58.08 $603.48 "$2,086.00 " $814.70 $814.70 $814.70 $814.70 "$2,688.00 " $342.51 $326.20 "$3,440.00 " $296.51 $296.51 $277.27 $277.27 $326.20 $58.08 "$3,777.00 " 330104 0707T 5113 49 761 HC NJX BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT O "$7,082.33 " "$3,571.22 " "$3,571.22 " $296.51 $936.00 "$4,391.04 " "$4,391.04 " "$3,535.51 " $296.51 "$6,785.31 " $296.51 "$3,571.22 " "$5,311.75 " "$3,928.34 " "$2,217.33 " N/A $355.81 $296.51 "$4,249.40 " "$5,665.86 " "$12,142.14 " "$3,541.16 " $296.51 "$3,571.22 " "$4,285.46 " $415.11 "$2,467.00 " $296.51 $296.51 $355.81 "$4,999.71 " $296.51 "$3,571.22 " "$2,500.00 " "$3,892.63 " "$5,665.86 " "$6,019.98 " $296.51 "$3,777.00 " N/A N/A "$3,541.16 " "$2,086.00 " "$4,780.57 " "$4,780.57 " "$4,780.57 " "$4,780.57 " "$2,688.00 " "$3,749.78 " "$3,571.22 " "$3,440.00 " $296.51 $296.51 "$3,035.54 " "$3,035.54 " "$3,571.22 " $296.51 "$12,142.14 " 330104 0672T 159 761 HC NDOVAG CRYG COOLD RF REMDL TISS FML BLDR NCK & URT O "$4,420.17 " N/A N/A $395.93 $936.00 "$2,740.51 " "$2,740.51 " N/A $395.93 N/A $395.93 N/A "$3,315.13 " N/A "$2,217.33 " N/A $475.12 $395.93 "$2,652.10 " "$3,536.14 " N/A "$2,210.09 " $395.93 N/A "$2,873.11 " $554.30 "$2,467.00 " $395.93 $395.93 $475.12 N/A $395.93 N/A "$2,500.00 " N/A "$3,536.14 " "$3,757.14 " $534.51 "$3,777.00 " $811.66 $534.51 "$2,210.09 " "$2,873.11 " "$2,983.61 " "$2,983.61 " "$2,983.61 " "$2,983.61 " "$2,688.00 " N/A N/A "$3,440.00 " $395.93 $395.93 N/A N/A N/A $395.93 "$3,777.00 " 330104 0681T 276 761 HC INTERROGATION DEVICE EVALUATION IN PERSON ISDSS O "$6,157.85 " N/A N/A "$1,954.06 " $936.00 "$3,817.87 " "$3,817.87 " N/A "$1,954.06 " N/A "$1,954.06 " N/A "$4,618.39 " N/A "$2,217.33 " N/A "$2,344.87 " "$1,954.06 " "$3,694.71 " "$4,926.28 " N/A "$3,078.93 " "$1,954.06 " N/A "$4,002.60 " "$2,735.68 " "$2,467.00 " "$1,954.06 " "$1,954.06 " "$2,344.87 " N/A "$1,954.06 " N/A "$2,500.00 " N/A "$4,926.28 " "$5,234.17 " "$2,637.98 " "$3,777.00 " "$4,005.82 " "$2,637.98 " "$3,078.93 " "$4,002.60 " "$4,156.55 " "$4,156.55 " "$4,156.55 " "$4,156.55 " "$2,688.00 " N/A N/A "$3,440.00 " "$1,954.06 " "$1,954.06 " N/A N/A N/A $936.00 "$5,234.17 " 330104 0682T 276 761 HC REMOVAL PULSE GENERATOR ONLY ISDSS O "$6,168.55 " N/A N/A "$1,954.06 " $936.00 "$3,824.50 " "$3,824.50 " N/A "$1,954.06 " N/A "$1,954.06 " N/A "$4,626.41 " N/A "$2,217.33 " N/A "$2,344.87 " "$1,954.06 " "$3,701.13 " "$4,934.84 " N/A "$3,084.28 " "$1,954.06 " N/A "$4,009.56 " "$2,735.68 " "$2,467.00 " "$1,954.06 " "$1,954.06 " "$2,344.87 " N/A "$1,954.06 " N/A "$2,500.00 " N/A "$4,934.84 " "$5,243.27 " "$2,637.98 " "$3,777.00 " "$4,005.82 " "$2,637.98 " "$3,084.28 " "$4,009.56 " "$4,163.77 " "$4,163.77 " "$4,163.77 " "$4,163.77 " "$2,688.00 " N/A N/A "$3,440.00 " "$1,954.06 " "$1,954.06 " N/A N/A N/A $936.00 "$5,243.27 " 330104 0683T 488 761 HC PROGRAMMING DEVICE EVALUATION IN PERSON ISDSS O $289.97 N/A N/A $84.24 $936.00 $179.78 $179.78 N/A $84.24 N/A $84.24 N/A $217.48 N/A "$2,217.33 " N/A $101.09 $84.24 $173.98 $231.98 N/A $144.99 $84.24 N/A $188.48 $117.93 "$2,467.00 " $84.24 $84.24 $101.09 N/A $84.24 N/A "$2,500.00 " N/A $231.98 $246.47 $113.72 "$3,777.00 " $172.69 $113.72 $144.99 $188.48 $195.73 $195.73 $195.73 $195.73 "$2,688.00 " N/A N/A "$3,440.00 " $84.24 $84.24 N/A N/A N/A $84.24 "$3,777.00 " 330104 0684T 488 761 HC PERIPROCEDURAL DEVICE EVALUATION IN PERSON ISDSS O $113.42 N/A N/A $84.24 $936.00 $70.32 $70.32 N/A $84.24 N/A $84.24 N/A $85.06 N/A "$2,217.33 " N/A $101.09 $84.24 $68.05 $90.74 N/A $56.71 $84.24 N/A $73.72 $117.93 "$2,467.00 " $84.24 $84.24 $101.09 N/A $84.24 N/A "$2,500.00 " N/A $90.74 $96.41 $113.72 "$3,777.00 " $172.69 $113.72 $56.71 $73.72 $76.56 $76.56 $76.56 $76.56 "$2,688.00 " N/A N/A "$3,440.00 " $84.24 $84.24 N/A N/A N/A $56.71 "$3,777.00 " 330104 0685T 488 761 HC INTERROGATION DEVICE EVALUATION IN PERSON ISDSS O $353.10 N/A N/A $84.24 $936.00 $218.92 $218.92 N/A $84.24 N/A $84.24 N/A $264.83 N/A "$2,217.33 " N/A $101.09 $84.24 $211.86 $282.48 N/A $176.55 $84.24 N/A $229.52 $117.93 "$2,467.00 " $84.24 $84.24 $101.09 N/A $84.24 N/A "$2,500.00 " N/A $282.48 $300.13 $113.72 "$3,777.00 " $172.69 $113.72 $176.55 $229.52 $238.34 $238.34 $238.34 $238.34 "$2,688.00 " N/A N/A "$3,440.00 " $84.24 $84.24 N/A N/A N/A $84.24 "$3,777.00 " 330104 0686T 1575 130 761 HC HISTOTRIPSY MAL HEPATOCELLULAR TISS W/IMG GDN O "$32,253.01 " "$14,997.35 " "$14,997.35 " $507.89 $936.00 "$19,996.87 " "$19,996.87 " "$14,847.38 " $507.89 "$28,494.96 " $507.89 "$14,997.35 " "$24,189.76 " "$16,497.08 " "$2,217.33 " N/A $609.46 $507.89 "$19,351.81 " "$25,802.41 " "$50,990.99 " "$16,126.50 " $507.89 "$14,997.35 " "$17,996.82 " $711.04 "$2,467.00 " $507.89 $507.89 $609.46 "$20,996.29 " $507.89 "$14,997.35 " "$2,500.00 " "$16,347.11 " "$25,802.41 " "$27,415.06 " $507.89 "$3,777.00 " N/A N/A "$16,126.50 " "$2,086.00 " "$21,770.78 " "$21,770.78 " "$21,770.78 " "$21,770.78 " "$2,688.00 " "$15,747.22 " "$14,997.35 " "$3,440.00 " $507.89 $507.89 "$12,747.75 " "$12,747.75 " "$14,997.35 " $507.89 "$50,990.99 " 330104 10005 5071 2 761 HC FNA BX W/US GDN 1ST LES O "$2,603.31 " $778.60 $778.60 $512.29 $936.00 "$1,614.05 " "$1,614.05 " $770.81 $512.29 "$1,479.33 " $512.29 $778.60 "$1,952.48 " $856.45 "$2,217.33 " N/A $614.75 $512.29 "$1,561.99 " "$2,082.65 " "$2,647.22 " "$1,301.65 " $512.29 $778.60 $934.31 $717.21 "$2,467.00 " $512.29 $512.29 $614.75 "$1,090.03 " $512.29 $778.60 "$2,500.00 " $848.67 "$2,082.65 " "$2,212.81 " $512.29 "$3,777.00 " $101.78 $92.53 "$1,301.65 " "$2,086.00 " "$1,757.23 " "$1,757.23 " "$1,757.23 " "$1,757.23 " "$2,688.00 " $817.53 $778.60 "$3,440.00 " $512.29 $512.29 $661.81 $661.81 $778.60 $92.53 "$3,777.00 " 330104 10006 2 761 HC FNA BX W/US GDN EA ADDL O "$3,640.14 " N/A N/A $512.29 $936.00 "$2,256.89 " "$2,256.89 " $58.62 $512.29 N/A $512.29 N/A "$2,730.11 " N/A "$2,217.33 " N/A $614.75 $512.29 "$2,184.08 " "$2,912.11 " N/A "$1,820.07 " $512.29 N/A "$2,366.09 " $717.21 "$2,467.00 " $512.29 $512.29 $614.75 N/A $512.29 N/A "$2,500.00 " N/A "$2,912.11 " "$3,094.12 " $691.59 "$3,777.00 " "$1,050.20 " $691.59 "$1,820.07 " "$2,366.09 " "$2,457.09 " "$2,457.09 " "$2,457.09 " "$2,457.09 " "$2,688.00 " N/A N/A "$3,440.00 " $512.29 $512.29 N/A N/A N/A $58.62 "$3,777.00 " 330104 10030 5071 4 761 HC DRAINAGE ABSCESS W/IMAGE AND GUIDANCE O "$3,143.66 " $778.60 $778.60 $616.26 $936.00 "$1,949.07 " "$1,949.07 " $770.81 $616.26 "$1,479.33 " $616.26 $778.60 "$2,357.74 " $856.45 "$2,217.33 " N/A $739.52 $616.26 "$1,886.20 " "$2,514.93 " "$2,647.22 " "$1,571.83 " $616.26 $778.60 $934.31 $862.77 "$2,467.00 " $616.26 $616.26 $739.52 "$1,090.03 " $616.26 $778.60 "$2,500.00 " $848.67 "$2,514.93 " "$2,672.11 " $616.26 "$3,777.00 " $184.44 $167.67 "$1,571.83 " "$2,086.00 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,121.97 " "$2,688.00 " $817.53 $778.60 "$3,440.00 " $616.26 $616.26 $661.81 $661.81 $778.60 $167.67 "$3,777.00 " 330104 11102 5051 9 761 HC TANGNTL BX SKIN SINGLE LES O $983.33 $216.65 $216.65 $636.95 $936.00 $609.66 $609.66 $214.48 $636.95 $411.63 $636.95 $216.65 $737.50 $238.31 "$2,217.33 " N/A $764.34 $636.95 $590.00 $786.66 $736.61 $491.67 $636.95 $216.65 $259.98 $891.73 "$2,467.00 " $636.95 $636.95 $764.34 $303.31 $636.95 $216.65 "$2,500.00 " $236.15 $786.66 $835.83 $636.95 "$3,777.00 " $52.10 $47.36 $491.67 "$2,086.00 " $663.75 $663.75 $663.75 $663.75 "$2,688.00 " $227.48 $216.65 "$3,440.00 " $636.95 $636.95 $184.15 $184.15 $216.65 $47.36 "$3,777.00 " 330104 11103 9 761 HC TANGNTL BX SKIN EA SEP/ADDL O $590.64 N/A N/A $636.95 $936.00 $366.20 $366.20 $25.50 $636.95 N/A $636.95 N/A $442.98 N/A "$2,217.33 " N/A $764.34 $636.95 $354.38 $472.51 N/A $295.32 $636.95 N/A $383.92 $891.73 "$2,467.00 " $636.95 $636.95 $764.34 N/A $636.95 N/A "$2,500.00 " N/A $472.51 $502.04 $859.88 "$3,777.00 " "$1,305.74 " $859.88 $295.32 $383.92 $398.68 $398.68 $398.68 $398.68 "$2,688.00 " N/A N/A "$3,440.00 " $636.95 $636.95 N/A N/A N/A $25.50 "$3,777.00 " 330104 11104 5052 9 761 HC PUNCH BX SKIN SINGLE LESION O $983.33 $447.59 $447.59 $636.95 $936.00 $609.66 $609.66 $443.11 $636.95 $850.42 $636.95 $447.59 $737.50 $492.35 "$2,217.33 " N/A $764.34 $636.95 $590.00 $786.66 "$1,521.80 " $491.67 $636.95 $447.59 $537.10 $891.73 "$2,467.00 " $636.95 $636.95 $764.34 $626.62 $636.95 $447.59 "$2,500.00 " $487.87 $786.66 $835.83 $636.95 "$3,777.00 " $65.16 $59.23 $491.67 "$2,086.00 " $663.75 $663.75 $663.75 $663.75 "$2,688.00 " $469.97 $447.59 "$3,440.00 " $636.95 $636.95 $380.45 $380.45 $447.59 $59.23 "$3,777.00 " 330104 11105 9 761 HC PUNCH BX SKIN EA SEP/ADDL O $590.64 N/A N/A $636.95 $936.00 $366.20 $366.20 $30.75 $636.95 N/A $636.95 N/A $442.98 N/A "$2,217.33 " N/A $764.34 $636.95 $354.38 $472.51 N/A $295.32 $636.95 N/A $383.92 $891.73 "$2,467.00 " $636.95 $636.95 $764.34 N/A $636.95 N/A "$2,500.00 " N/A $472.51 $502.04 $859.88 "$3,777.00 " "$1,305.74 " $859.88 $295.32 $383.92 $398.68 $398.68 $398.68 $398.68 "$2,688.00 " N/A N/A "$3,440.00 " $636.95 $636.95 N/A N/A N/A $30.75 "$3,777.00 " 330104 11106 5053 9 761 HC INCAL BX SKN SINGLE LES O "$1,474.46 " $696.99 $696.99 $636.95 $936.00 $914.17 $914.17 $690.02 $636.95 "$1,324.28 " $636.95 $696.99 "$1,105.85 " $766.69 "$2,217.33 " N/A $764.34 $636.95 $884.68 "$1,179.57 " "$2,369.76 " $737.23 $636.95 $696.99 $836.39 $891.73 "$2,467.00 " $636.95 $636.95 $764.34 $975.78 $636.95 $696.99 "$2,500.00 " $759.72 "$1,179.57 " "$1,253.29 " $636.95 "$3,777.00 " $78.20 $71.09 $737.23 "$2,086.00 " $995.26 $995.26 $995.26 $995.26 "$2,688.00 " $731.84 $696.99 "$3,440.00 " $636.95 $636.95 $592.44 $592.44 $696.99 $71.09 "$3,777.00 " 330104 11107 9 761 HC INCAL BX SKN EA SEP/ADDL O $590.64 N/A N/A $636.95 $936.00 $366.20 $366.20 $36.75 $636.95 N/A $636.95 N/A $442.98 N/A "$2,217.33 " N/A $764.34 $636.95 $354.38 $472.51 N/A $295.32 $636.95 N/A $383.92 $891.73 "$2,467.00 " $636.95 $636.95 $764.34 N/A $636.95 N/A "$2,500.00 " N/A $472.51 $502.04 $859.88 "$3,777.00 " "$1,305.74 " $859.88 $295.32 $383.92 $398.68 $398.68 $398.68 $398.68 "$2,688.00 " N/A N/A "$3,440.00 " $636.95 $636.95 N/A N/A N/A $36.75 "$3,777.00 " 330104 15271 5054 56 761 HC APP SKN SUB TRNK/ARM/LEG <25CM O "$7,477.16 " "$2,070.58 " "$2,070.58 " "$1,466.46 " $936.00 "$4,635.84 " "$4,635.84 " "$2,049.88 " "$1,466.46 " "$3,934.11 " "$1,466.46 " "$2,070.58 " "$5,607.87 " "$2,277.64 " "$2,217.33 " N/A "$1,759.75 " "$1,466.46 " "$4,486.30 " "$5,981.73 " "$7,039.98 " "$3,738.58 " "$1,466.46 " "$2,070.58 " "$2,484.70 " "$2,053.05 " "$2,467.00 " "$1,466.46 " "$1,466.46 " "$1,759.75 " "$2,898.82 " "$1,466.46 " "$2,070.58 " "$2,500.00 " "$2,256.94 " "$5,981.73 " "$6,355.59 " "$1,466.46 " "$3,777.00 " $117.44 $106.76 "$3,738.58 " "$2,086.00 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$5,047.08 " "$2,688.00 " "$2,174.11 " "$2,070.58 " "$3,440.00 " "$1,466.46 " "$1,466.46 " "$1,760.00 " "$1,760.00 " "$2,070.58 " $106.76 "$7,039.98 " 330104 20606 5442 50 761 HC DRAIN/INJ INTER JOINT/BURSA W/US O "$2,669.65 " $773.04 $773.04 $538.09 $936.00 "$1,655.18 " "$1,655.18 " $765.31 $538.09 "$1,468.78 " $538.09 $773.04 "$2,002.24 " $850.34 "$2,217.33 " N/A $645.71 $538.09 "$1,601.79 " "$2,135.72 " "$2,628.34 " "$1,334.83 " $538.09 $773.04 $927.65 $753.33 "$2,467.00 " $538.09 $538.09 $645.71 "$1,082.26 " $538.09 $773.04 "$2,500.00 " $842.61 "$2,135.72 " "$2,269.20 " $538.09 "$3,777.00 " $72.09 $65.54 "$1,334.83 " "$2,086.00 " "$1,802.01 " "$1,802.01 " "$1,802.01 " "$1,802.01 " "$2,688.00 " $811.69 $773.04 "$3,440.00 " $538.09 $538.09 $657.08 $657.08 $773.04 $65.54 "$3,777.00 " 330104 23350 278 761 HC SHOULDER ARTHROGRAM INJ O "$1,445.57 " N/A N/A $468.99 $936.00 $896.25 $896.25 $58.62 $468.99 N/A $468.99 N/A "$1,084.18 " N/A "$2,217.33 " N/A $562.78 $468.99 $867.34 "$1,156.46 " N/A $722.78 $468.99 N/A $939.62 $656.58 "$2,467.00 " $468.99 $468.99 $562.78 N/A $468.99 N/A "$2,500.00 " N/A "$1,156.46 " "$1,228.73 " $633.13 "$3,777.00 " $961.42 $633.13 $722.78 $939.62 $975.76 $975.76 $975.76 $975.76 "$2,688.00 " N/A N/A "$3,440.00 " $468.99 $468.99 N/A N/A N/A $58.62 "$3,777.00 " 330104 0699T 5491 237 761 HC INJECTION POSTERIOR CHAMBER EYE MEDICATION O "$4,782.90 " "$2,590.77 " "$2,590.77 " $587.75 $936.00 "$2,965.40 " "$2,965.40 " "$2,564.86 " $587.75 "$4,922.46 " $587.75 "$2,590.77 " "$3,587.17 " "$2,849.84 " "$2,217.33 " N/A $705.31 $587.75 "$2,869.74 " "$3,826.32 " "$8,808.61 " "$2,391.45 " $587.75 "$2,590.77 " "$3,108.92 " $822.86 "$2,467.00 " $587.75 $587.75 $705.31 "$3,627.07 " $587.75 "$2,590.77 " "$2,500.00 " "$2,823.94 " "$3,826.32 " "$4,065.46 " $587.75 "$3,777.00 " N/A N/A "$2,391.45 " "$2,086.00 " "$3,228.46 " "$3,228.46 " "$3,228.46 " "$3,228.46 " "$2,688.00 " "$2,720.30 " "$2,590.77 " "$3,440.00 " $587.75 $587.75 "$2,202.15 " "$2,202.15 " "$2,590.77 " $587.75 "$8,808.61 " 330104 G0378 450 762 HC HOSPITAL OBSERVATION PER HR O $934.11 N/A N/A $28.97 $936.00 $579.15 $579.15 N/A $28.97 N/A $28.97 N/A $700.58 N/A "$2,217.33 " N/A $34.77 $28.97 $560.47 $747.29 N/A $467.06 $28.97 N/A $607.17 $40.56 "$2,467.00 " $28.97 $28.97 $34.77 N/A $28.97 N/A "$2,500.00 " N/A $747.29 $793.99 $39.11 "$3,777.00 " $59.40 $39.11 $467.06 $607.17 $630.52 $630.52 $630.52 $630.52 "$2,688.00 " N/A N/A "$3,440.00 " $28.97 $28.97 N/A N/A N/A $28.97 "$3,777.00 " 330104 G0296 5822 491 770 HC VISIT TO DETERM LDCT ELIG O $337.05 $91.00 $91.00 N/A $168.53 $208.97 $208.97 $90.09 N/A $172.90 N/A $91.00 $252.79 $100.10 $219.08 $246.38 N/A N/A $202.23 $269.64 $309.40 $168.53 N/A $91.00 $109.20 N/A $269.64 N/A N/A N/A $127.40 N/A $91.00 $91.00 $99.19 $269.64 $286.49 N/A $252.79 N/A N/A $168.53 $150.15 $227.51 $227.51 $227.51 $227.51 N/A $95.55 $91.00 $224.81 N/A N/A $77.35 $77.35 $91.00 $77.35 $309.40 330104 90471 5692 459 771 HC ADMIN IMMUNIZATION ID/SQ/IM; 1 VACCINE O $321.00 $80.95 $80.95 $13.23 $160.50 $199.02 $199.02 $80.14 $13.23 $153.80 $13.23 $80.95 $240.75 $89.04 $208.65 $234.65 $15.88 $13.23 $192.60 $256.80 $117.00 $197.00 $13.23 $80.95 $97.14 $18.52 $256.80 $13.23 $13.23 $15.88 $113.33 $13.23 $80.95 $80.95 $88.23 $256.80 $272.85 $13.23 $240.75 $27.12 $13.23 $160.50 $133.56 $216.68 $216.68 $216.68 $216.68 N/A $84.99 $80.95 $214.11 $13.23 $13.23 $68.80 $68.80 $80.95 $13.23 $272.85 330104 0071A 9397 459 771 HC PFIZER-BIONTECH COVID-19 PEDIATRIC VACCINE - ADMINISTRATION - FIRST DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0072A 9398 459 771 HC PFIZER-BIONTECH COVID-19 PEDIATRIC VACCINE - ADMINISTRATION - SECOND DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0073A 9398 459 771 HC IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE 3RD DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0064A 9398 459 771 HC IMM ADMN SARSCOV2 50 MCG/0.25 ML BOOSTER DOSE û MODERNA O $56.71 $49.81 $49.81 N/A $28.36 $35.16 $35.16 $49.32 N/A $94.65 N/A $49.81 $42.53 $54.79 $36.86 $41.46 N/A N/A $34.03 $45.37 $169.36 $28.36 N/A $49.81 $59.78 N/A $45.37 N/A N/A N/A $69.74 N/A $49.81 $49.81 $54.30 $45.37 $48.20 N/A $42.53 N/A N/A $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 N/A N/A $42.34 $42.34 $49.81 $28.36 $169.36 330104 0083A 9398 459 771 HC IMM ADMN SARSCOV2 3MCG/0.2ML TRIS-SUCROSE 3RD DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0091A 9397 459 771 HC COVID VACC IMM ADMN SARSCOV2 50 MCG/0.5 ML 1ST DOSE 6-11 - MODERNA O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0092A 9398 459 771 HC COVID VACC IMM ADMN SARSCOV2 50 MCG/0.5 ML 3RD DOSE 6-11 - MODERNA O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0093A 9398 459 771 HC COVID VACC IMM ADMN SARSCOV2 50 MCG/0.5 ML 2ND DOSE 6-11 - MODERNA O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0094A 9398 459 771 HC ADMIN MODERNA COVID VACCINE PRESERVATIVE FREE- 50 MCG/0.5 ML DOSAGE- 2ND BOOSTER DOSE O $56.71 $49.81 $49.81 N/A $28.36 $35.16 $35.16 $49.32 N/A $94.65 N/A $49.81 $42.53 $54.79 $36.86 $41.46 N/A N/A $34.03 $45.37 $169.36 $28.36 N/A $49.81 $59.78 N/A $45.37 N/A N/A N/A $69.74 N/A $49.81 $49.81 $54.30 $45.37 $48.20 N/A $42.53 N/A N/A $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 N/A N/A $42.34 $42.34 $49.81 $28.36 $169.36 330104 0111A 9397 459 771 HC IMM ADMN SARSCOV2 25 MCG/0.25 ML 1ST DOSE - 6 MTHS THRU 5 YRS OLD O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0112A 9398 459 771 HC IMM ADMN SARSCOV2 25 MCG/0.25 ML 2ND DOSE - 6 MTHS THRU 5 YRS OLD O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0113A 9398 459 771 HC IMM ADMN COVID VACCINE SARSCOV2 25 MCG/0.25 ML 3RD DOSE - MODERNA O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0124A 9398 459 771 HC IMM ADMN SARSCOV2 BIVALENT 30 MCG/0.3 ML BST O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0134A 459 771 HC IMM ADMN SARSCOV2 BIVALENT 50 MCG/0.5 ML BST O $56.71 N/A N/A $40.00 $28.36 $35.16 $35.16 N/A $40.00 N/A $40.00 N/A $42.53 N/A $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 N/A $28.36 $40.00 N/A $36.86 $56.00 $45.37 $40.00 $40.00 $48.00 N/A $40.00 N/A N/A N/A $45.37 $48.20 $54.00 $42.53 $82.00 $54.00 $28.36 $36.86 $38.28 $38.28 $38.28 $38.28 N/A N/A N/A $37.83 $40.00 $40.00 N/A N/A N/A $28.36 $82.00 330104 0144A 9398 459 771 HC IMM ADMN SARSCOV2 BIVALENT 25 MCG/0.25 ML BST O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0154A 9398 459 771 HC IMM ADMN SARSCOV2 BIVALENT 10 MCG/0.2 ML BST O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 M0220 109 771 HC IV INFUSION- TIZAGEVIMAB AND CILGAIMAB- AND POST ADMIN MONITORING O $588.50 N/A N/A $105.35 $294.25 $364.87 $364.87 N/A $105.35 N/A $105.35 N/A $441.38 N/A $382.53 $430.19 $126.42 $105.35 $353.10 $470.80 N/A $294.25 $105.35 N/A $382.53 $147.49 $470.80 $105.35 $105.35 $126.42 N/A $105.35 N/A N/A N/A $470.80 $500.22 $142.22 $441.38 $215.97 $142.22 $294.25 $382.53 $397.24 $397.24 $397.24 $397.24 N/A N/A N/A $392.53 $105.35 $105.35 N/A N/A N/A $105.35 $500.22 330104 0104A 459 771 HC IMM ADMN SARSCOV2 5 MCG/0.5 ML AS03 EMULSN BOOSTER - 18 YRS AND OLDER O $56.71 N/A N/A N/A $28.36 $35.16 $35.16 $37.09 N/A N/A N/A N/A $42.53 N/A $36.86 $41.46 N/A N/A $34.03 $45.37 N/A $28.36 N/A N/A N/A N/A $45.37 N/A N/A N/A N/A N/A N/A N/A N/A $45.37 $48.20 N/A $42.53 N/A N/A $28.36 $36.86 $38.28 $38.28 $38.28 $38.28 N/A N/A N/A $37.83 N/A N/A N/A N/A N/A $28.36 $48.20 330104 0054A 9398 459 771 HC PFIZER-BIONTECH COVID-19 VACCINE (READY TO USE) ADMINISTRATION - BOOSTER O $56.71 $49.81 $49.81 N/A $28.36 $35.16 $35.16 $49.32 N/A $94.65 N/A $49.81 $42.53 $54.79 $36.86 $41.46 N/A N/A $34.03 $45.37 $169.36 $28.36 N/A $49.81 $59.78 N/A $45.37 N/A N/A N/A $69.74 N/A $49.81 $49.81 $54.30 $45.37 $48.20 N/A $42.53 N/A N/A $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 N/A N/A $42.34 $42.34 $49.81 $28.36 $169.36 330104 90472 459 771 HC ADMIN IMMUNIZATION ID/SQ/IM; EACH ADDL VACCINE O $321.00 N/A N/A $13.23 $160.50 $199.02 $199.02 $17.07 $13.23 N/A $13.23 N/A $240.75 N/A $208.65 $234.65 $15.88 $13.23 $192.60 $256.80 $54.00 $92.00 $13.23 N/A $208.65 $18.52 $256.80 $13.23 $13.23 $15.88 N/A $13.23 N/A N/A N/A $256.80 $272.85 $17.86 $240.75 $27.12 $17.86 $160.50 $208.65 $216.68 $216.68 $216.68 $216.68 N/A N/A N/A $214.11 $13.23 $13.23 N/A N/A N/A $13.23 $272.85 330104 0052A 9398 459 771 HC PFIZER-BIONTECH COVID-19 VACCINE (READY TO USE) ADMINISTRATION - SECOND DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0053A 9398 459 771 HC PFIZER-BIONTECH COVID-19 VACCINE (READY TO USE) ADMINISTRATION - THIRD DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0001A 9397 459 771 HC PFIZER VACCINE ADMIN SARS-COV-2 COVID-19- MRNA-LNP- 30 MCG/0.3ML DOSAG ; 1ST DOSE PFIZER O $63.13 $49.81 $49.81 $40.00 $31.57 N/A N/A $49.32 $40.00 $94.65 $40.00 $49.81 $47.35 $54.79 $41.03 $46.15 $48.00 $40.00 $37.88 $50.50 $169.36 $31.57 $40.00 $49.81 $59.78 $56.00 $50.50 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $50.50 $53.66 $40.00 $47.35 $82.00 $40.00 $31.57 $82.19 $42.61 $42.61 $42.61 $42.61 N/A $52.30 $49.81 $42.11 $40.00 $40.00 $42.34 $42.34 $49.81 $31.57 $169.36 330104 0002A 9398 459 771 HC PFIZER VACCINE ADMIN SARS-COV-2 COVID-19- MRNA-LNP- 30 MCG/0.3ML DOSAG ; 2ND DOSE O $104.86 $49.81 $49.81 $40.00 $52.43 N/A N/A $49.32 $40.00 $94.65 $40.00 $49.81 $78.64 $54.79 $68.16 $76.65 $48.00 $40.00 $62.92 $83.89 $169.36 $52.43 $40.00 $49.81 $59.78 $56.00 $83.89 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $83.89 $89.13 $40.00 $78.64 $82.00 $40.00 $52.43 $82.19 $70.78 $70.78 $70.78 $70.78 N/A $52.30 $49.81 $69.94 $40.00 $40.00 $42.34 $42.34 $49.81 $40.00 $169.36 330104 0003A 9398 459 771 HC PFIZER COVID VACCINE ADM SARSCOV2 30MCG/0.3ML 3RD DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0011A 9397 459 771 HC MODERNA VACC ADMIN SARS-COV-2 CORONAVIRUS DISEASE COVID-19 - MRNA-LNP- 100 MCG/1ST DOSE O $63.13 $49.81 $49.81 $40.00 $31.57 N/A N/A $49.32 $40.00 $94.65 $40.00 $49.81 $47.35 $54.79 $41.03 $46.15 $48.00 $40.00 $37.88 $50.50 $169.36 $31.57 $40.00 $49.81 $59.78 $56.00 $50.50 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $50.50 $53.66 $40.00 $47.35 $82.00 $40.00 $31.57 $82.19 $42.61 $42.61 $42.61 $42.61 N/A $52.30 $49.81 $42.11 $40.00 $40.00 $42.34 $42.34 $49.81 $31.57 $169.36 330104 0012A 9398 459 771 HC MODERNA VACC ADMIN SARS-COV-2 CORONAVIRUS DISEASE COVID-19 - MRNA-LNP- 100 MCG/2ND DOSE O $104.86 $49.81 $49.81 $40.00 $52.43 N/A N/A $49.32 $40.00 $94.65 $40.00 $49.81 $78.64 $54.79 $68.16 $76.65 $48.00 $40.00 $62.92 $83.89 $169.36 $52.43 $40.00 $49.81 $59.78 $56.00 $83.89 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $83.89 $89.13 $40.00 $78.64 $82.00 $40.00 $52.43 $82.19 $70.78 $70.78 $70.78 $70.78 N/A $52.30 $49.81 $69.94 $40.00 $40.00 $42.34 $42.34 $49.81 $40.00 $169.36 330104 0013A 9398 459 771 "HC MODERNA COVID VACCINE ADM, SARSCOV2 100MCG/0.5ML3RD DOSE" O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0021A 459 771 HC ASTRAZENECA COVID-19 VACCINE ADMIN IM 1ST DOSE O $63.13 N/A N/A N/A $31.57 N/A N/A $41.29 N/A N/A N/A N/A $47.35 N/A $41.03 $46.15 N/A N/A $37.88 $50.50 N/A $31.57 N/A N/A N/A N/A $50.50 N/A N/A N/A N/A N/A N/A N/A N/A $50.50 $53.66 N/A $47.35 N/A N/A $31.57 $41.03 $42.61 $42.61 $42.61 $42.61 N/A N/A N/A $42.11 N/A N/A N/A N/A N/A $31.57 $53.66 330104 0022A 459 771 HC ASTRAZENECA COVID VACCINE ADMIN IM 2ND DOSE O $104.86 N/A N/A N/A $52.43 N/A N/A $68.58 N/A N/A N/A N/A $78.64 N/A $68.16 $76.65 N/A N/A $62.92 $83.89 N/A $52.43 N/A N/A N/A N/A $83.89 N/A N/A N/A N/A N/A N/A N/A N/A $83.89 $89.13 N/A $78.64 N/A N/A $52.43 $68.16 $70.78 $70.78 $70.78 $70.78 N/A N/A N/A $69.94 N/A N/A N/A N/A N/A $52.43 $89.13 330104 M0221 1504 109 771 HC INJ TIXAGEV AND CILGAV- W-POST MONITORING AGE 12YRS AND OLDER O $588.50 $300.53 $300.53 N/A $294.25 $364.87 $364.87 $297.53 N/A $571.02 N/A $300.53 $441.38 $330.59 $382.53 $430.19 N/A N/A $353.10 $470.80 "$1,021.82 " $294.25 N/A $300.53 $360.64 N/A $470.80 N/A N/A N/A $420.75 N/A $300.53 $300.53 $327.58 $470.80 $500.22 N/A $441.38 N/A N/A $294.25 $495.88 $397.24 $397.24 $397.24 $397.24 N/A $315.56 $300.53 $392.53 N/A N/A $255.45 $255.45 $300.53 $255.45 "$1,021.82 " 330104 0074A 9398 459 771 HC IMM ADMN SARSCOV2 10MCG/0.2ML TRIS-SUCROSE BOOSTER O $56.71 $49.81 $49.81 N/A $28.36 $35.16 $35.16 $49.32 N/A $94.65 N/A $49.81 $42.53 $54.79 $36.86 $41.46 N/A N/A $34.03 $45.37 $169.36 $28.36 N/A $49.81 $59.78 N/A $45.37 N/A N/A N/A $69.74 N/A $49.81 $49.81 $54.30 $45.37 $48.20 N/A $42.53 N/A N/A $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 N/A N/A $42.34 $42.34 $49.81 $28.36 $169.36 330104 M0239 111 771 HC IV INFUSION- BAMLANIVIMAB-XXXX- INCLUDES INFUSION AND POST ADMIN MONITORING O $588.50 N/A N/A N/A $294.25 $364.87 $364.87 $384.88 N/A N/A N/A N/A $441.38 N/A $382.53 $430.19 N/A N/A $353.10 $470.80 N/A $294.25 N/A N/A N/A N/A $470.80 N/A N/A N/A N/A N/A N/A N/A N/A $470.80 $500.22 N/A $441.38 N/A N/A $294.25 $382.53 $397.24 $397.24 $397.24 $397.24 N/A N/A N/A $392.53 N/A N/A N/A N/A N/A $294.25 $500.22 330104 M0222 1505 109 771 HC IV INJ- BEBTELOVIMAB- INCLD INJ & POST ADMIN MONITORING O $588.50 $420.51 $420.51 $245.35 $294.25 $364.87 $364.87 $416.30 $245.35 $798.97 $245.35 $420.51 $441.38 $462.56 $382.53 $430.19 $294.42 $245.35 $353.10 $470.80 "$1,429.73 " $294.25 $245.35 $420.51 $504.61 $343.49 $470.80 $245.35 $245.35 $294.42 $588.71 $245.35 $420.51 $420.51 $458.35 $470.80 $500.22 $245.35 $441.38 $502.97 $245.35 $294.25 $693.84 $397.24 $397.24 $397.24 $397.24 N/A $441.53 $420.51 $392.53 $245.35 $245.35 $357.43 $357.43 $420.51 $245.35 "$1,429.73 " 330104 0042A 9398 459 771 HC NOVAVAX COVID VACCINE ADMIN- SAPONIN-BASED ADJUVANT- PRESERVATIVE FREE- 5 MCG/0.5ML DOSAGE; 2ND DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0041A 9397 459 771 HC NOVAVAX COVID-19 VACCINE ADMIN- SAPONIN-BASED ADJUVANT- PRESERVATIVE FREE- 5 MCG/0.5ML DOSAGE; 1ST DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0034A 9398 459 771 HC IMM ADMN INJ IM- SARSCOV2 AD26 5X1010 VP/0.5 ML BOOSTER DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 0051A 9397 459 771 HC PFIZER-BIONTECH COVID-19 VACCINE (READY TO USE) ADMINISTRATION - FIRST DOSE O $56.71 $49.81 $49.81 $40.00 $28.36 $35.16 $35.16 $49.32 $40.00 $94.65 $40.00 $49.81 $42.53 $54.79 $36.86 $41.46 $48.00 $40.00 $34.03 $45.37 $169.36 $28.36 $40.00 $49.81 $59.78 $56.00 $45.37 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $45.37 $48.20 $40.00 $42.53 $82.00 $40.00 $28.36 $82.19 $38.28 $38.28 $38.28 $38.28 N/A $52.30 $49.81 $37.83 $40.00 $40.00 $42.34 $42.34 $49.81 $28.36 $169.36 330104 M0247 1506 111 771 HC IV INFUSION-SOTROVIMAB-INCL INFUSION AND POST ADMIN MONITORING O $588.50 $540.48 $540.48 N/A $294.25 $364.87 $364.87 $535.08 N/A "$1,026.92 " N/A $540.48 $441.38 $594.53 $382.53 $430.19 N/A N/A $353.10 $470.80 "$1,837.64 " $294.25 N/A $540.48 $648.58 N/A $470.80 N/A N/A N/A $756.68 N/A $540.48 $540.48 $589.13 $470.80 $500.22 N/A $441.38 N/A N/A $294.25 $891.80 $397.24 $397.24 $397.24 $397.24 N/A $567.51 $540.48 $392.53 N/A N/A $459.41 $459.41 $540.48 $294.25 "$1,837.64 " 330104 M0245 1506 111 771 HC IV INFUSION- BAMLANIVIMAB AND ETESEVIMAB- INCL INFUSION AND POST ADMIN MONITORING O $588.50 $540.48 $540.48 N/A $294.25 $364.87 $364.87 $535.08 N/A "$1,026.92 " N/A $540.48 $441.38 $594.53 $382.53 $430.19 N/A N/A $353.10 $470.80 "$1,837.64 " $294.25 N/A $540.48 $648.58 N/A $470.80 N/A N/A N/A $756.68 N/A $540.48 $540.48 $589.13 $470.80 $500.22 N/A $441.38 N/A N/A $294.25 $891.80 $397.24 $397.24 $397.24 $397.24 N/A $567.51 $540.48 $392.53 N/A N/A $459.41 $459.41 $540.48 $294.25 "$1,837.64 " 330104 M0244 1509 117 771 HC CASIRIVI AND IMDEVI INFUS HM O $588.50 $900.40 $900.40 N/A $294.25 $364.87 $364.87 $891.40 N/A "$1,710.77 " N/A $900.40 $441.38 $990.45 $382.53 $430.19 N/A N/A $353.10 $470.80 "$3,061.38 " $294.25 N/A $900.40 "$1,080.49 " N/A $470.80 N/A N/A N/A "$1,260.57 " N/A $900.40 $900.40 $981.44 $470.80 $500.22 N/A $441.38 N/A N/A $294.25 "$1,485.67 " $397.24 $397.24 $397.24 $397.24 N/A $945.43 $900.40 $392.53 N/A N/A $765.34 $765.34 $900.40 $294.25 "$3,061.38 " 330104 M0243 1506 111 771 HC CASIRIVI AND IMDEVI INFUSION O $618.46 $540.48 $540.48 N/A $309.23 $383.45 $383.45 $535.08 N/A "$1,026.92 " N/A $540.48 $463.85 $594.53 $402.00 $452.09 N/A N/A $371.08 $494.77 "$1,837.64 " $309.23 N/A $540.48 $648.58 N/A $494.77 N/A N/A N/A $756.68 N/A $540.48 $540.48 $589.13 $494.77 $525.69 N/A $463.85 N/A N/A $309.23 $891.80 $417.46 $417.46 $417.46 $417.46 N/A $567.51 $540.48 $412.51 N/A N/A $459.41 $459.41 $540.48 $309.23 "$1,837.64 " 330104 0031A 9398 459 771 HC JOHNSON & JOHNSON COVID VACCINE ADM- SARSCOV2 VAC AD26 .5ML IM O $97.37 $49.81 $49.81 $40.00 $48.69 N/A N/A $49.32 $40.00 $94.65 $40.00 $49.81 $73.03 $54.79 $63.29 $71.18 $48.00 $40.00 $58.42 $77.90 $169.36 $48.69 $40.00 $49.81 $59.78 $56.00 $77.90 $40.00 $40.00 $48.00 $69.74 $40.00 $49.81 $49.81 $54.30 $77.90 $82.76 $40.00 $73.03 $82.00 $40.00 $48.69 $82.19 $65.72 $65.72 $65.72 $65.72 N/A $52.30 $49.81 $64.95 $40.00 $40.00 $42.34 $42.34 $49.81 $40.00 $169.36 330104 Q3014 497 780 HC TELEHEALTH FACILITY FEE O $621.67 N/A N/A N/A $310.83 $385.44 $385.44 N/A N/A N/A N/A N/A $466.25 N/A $404.09 $454.44 N/A N/A $373.00 $497.34 N/A $310.83 N/A N/A $404.09 $50.00 $497.34 $50.00 N/A N/A N/A N/A N/A N/A N/A $497.34 $528.42 N/A $466.25 N/A N/A $310.83 $404.09 $419.63 $419.63 $419.63 $419.63 N/A N/A N/A $414.65 N/A N/A N/A N/A N/A $50.00 $528.42 330104 50590 5374 171 790 HC FRAGMENTING OF KIDNEY STONE O "$27,875.64 " "$3,845.31 " "$3,845.31 " "$1,461.99 " "$5,623.00 " "$4,196.00 " "$3,823.00 " "$3,806.86 " "$1,461.99 " "$7,306.09 " "$1,461.99 " "$3,845.31 " "$20,906.73 " "$4,229.84 " "$18,119.17 " "$18,537.30 " "$1,754.39 " "$1,461.99 " "$16,725.38 " "$14,074.00 " "$13,074.06 " "$9,788.00 " "$1,461.99 " "$3,845.31 " "$4,614.37 " "$2,046.79 " "$18,280.90 " "$1,461.99 " "$1,461.99 " "$1,754.39 " "$5,383.43 " "$1,461.99 " "$3,845.31 " "$3,845.31 " "$4,191.39 " "$22,300.51 " "$23,694.29 " "$1,461.99 " "$12,571.00 " "$2,997.09 " "$1,461.99 " "$13,937.82 " "$6,344.76 " "$18,816.06 " "$18,816.06 " "$18,816.06 " "$18,816.06 " "$8,611.00 " "$4,037.58 " "$3,845.31 " "$9,057.00 " "$1,461.99 " "$1,461.99 " "$3,268.51 " "$3,268.51 " "$3,845.31 " "$1,461.99 " "$23,694.29 " 330104 90935 5401 168 821 HC HEMODIALYSIS ONE EVALUATION O "$5,447.37 " $756.46 $756.46 $253.06 "$2,723.68 " "$3,377.37 " "$3,377.37 " $748.90 $253.06 "$1,437.27 " $253.06 $756.46 "$4,085.53 " $832.11 "$3,540.79 " "$3,982.03 " $303.67 $253.06 "$3,268.42 " "$2,946.00 " "$1,246.00 " "$2,418.00 " $253.06 $756.46 $907.75 $354.28 "$4,357.90 " $253.06 $253.06 $303.67 "$1,059.04 " $253.06 $756.46 $756.46 $824.54 "$4,357.90 " "$4,630.26 " $253.06 "$4,085.53 " $518.76 $253.06 "$2,723.68 " "$1,248.16 " "$3,676.97 " "$3,676.97 " "$3,676.97 " "$3,676.97 " N/A $794.28 $756.46 "$3,633.40 " $253.06 $253.06 $642.99 $642.99 $756.46 $253.06 "$4,630.26 " 330104 0692T 5241 111 881 HC THERAPEUTIC ULTRAFILTRATION O $963.00 $489.19 $489.19 $271.09 $481.50 $597.06 $597.06 $484.30 $271.09 $929.47 $271.09 $489.19 $722.25 $538.11 $625.95 $703.95 $325.31 $271.09 $577.80 "$2,946.00 " "$1,246.00 " "$2,418.00 " $271.09 $489.19 $587.03 $379.53 $770.40 $271.09 $271.09 $325.31 $684.87 $271.09 $489.19 $489.19 $533.22 $770.40 $818.55 $271.09 $722.25 $555.74 $271.09 $481.50 $807.17 $650.03 $650.03 $650.03 $650.03 N/A $513.65 $489.19 $642.32 $271.09 $271.09 $415.81 $415.81 $489.19 $271.09 "$2,946.00 " 330104 G8510 490 900 HC PT INELIG NEG SCRN DEPRES O $303.88 N/A N/A N/A $151.94 $188.41 $188.41 N/A N/A N/A N/A N/A $227.91 N/A $197.52 $222.14 N/A N/A $182.33 $243.10 N/A $151.94 N/A N/A $197.52 N/A $243.10 N/A N/A N/A N/A N/A N/A N/A N/A $243.10 $258.30 N/A $227.91 N/A N/A $151.94 $197.52 $205.12 $205.12 $205.12 $205.12 N/A N/A N/A $202.69 N/A N/A N/A N/A N/A $151.94 $258.30 330104 G8431 490 900 HC POS CLIN DEPRES SCRN F/U DOC O $303.88 N/A N/A N/A $151.94 $188.41 $188.41 N/A N/A N/A N/A N/A $227.91 N/A $197.52 $222.14 N/A N/A $182.33 $243.10 N/A $151.94 N/A N/A $197.52 N/A $243.10 N/A N/A N/A N/A N/A N/A N/A N/A $243.10 $258.30 N/A $227.91 N/A N/A $151.94 $197.52 $205.12 $205.12 $205.12 $205.12 N/A N/A N/A $202.69 N/A N/A N/A N/A N/A $151.94 $258.30 330104 G8427 490 900 HC DOC CUR MEDS BY PROV O $2.14 N/A N/A N/A $1.07 $1.33 $1.33 N/A N/A N/A N/A N/A $1.60 N/A $1.39 $1.56 N/A N/A $1.28 $1.71 N/A $1.07 N/A N/A $1.39 N/A $1.71 N/A N/A N/A N/A N/A N/A N/A N/A $1.71 $1.82 N/A $1.60 N/A N/A $1.07 $1.39 $1.44 $1.44 $1.44 $1.44 N/A N/A N/A $1.43 N/A N/A N/A N/A N/A $1.07 $1.82 330104 S9480 327 905 HC INTENSIVE OUTPATIENT PSYCH PER DAY O $430.14 N/A N/A $112.94 $215.07 $266.69 $266.69 N/A $112.94 N/A $112.94 N/A $322.61 N/A $279.59 $314.43 $135.53 $112.94 $258.08 $344.11 N/A $215.07 $112.94 N/A $279.59 $158.12 $517.00 $112.94 $112.94 $135.53 N/A $112.94 N/A N/A N/A $344.11 $365.62 $152.47 $322.61 $231.53 $152.47 $215.07 $279.59 $290.34 $290.34 $290.34 $290.34 $215.07 N/A N/A $286.90 $112.94 $112.94 N/A N/A N/A $112.94 $517.00 330104 H0015 327 906 HC ALCOHOL AND/OR DRUG SERVICES O $430.14 N/A N/A $112.94 $215.07 $266.69 $266.69 N/A $112.94 N/A $112.94 N/A $322.61 N/A $279.59 $314.43 $135.53 $112.94 $258.08 $344.11 N/A $215.07 $112.94 N/A $279.59 $158.12 $517.00 $112.94 $112.94 $135.53 N/A $112.94 N/A N/A N/A $344.11 $365.62 $152.47 $322.61 $231.53 $152.47 $215.07 $279.59 $290.34 $290.34 $290.34 $290.34 $215.07 N/A N/A $286.90 $112.94 $112.94 N/A N/A N/A $112.94 $517.00 330104 H0004 315 906 HC BRIEF TREATMENT 15 MIN O $298.53 N/A N/A $115.05 $149.26 $185.09 $185.09 N/A $115.05 N/A $115.05 N/A $223.90 N/A $194.04 $218.23 $138.06 $115.05 $179.12 $238.82 N/A $149.26 $115.05 N/A $194.04 $161.07 $517.00 $115.05 $115.05 $138.06 N/A $115.05 N/A N/A N/A $238.82 $253.75 $155.32 $223.90 $235.85 $155.32 $149.26 $194.04 $201.51 $201.51 $201.51 $201.51 $149.26 N/A N/A $199.12 $115.05 $115.05 N/A N/A N/A $115.05 $517.00 330104 90791 5823 323 914 HC PSYCH DIAGNOSTIC EVALUATION O $605.62 $174.80 $174.80 $191.75 $302.81 $403.00 $367.00 $173.05 $191.75 $332.12 $191.75 $174.80 $454.22 $192.28 $393.65 $442.71 $230.10 $191.75 $363.37 $484.50 $594.33 $302.81 $191.75 $174.80 $209.76 $268.45 $484.50 $191.75 $191.75 $230.10 $244.72 $191.75 $174.80 $174.80 $190.53 $484.50 $514.78 $191.75 $454.22 $393.09 $191.75 $302.81 $288.42 $408.79 $408.79 $408.79 $408.79 N/A $183.54 $174.80 $403.95 $191.75 $191.75 $148.58 $148.58 $174.80 $148.58 $594.33 330104 90792 5823 323 914 HC PSYCH DIAG EVAL W/MED SRVCS O $728.67 $174.80 $174.80 $191.75 $364.33 $403.00 $367.00 $173.05 $191.75 $332.12 $191.75 $174.80 $546.50 $192.28 $473.64 $532.66 $230.10 $191.75 $437.20 $582.94 $594.33 $364.33 $191.75 $174.80 $209.76 $268.45 $582.94 $191.75 $191.75 $230.10 $244.72 $191.75 $174.80 $174.80 $190.53 $582.94 $619.37 $191.75 $546.50 $393.09 $191.75 $364.33 $288.42 $491.85 $491.85 $491.85 $491.85 N/A $183.54 $174.80 $486.02 $191.75 $191.75 $148.58 $148.58 $174.80 $148.58 $619.37 330104 90853 5822 318 915 HC GROUP PSYCHOTHERAPY O $363.80 $91.00 $91.00 $59.44 $181.90 $214.00 $193.00 $90.09 $59.44 $172.90 $59.44 $91.00 $272.85 $100.10 $236.47 $265.94 $71.33 $59.44 $218.28 $291.04 $309.40 $181.90 $59.44 $91.00 $109.20 $83.22 $291.04 $59.44 $59.44 $71.33 $127.40 $59.44 $91.00 $91.00 $99.19 $291.04 $309.23 $59.44 $272.85 $121.86 $59.44 $181.90 $150.15 $245.57 $245.57 $245.57 $245.57 N/A $95.55 $91.00 $242.65 $59.44 $59.44 $77.35 $77.35 $91.00 $59.44 $309.40 330104 90846 5823 317 916 HC FAMILY PSYTX W/O PATIENT 50 MN O $659.12 $174.80 $174.80 $115.05 $329.56 $316.00 $286.00 $173.05 $115.05 $332.12 $115.05 $174.80 $494.34 $192.28 $428.43 $481.82 $138.06 $115.05 $395.47 $527.30 $594.33 $329.56 $115.05 $174.80 $209.76 $161.07 $527.30 $115.05 $115.05 $138.06 $244.72 $115.05 $174.80 $174.80 $190.53 $527.30 $560.25 $115.05 $494.34 $235.85 $115.05 $329.56 $288.42 $444.91 $444.91 $444.91 $444.91 N/A $183.54 $174.80 $439.63 $115.05 $115.05 $148.58 $148.58 $174.80 $115.05 $594.33 330104 90849 5823 318 916 HC MULTIPLE FAMILY GROU PSYTX O $610.97 $174.80 $174.80 $59.44 $305.49 $214.00 $193.00 $173.05 $59.44 $332.12 $59.44 $174.80 $458.23 $192.28 $397.13 $446.62 $71.33 $59.44 $366.58 $488.78 $594.33 $305.49 $59.44 $174.80 $209.76 $83.22 $488.78 $59.44 $59.44 $71.33 $244.72 $59.44 $174.80 $174.80 $190.53 $488.78 $519.32 $59.44 $458.23 $121.86 $59.44 $305.49 $288.42 $412.40 $412.40 $412.40 $412.40 N/A $183.54 $174.80 $407.52 $59.44 $59.44 $148.58 $148.58 $174.80 $59.44 $594.33 330104 97127 269 918 HC THER IVNTJ W/FOCUS COG FUNCJ O $511.46 N/A N/A $72.07 $255.73 $317.11 $317.11 $334.49 $72.07 N/A $72.07 N/A $383.59 N/A $332.45 $373.88 $86.49 $72.07 $306.88 $409.17 N/A $255.73 $72.07 N/A N/A $100.90 $409.17 $72.07 $72.07 $86.49 N/A $72.07 N/A N/A N/A $409.17 $434.74 $97.30 $383.59 $147.75 $97.30 $255.73 $332.45 $345.24 $345.24 $345.24 $345.24 N/A N/A N/A $341.14 $72.07 $72.07 N/A N/A N/A $72.07 $434.74 330104 96105 310 918 HC ASSESSMENT OF APHASIA O "$1,530.10 " $113.57 $113.57 $150.00 $765.05 $948.66 $948.66 $112.43 $150.00 $215.78 $150.00 $113.57 "$1,147.57 " $124.92 $994.56 "$1,118.50 " $180.00 $150.00 $918.06 "$1,224.08 " $386.12 $765.05 $150.00 $113.57 $994.56 $210.00 "$1,224.08 " $150.00 $150.00 $180.00 $158.99 $150.00 $113.57 $113.57 $123.79 "$1,224.08 " "$1,300.58 " $202.50 "$1,147.57 " $307.50 $202.50 $765.05 $994.56 "$1,032.82 " "$1,032.82 " "$1,032.82 " "$1,032.82 " N/A $119.24 $113.57 "$1,020.58 " $150.00 $150.00 $96.53 $96.53 $113.57 $96.53 "$1,300.58 " 330104 95249 5733 418 920 HC CONT GLUC MNTR PT PROV EQP O $224.70 $68.96 $68.96 $187.76 $112.35 $139.31 $139.31 $68.27 $187.76 $131.03 $187.76 $68.96 $168.52 $75.86 $146.06 $164.26 $225.31 $187.76 $134.82 $179.76 $234.47 $112.35 $187.76 $68.96 $82.75 $262.86 $179.76 $187.76 $187.76 $225.31 $96.55 $187.76 $68.96 $68.96 $75.17 $179.76 $190.99 $187.76 $168.52 $384.90 $187.76 $112.35 $113.79 $151.67 $151.67 $151.67 $151.67 N/A $72.41 $68.96 $149.87 $187.76 $187.76 $58.62 $58.62 $68.96 $58.62 $384.90 330104 93882 5522 288 920 HC EXTRACRANIAL UNI/LTD STUDY O "$2,595.82 " $128.23 $128.23 $93.00 "$1,297.91 " "$1,609.41 " "$1,609.41 " $126.95 $93.00 $243.63 $93.00 $128.23 "$1,946.87 " $141.05 "$1,687.28 " "$1,897.54 " $111.60 $93.00 "$1,557.49 " "$2,076.66 " $435.98 "$1,297.91 " $93.00 $128.23 $153.87 $130.20 "$2,076.66 " $93.00 $93.00 $111.60 $179.52 $93.00 $128.23 $128.23 $139.77 "$2,076.66 " "$2,206.45 " $93.00 "$1,946.87 " $190.65 $93.00 "$1,297.91 " $211.58 "$1,752.18 " "$1,752.18 " "$1,752.18 " "$1,752.18 " N/A $134.64 $128.23 "$1,731.41 " $93.00 $93.00 $108.99 $108.99 $128.23 $93.00 "$2,206.45 " 330104 93880 5523 289 920 HC EXTRACRANIAL BILAT STUDY O "$3,075.18 " $280.16 $280.16 $108.00 "$1,537.59 " "$1,906.61 " "$1,906.61 " $277.36 $108.00 $532.31 $108.00 $280.16 "$2,306.38 " $308.18 "$1,998.87 " "$2,247.96 " $129.60 $108.00 "$1,845.11 " "$2,460.14 " $952.56 "$1,537.59 " $108.00 $280.16 $336.20 $151.20 "$2,460.14 " $108.00 $108.00 $129.60 $392.23 $108.00 $280.16 $280.16 $305.38 "$2,460.14 " "$2,613.90 " $108.00 "$2,306.38 " $221.40 $108.00 "$1,537.59 " $462.27 "$2,075.75 " "$2,075.75 " "$2,075.75 " "$2,075.75 " N/A $294.17 $280.16 "$2,051.15 " $108.00 $108.00 $238.14 $238.14 $280.16 $108.00 "$2,613.90 " 330104 91113 5311 130 920 HC GI TRC IMG INTRAL COLON I&R O "$2,779.86 " $997.03 $997.03 $507.89 "$1,389.93 " "$1,723.51 " "$1,723.51 " $987.06 $507.89 "$1,894.36 " $507.89 $997.03 "$2,084.89 " "$1,096.74 " "$1,806.91 " "$2,032.08 " $609.46 $507.89 "$1,667.92 " "$2,223.89 " "$3,389.91 " "$1,389.93 " $507.89 $997.03 "$1,196.44 " $711.04 "$2,223.89 " $507.89 $507.89 $609.46 "$1,395.84 " $507.89 $997.03 $997.03 "$1,086.76 " "$2,223.89 " "$2,362.88 " $507.89 "$2,084.89 " "$1,041.17 " $507.89 "$1,389.93 " "$1,645.10 " "$1,876.41 " "$1,876.41 " "$1,876.41 " "$1,876.41 " N/A "$1,046.88 " $997.03 "$1,854.17 " $507.89 $507.89 $847.48 $847.48 $997.03 $507.89 "$3,389.91 " 330104 95783 5724 222 920 HC POLYSOM <6 YRS CPAP/BILVL O "$6,403.95 " "$1,121.01 " "$1,121.01 " $867.33 "$3,201.97 " "$3,970.45 " "$3,970.45 " "$1,109.80 " $867.33 "$2,129.92 " $867.33 "$1,121.01 " "$4,802.96 " "$1,233.11 " "$4,162.57 " "$4,681.29 " "$1,040.80 " $867.33 "$3,842.37 " "$5,123.16 " "$3,811.44 " "$3,201.97 " $867.33 "$1,121.01 " "$1,345.22 " "$1,214.27 " "$5,123.16 " $867.33 $867.33 "$1,040.80 " "$1,569.42 " $867.33 "$1,121.01 " "$1,121.01 " "$1,221.90 " "$5,123.16 " "$5,443.36 " $867.33 "$4,802.96 " "$1,778.03 " $867.33 "$3,201.97 " "$1,849.67 " "$4,322.67 " "$4,322.67 " "$4,322.67 " "$4,322.67 " N/A "$1,177.06 " "$1,121.01 " "$4,271.43 " $867.33 $867.33 $952.86 $952.86 "$1,121.01 " $867.33 "$5,443.36 " 330104 95806 5721 226 920 HC SLEEP STUDY UNATT&RESP EFFT O "$3,468.94 " $174.48 $174.48 N/A "$1,734.47 " "$2,150.74 " "$2,150.74 " $172.73 N/A $331.51 N/A $174.48 "$2,601.70 " $191.93 "$2,254.81 " "$5,924.00 " N/A N/A "$2,081.36 " "$2,775.15 " $593.23 "$1,734.47 " N/A $174.48 $209.37 N/A "$2,775.15 " N/A N/A N/A $244.27 N/A $174.48 $174.48 $190.18 "$2,775.15 " "$2,948.60 " N/A "$2,601.70 " N/A N/A "$1,734.47 " $287.89 "$2,341.53 " "$2,341.53 " "$2,341.53 " "$2,341.53 " N/A $183.20 $174.48 "$2,313.78 " N/A N/A $148.31 $148.31 $174.48 $148.31 "$5,924.00 " 330104 90869 5722 212 920 HC REPET TMS TX SUBSEQ MOTR THRESHLD W/DELIV & MN O $749.00 $336.00 $336.00 $389.05 $374.50 $464.38 $464.38 $332.64 $389.05 $638.40 $389.05 $336.00 $561.75 $369.60 $486.85 $547.52 $466.85 $389.05 $449.40 $599.20 "$1,142.40 " $374.50 $389.05 $336.00 $403.20 $544.66 $599.20 $389.05 $389.05 $466.85 $470.40 $389.05 $336.00 $336.00 $366.24 $599.20 $636.65 $389.05 $561.75 $797.54 $389.05 $374.50 $554.40 $505.58 $505.58 $505.58 $505.58 N/A $352.80 $336.00 $499.58 $389.05 $389.05 $285.60 $285.60 $336.00 $285.60 "$1,142.40 " 330104 95805 5723 222 920 HC MULTIPLE SLEEP LATENCY TEST O "$5,216.25 " $579.99 $579.99 $867.33 "$2,608.12 " "$3,234.07 " "$3,234.07 " $574.19 $867.33 "$1,101.98 " $867.33 $579.99 "$3,912.19 " $637.99 "$3,390.56 " "$5,924.00 " "$1,040.80 " $867.33 "$3,129.75 " "$4,173.00 " "$1,971.97 " "$2,608.12 " $867.33 $579.99 $695.99 "$1,214.27 " "$4,173.00 " $867.33 $867.33 "$1,040.80 " $811.99 $867.33 $579.99 $579.99 $632.19 "$4,173.00 " "$4,433.81 " $867.33 "$3,912.19 " "$1,778.03 " $867.33 "$2,608.12 " $956.98 "$3,520.97 " "$3,520.97 " "$3,520.97 " "$3,520.97 " N/A $608.99 $579.99 "$3,479.24 " $867.33 $867.33 $492.99 $492.99 $579.99 $492.99 "$5,924.00 " 330104 95807 5723 222 920 HC SLEEP STUDY ATTENDED O "$6,403.95 " $579.99 $579.99 $867.33 "$3,201.97 " "$3,970.45 " "$3,970.45 " $574.19 $867.33 "$1,101.98 " $867.33 $579.99 "$4,802.96 " $637.99 "$4,162.57 " "$5,924.00 " "$1,040.80 " $867.33 "$3,842.37 " "$5,123.16 " "$1,971.97 " "$3,201.97 " $867.33 $579.99 $695.99 "$1,214.27 " "$5,123.16 " $867.33 $867.33 "$1,040.80 " $811.99 $867.33 $579.99 $579.99 $632.19 "$5,123.16 " "$5,443.36 " $867.33 "$4,802.96 " "$1,778.03 " $867.33 "$3,201.97 " $956.98 "$4,322.67 " "$4,322.67 " "$4,322.67 " "$4,322.67 " N/A $608.99 $579.99 "$4,271.43 " $867.33 $867.33 $492.99 $492.99 $579.99 $492.99 "$5,924.00 " 330104 95811 5724 222 920 HC POLYSOM 6/>YRS CPAP 4/> PARM O "$12,556.45 " "$1,121.01 " "$1,121.01 " $867.33 "$6,278.23 " "$7,785.00 " "$7,785.00 " "$1,109.80 " $867.33 "$2,129.92 " $867.33 "$1,121.01 " "$9,417.34 " "$1,233.11 " "$8,161.69 " "$9,178.76 " "$1,040.80 " $867.33 "$7,533.87 " "$10,045.16 " "$3,811.44 " "$6,278.23 " $867.33 "$1,121.01 " "$1,345.22 " "$1,214.27 " "$9,133.00 " $867.33 $867.33 "$1,040.80 " "$1,569.42 " $867.33 "$1,121.01 " "$1,121.01 " "$1,221.90 " "$10,045.16 " "$10,672.98 " $867.33 "$9,417.34 " "$1,778.03 " $867.33 "$6,278.23 " "$1,849.67 " "$8,475.60 " "$8,475.60 " "$8,475.60 " "$8,475.60 " N/A "$1,177.06 " "$1,121.01 " "$8,375.15 " $867.33 $867.33 $952.86 $952.86 "$1,121.01 " $867.33 "$10,672.98 " 330104 95810 5724 222 920 HC POLYSOM 6/> YRS 4/> PARAM O "$11,508.92 " "$1,121.01 " "$1,121.01 " $867.33 "$5,754.46 " "$7,135.53 " "$7,135.53 " "$1,109.80 " $867.33 "$2,129.92 " $867.33 "$1,121.01 " "$8,631.69 " "$1,233.11 " "$7,480.80 " "$8,413.02 " "$1,040.80 " $867.33 "$6,905.35 " "$9,207.14 " "$3,811.44 " "$5,754.46 " $867.33 "$1,121.01 " "$1,345.22 " "$1,214.27 " "$8,473.00 " $867.33 $867.33 "$1,040.80 " "$1,569.42 " $867.33 "$1,121.01 " "$1,121.01 " "$1,221.90 " "$9,207.14 " "$9,782.58 " $867.33 "$8,631.69 " "$1,778.03 " $867.33 "$5,754.46 " "$1,849.67 " "$7,768.52 " "$7,768.52 " "$7,768.52 " "$7,768.52 " N/A "$1,177.06 " "$1,121.01 " "$7,676.45 " $867.33 $867.33 $952.86 $952.86 "$1,121.01 " $867.33 "$9,782.58 " 330104 93980 5522 289 921 HC PENILE VASCULAR STUDY;COMPLETE O $789.66 $128.23 $128.23 $58.00 $394.83 $489.59 $489.59 $126.95 $58.00 $243.63 $58.00 $128.23 $592.25 $141.05 $513.28 $577.24 $69.60 $58.00 $473.80 $631.73 $435.98 $394.83 $58.00 $128.23 $153.87 $81.20 $631.73 $58.00 $58.00 $69.60 $179.52 $58.00 $128.23 $128.23 $139.77 $631.73 $671.21 $58.00 $592.25 $118.90 $58.00 $394.83 $211.58 $533.02 $533.02 $533.02 $533.02 N/A $134.64 $128.23 $526.70 $58.00 $58.00 $108.99 $108.99 $128.23 $58.00 $671.21 330104 93978 5523 289 921 HC DUP AORTA IVC COMP O "$3,088.02 " $280.16 $280.16 $67.50 "$1,544.01 " "$1,914.57 " "$1,914.57 " $277.36 $67.50 $532.31 $67.50 $280.16 "$2,316.01 " $308.18 "$2,007.21 " "$2,257.34 " $81.00 $67.50 "$1,852.81 " "$2,470.42 " $952.56 "$1,544.01 " $67.50 $280.16 $336.20 $94.50 "$2,470.42 " $67.50 $67.50 $81.00 $392.23 $67.50 $280.16 $280.16 $305.38 "$2,470.42 " "$2,624.82 " $67.50 "$2,316.01 " $138.38 $67.50 "$1,544.01 " $462.27 "$2,084.41 " "$2,084.41 " "$2,084.41 " "$2,084.41 " N/A $294.17 $280.16 "$2,059.71 " $67.50 $67.50 $238.14 $238.14 $280.16 $67.50 "$2,624.82 " 330104 93971 5522 288 921 HC EXTREMITY STUDY O "$2,224.53 " $128.23 $128.23 $93.00 "$1,112.27 " "$1,379.21 " "$1,379.21 " $126.95 $93.00 $243.63 $93.00 $128.23 "$1,668.40 " $141.05 "$1,445.94 " "$1,626.13 " $111.60 $93.00 "$1,334.72 " "$1,779.62 " $435.98 "$1,112.27 " $93.00 $128.23 $153.87 $130.20 "$1,779.62 " $93.00 $93.00 $111.60 $179.52 $93.00 $128.23 $128.23 $139.77 "$1,779.62 " "$1,890.85 " $93.00 "$1,668.40 " $190.65 $93.00 "$1,112.27 " $211.58 "$1,501.56 " "$1,501.56 " "$1,501.56 " "$1,501.56 " N/A $134.64 $128.23 "$1,483.76 " $93.00 $93.00 $108.99 $108.99 $128.23 $93.00 "$1,890.85 " 330104 93931 5522 288 921 HC DUP ART-LTD/UNI UE O "$1,744.10 " $128.23 $128.23 $93.00 $872.05 "$1,081.34 " "$1,081.34 " $126.95 $93.00 $243.63 $93.00 $128.23 "$1,308.07 " $141.05 "$1,133.66 " "$1,274.94 " $111.60 $93.00 "$1,046.46 " "$1,395.28 " $435.98 $872.05 $93.00 $128.23 $153.87 $130.20 "$1,395.28 " $93.00 $93.00 $111.60 $179.52 $93.00 $128.23 $128.23 $139.77 "$1,395.28 " "$1,482.48 " $93.00 "$1,308.07 " $190.65 $93.00 $872.05 $211.58 "$1,177.27 " "$1,177.27 " "$1,177.27 " "$1,177.27 " N/A $134.64 $128.23 "$1,163.31 " $93.00 $93.00 $108.99 $108.99 $128.23 $93.00 "$1,482.48 " 330104 93975 5523 289 921 HC VISCERAL DUP COMP-ART+VENOUS O "$1,800.81 " $280.16 $280.16 $67.50 $900.40 "$1,116.50 " "$1,116.50 " $277.36 $67.50 $532.31 $67.50 $280.16 "$1,350.61 " $308.18 "$1,170.53 " "$1,316.39 " $81.00 $67.50 "$1,080.49 " "$1,440.65 " $952.56 $900.40 $67.50 $280.16 $336.20 $94.50 "$1,440.65 " $67.50 $67.50 $81.00 $392.23 $67.50 $280.16 $280.16 $305.38 "$1,440.65 " "$1,530.69 " $67.50 "$1,350.61 " $138.38 $67.50 $900.40 $462.27 "$1,215.55 " "$1,215.55 " "$1,215.55 " "$1,215.55 " N/A $294.17 $280.16 "$1,201.14 " $67.50 $67.50 $238.14 $238.14 $280.16 $67.50 "$1,530.69 " 330104 93926 5522 288 921 HC LOWER EXTREMITY ARTERY; UNILATERL OR LIMITED STUDY O "$2,036.21 " $128.23 $128.23 $93.00 "$1,018.11 " "$1,262.45 " "$1,262.45 " $126.95 $93.00 $243.63 $93.00 $128.23 "$1,527.16 " $141.05 "$1,323.54 " "$1,488.47 " $111.60 $93.00 "$1,221.73 " "$1,628.97 " $435.98 "$1,018.11 " $93.00 $128.23 $153.87 $130.20 "$1,628.97 " $93.00 $93.00 $111.60 $179.52 $93.00 $128.23 $128.23 $139.77 "$1,628.97 " "$1,730.78 " $93.00 "$1,527.16 " $190.65 $93.00 "$1,018.11 " $211.58 "$1,374.44 " "$1,374.44 " "$1,374.44 " "$1,374.44 " N/A $134.64 $128.23 "$1,358.15 " $93.00 $93.00 $108.99 $108.99 $128.23 $93.00 "$1,730.78 " 330104 93925 5523 289 921 HC LOWER EXTREMITY ARTERY COMPLETE BILAT STUDY O "$3,382.27 " $280.16 $280.16 $108.00 "$1,691.13 " "$2,097.01 " "$2,097.01 " $277.36 $108.00 $532.31 $108.00 $280.16 "$2,536.70 " $308.18 "$2,198.48 " "$2,472.44 " $129.60 $108.00 "$2,029.36 " "$2,705.82 " $952.56 "$1,691.13 " $108.00 $280.16 $336.20 $151.20 "$2,705.82 " $108.00 $108.00 $129.60 $392.23 $108.00 $280.16 $280.16 $305.38 "$2,705.82 " "$2,874.93 " $108.00 "$2,536.70 " $221.40 $108.00 "$1,691.13 " $462.27 "$2,283.03 " "$2,283.03 " "$2,283.03 " "$2,283.03 " N/A $294.17 $280.16 "$2,255.97 " $108.00 $108.00 $238.14 $238.14 $280.16 $108.00 "$2,874.93 " 330104 93923 5721 80 921 HC UPR/LXTR ART STDY 3+ LVLS O "$2,587.26 " $174.48 $174.48 $72.00 "$1,293.63 " "$1,604.10 " "$1,604.10 " $172.73 $72.00 $331.51 $72.00 $174.48 "$1,940.45 " $191.93 "$1,681.72 " "$1,891.29 " $86.40 $72.00 "$1,552.36 " "$2,069.81 " $593.23 "$1,293.63 " $72.00 $174.48 $209.37 $100.80 "$2,069.81 " $72.00 $72.00 $86.40 $244.27 $72.00 $174.48 $174.48 $190.18 "$2,069.81 " "$2,199.17 " $72.00 "$1,940.45 " $147.60 $72.00 "$1,293.63 " $287.89 "$1,746.40 " "$1,746.40 " "$1,746.40 " "$1,746.40 " N/A $183.20 $174.48 "$1,725.70 " $72.00 $72.00 $148.31 $148.31 $174.48 $72.00 "$2,199.17 " 330104 93922 5734 288 921 HC UPR/L XTREMITY ART 2 LEVELS O "$2,295.15 " $139.30 $139.30 $72.00 "$1,147.58 " "$1,422.99 " "$1,422.99 " $137.91 $72.00 $264.67 $72.00 $139.30 "$1,721.36 " $153.23 "$1,491.85 " "$1,677.75 " $86.40 $72.00 "$1,377.09 " "$1,836.12 " $473.63 "$1,147.58 " $72.00 $139.30 $167.16 $100.80 "$1,836.12 " $72.00 $72.00 $86.40 $195.02 $72.00 $139.30 $139.30 $151.84 "$1,836.12 " "$1,950.88 " $72.00 "$1,721.36 " $147.60 $72.00 "$1,147.58 " $229.85 "$1,549.23 " "$1,549.23 " "$1,549.23 " "$1,549.23 " N/A $146.27 $139.30 "$1,530.87 " $72.00 $72.00 $118.41 $118.41 $139.30 $72.00 "$1,950.88 " 330104 93976 5522 289 921 HC VISCERAL DUP F/U-ART+VENOUS O "$1,510.84 " $128.23 $128.23 $58.00 $755.42 $936.72 $936.72 $126.95 $58.00 $243.63 $58.00 $128.23 "$1,133.13 " $141.05 $982.05 "$1,104.42 " $69.60 $58.00 $906.50 "$1,208.67 " $435.98 $755.42 $58.00 $128.23 $153.87 $81.20 "$1,208.67 " $58.00 $58.00 $69.60 $179.52 $58.00 $128.23 $128.23 $139.77 "$1,208.67 " "$1,284.21 " $58.00 "$1,133.13 " $118.90 $58.00 $755.42 $211.58 "$1,019.82 " "$1,019.82 " "$1,019.82 " "$1,019.82 " N/A $134.64 $128.23 "$1,007.73 " $58.00 $58.00 $108.99 $108.99 $128.23 $58.00 "$1,284.21 " 330104 93930 5523 288 921 HC DUP ART-BIL/COMP UE O "$3,319.14 " $280.16 $280.16 $108.00 "$1,659.57 " "$2,057.87 " "$2,057.87 " $277.36 $108.00 $532.31 $108.00 $280.16 "$2,489.36 " $308.18 "$2,157.44 " "$2,426.29 " $129.60 $108.00 "$1,991.48 " "$2,655.31 " $952.56 "$1,659.57 " $108.00 $280.16 $336.20 $151.20 "$2,655.31 " $108.00 $108.00 $129.60 $392.23 $108.00 $280.16 $280.16 $305.38 "$2,655.31 " "$2,821.27 " $108.00 "$2,489.36 " $221.40 $108.00 "$1,659.57 " $462.27 "$2,240.42 " "$2,240.42 " "$2,240.42 " "$2,240.42 " N/A $294.17 $280.16 "$2,213.87 " $108.00 $108.00 $238.14 $238.14 $280.16 $108.00 "$2,821.27 " 330104 93970 5523 289 921 HC DUPLEX SCAN EXT VEINS; COMPLETE BILATERAL STUDY O "$2,285.52 " $280.16 $280.16 $108.00 "$1,142.76 " "$1,417.02 " "$1,417.02 " $277.36 $108.00 $532.31 $108.00 $280.16 "$1,714.14 " $308.18 "$1,485.59 " "$1,670.72 " $129.60 $108.00 "$1,371.31 " "$1,828.42 " $952.56 "$1,142.76 " $108.00 $280.16 $336.20 $151.20 "$1,828.42 " $108.00 $108.00 $129.60 $392.23 $108.00 $280.16 $280.16 $305.38 "$1,828.42 " "$1,942.69 " $108.00 "$1,714.14 " $221.40 $108.00 "$1,142.76 " $462.27 "$1,542.73 " "$1,542.73 " "$1,542.73 " "$1,542.73 " N/A $294.17 $280.16 "$1,524.44 " $108.00 $108.00 $238.14 $238.14 $280.16 $108.00 "$1,942.69 " 330104 95782 5724 222 922 HC POLYSOM <6 YRS 4/> PARAMTRS O "$12,556.45 " "$1,121.01 " "$1,121.01 " $867.33 "$6,278.23 " "$7,785.00 " "$7,785.00 " "$1,109.80 " $867.33 "$2,129.92 " $867.33 "$1,121.01 " "$9,417.34 " "$1,233.11 " "$8,161.69 " "$9,178.76 " "$1,040.80 " $867.33 "$7,533.87 " "$10,045.16 " "$3,811.44 " "$6,278.23 " $867.33 "$1,121.01 " "$1,345.22 " "$1,214.27 " "$10,045.16 " $867.33 $867.33 "$1,040.80 " "$1,569.42 " $867.33 "$1,121.01 " "$1,121.01 " "$1,221.90 " "$10,045.16 " "$10,672.98 " $867.33 "$9,417.34 " "$1,778.03 " $867.33 "$6,278.23 " "$1,849.67 " "$8,475.60 " "$8,475.60 " "$8,475.60 " "$8,475.60 " N/A "$1,177.06 " "$1,121.01 " "$8,375.15 " $867.33 $867.33 $952.86 $952.86 "$1,121.01 " $867.33 "$10,672.98 " 330104 Q0091 5731 392 923 HC OBTAINING SCREEN PAP SMEAR O $108.07 $29.95 $29.95 N/A $54.03 $67.00 $67.00 $29.65 N/A $56.90 N/A $29.95 $81.05 $32.94 $70.25 $79.00 N/A N/A $64.84 $86.46 $101.81 $54.03 N/A $29.95 $35.93 N/A $86.46 N/A N/A N/A $41.92 N/A $29.95 $29.95 $32.64 $86.46 $91.86 N/A $81.05 N/A N/A $54.03 $49.41 $72.95 $72.95 $72.95 $72.95 $11.95 $31.44 $29.95 $11.95 N/A N/A $25.45 $25.45 $29.95 $11.95 $101.81 330104 98976 5741 418 940 HC REM THER MNTR DEV SUPPLY W/REC RESPIR SYS EA 30 DAYS O $99.51 $41.99 $41.99 $187.76 $49.76 $61.70 $61.70 $41.57 $187.76 $79.78 $187.76 $41.99 $74.63 $46.19 $64.68 $72.74 $225.31 $187.76 $59.71 $79.61 $142.77 $49.76 $187.76 $41.99 $50.39 $262.86 $79.61 $187.76 $187.76 $225.31 $58.79 $187.76 $41.99 $41.99 $45.77 $79.61 $84.58 $187.76 $74.63 $384.90 $187.76 $49.76 $69.28 $67.17 $67.17 $67.17 $67.17 N/A $44.09 $41.99 $66.37 $187.76 $187.76 $35.69 $35.69 $41.99 $35.69 $384.90 330104 G0396 5821 315 940 HC ALCOHOL/SUBS INTERV 15-30MN O $299.60 $35.61 $35.61 $115.05 $149.80 $185.75 $185.75 $35.25 $115.05 $67.66 $115.05 $35.61 $224.70 $39.17 $194.74 $219.01 $138.06 $115.05 $179.76 $239.68 $121.07 $149.80 $115.05 $35.61 $42.73 $161.07 $239.68 $115.05 $115.05 $138.06 $49.85 $115.05 $35.61 $35.61 $38.81 $239.68 $254.66 $115.05 $224.70 $235.85 $115.05 $149.80 $58.75 $202.23 $202.23 $202.23 $202.23 N/A $37.39 $35.61 $199.83 $115.05 $115.05 $30.27 $30.27 $35.61 $30.27 $254.66 330104 99195 5734 494 940 HC PHLEBOTOMY O $503.97 $139.30 $139.30 $10.00 $251.99 $312.46 $312.46 $137.91 $10.00 $264.67 $10.00 $139.30 $377.98 $153.23 $327.58 $368.40 $12.00 $10.00 $302.38 $403.18 $473.63 $251.99 $10.00 $139.30 $167.16 $14.00 $403.18 $10.00 $10.00 $12.00 $195.02 $10.00 $139.30 $139.30 $151.84 $403.18 $428.37 $10.00 $377.98 $20.50 $10.00 $251.99 $229.85 $340.18 $340.18 $340.18 $340.18 N/A $146.27 $139.30 $336.15 $10.00 $10.00 $118.41 $118.41 $139.30 $10.00 $473.63 330104 96372 5692 109 940 HC THER/PROPH/DIAG INJ SC/IM O $281.41 $80.95 $80.95 $13.23 $140.71 $174.47 $174.47 $80.14 $13.23 $153.80 $13.23 $80.95 $211.06 $89.04 $182.92 $205.71 $15.88 $13.23 $168.85 $225.13 $275.22 $140.71 $13.23 $80.95 $97.14 $18.52 $225.13 $13.23 $13.23 $15.88 $113.33 $13.23 $80.95 $80.95 $88.23 $225.13 $239.20 $13.23 $211.06 $27.12 $13.23 $140.71 $133.56 $189.95 $189.95 $189.95 $189.95 N/A $84.99 $80.95 $187.70 $13.23 $13.23 $68.80 $68.80 $80.95 $13.23 $275.22 330104 98977 5741 418 940 HC REM THER MNTR DEV SPLY W/REC MUSCSKEL SYS EA 30DAYS O $99.51 $41.99 $41.99 $187.76 $49.76 $61.70 $61.70 $41.57 $187.76 $79.78 $187.76 $41.99 $74.63 $46.19 $64.68 $72.74 $225.31 $187.76 $59.71 $79.61 $142.77 $49.76 $187.76 $41.99 $50.39 $262.86 $79.61 $187.76 $187.76 $225.31 $58.79 $187.76 $41.99 $41.99 $45.77 $79.61 $84.58 $187.76 $74.63 $384.90 $187.76 $49.76 $69.28 $67.17 $67.17 $67.17 $67.17 N/A $44.09 $41.99 $66.37 $187.76 $187.76 $35.69 $35.69 $41.99 $35.69 $384.90 330104 93668 5733 80 940 HC PAD REHAB PER SESSION O $242.89 $68.96 $68.96 $168.42 $121.44 $150.59 $150.59 $68.27 $168.42 $131.03 $168.42 $68.96 $182.17 $75.86 $157.88 $177.55 $202.10 $168.42 $145.73 $194.31 $234.47 $121.44 $168.42 $68.96 $82.75 $235.78 $194.31 $168.42 $168.42 $202.10 $96.55 $168.42 $68.96 $68.96 $75.17 $194.31 $206.46 $168.42 $182.17 $345.26 $168.42 $121.44 $113.79 $163.95 $163.95 $163.95 $163.95 N/A $72.41 $68.96 $162.01 $168.42 $168.42 $58.62 $58.62 $68.96 $58.62 $345.26 330104 H0005 318 940 HC GRP PSYCHOTHERAPY (OTHER THAN MULTIPLE-FAM.GRP) O $363.80 N/A N/A $59.44 $181.90 $225.56 $225.56 N/A $59.44 N/A $59.44 N/A $272.85 N/A $236.47 $265.94 $71.33 $59.44 $218.28 $291.04 N/A $181.90 $59.44 N/A $236.47 $83.22 $291.04 $59.44 $59.44 $71.33 N/A $59.44 N/A N/A N/A $291.04 $309.23 $80.25 $272.85 $121.86 $80.25 $181.90 $236.47 $245.57 $245.57 $245.57 $245.57 N/A N/A N/A $242.65 $59.44 $59.44 N/A N/A N/A $59.44 $309.23 330104 T1006 317 940 HC FAMILY/COUPLE COUNSELING O $354.17 N/A N/A $115.05 $177.09 $219.59 $219.59 N/A $115.05 N/A $115.05 N/A $265.63 N/A $230.21 $258.90 $138.06 $115.05 $212.50 $283.34 N/A $177.09 $115.05 N/A $230.21 $161.07 $283.34 $115.05 $115.05 $138.06 N/A $115.05 N/A N/A N/A $283.34 $301.04 $155.32 $265.63 $235.85 $155.32 $177.09 $230.21 $239.06 $239.06 $239.06 $239.06 N/A N/A N/A $236.23 $115.05 $115.05 N/A N/A N/A $115.05 $301.04 330104 G0397 5823 316 940 HC ALCOHOL/SUBS INTERV >30 MIN O $363.80 $174.80 $174.80 $153.40 $181.90 $225.56 $225.56 $173.05 $153.40 $332.12 $153.40 $174.80 $272.85 $192.28 $236.47 $265.94 $184.08 $153.40 $218.28 $291.04 $594.33 $181.90 $153.40 $174.80 $209.76 $214.76 $291.04 $153.40 $153.40 $184.08 $244.72 $153.40 $174.80 $174.80 $190.53 $291.04 $309.23 $153.40 $272.85 $314.47 $153.40 $181.90 $288.42 $245.57 $245.57 $245.57 $245.57 N/A $183.54 $174.80 $242.65 $153.40 $153.40 $148.58 $148.58 $174.80 $148.58 $594.33 330104 H0050 315 940 HC ALCOHOL &/OR DRUG SVC BRIEF INTERVENTION PER 15MIN O $218.28 N/A N/A $115.05 $109.14 $135.33 $135.33 N/A $115.05 N/A $115.05 N/A $163.71 N/A $141.88 $159.56 $138.06 $115.05 $130.97 $174.62 N/A $109.14 $115.05 N/A $141.88 $161.07 $174.62 $115.05 $115.05 $138.06 N/A $115.05 N/A N/A N/A $174.62 $185.54 $155.32 $163.71 $235.85 $155.32 $109.14 $141.88 $147.34 $147.34 $147.34 $147.34 N/A N/A N/A $145.59 $115.05 $115.05 N/A N/A N/A $109.14 $235.85 330104 H0002 323 940 HC PSYCHIATRIC DIAGNOSTIC EVALUATION O $432.28 N/A N/A $191.75 $216.14 $268.01 $268.01 N/A $191.75 N/A $191.75 N/A $324.21 N/A $280.98 $316.00 $230.10 $191.75 $259.37 $345.82 N/A $216.14 $191.75 N/A $280.98 $268.45 $345.82 $191.75 $191.75 $230.10 N/A $191.75 N/A N/A N/A $345.82 $367.44 $258.86 $324.21 $393.09 $258.86 $216.14 $280.98 $291.79 $291.79 $291.79 $291.79 N/A N/A N/A $288.33 $191.75 $191.75 N/A N/A N/A $191.75 $393.09 330104 H0001 323 940 HC ALCOHOL AND/OR DRUG ASSESSMENT O $355.24 N/A N/A $191.75 $177.62 $220.25 $220.25 N/A $191.75 N/A $191.75 N/A $266.43 N/A $230.91 $259.68 $230.10 $191.75 $213.14 $284.19 N/A $177.62 $191.75 N/A $230.91 $268.45 $284.19 $191.75 $191.75 $230.10 N/A $191.75 N/A N/A N/A $284.19 $301.95 $258.86 $266.43 $393.09 $258.86 $177.62 $230.91 $239.79 $239.79 $239.79 $239.79 N/A N/A N/A $236.95 $191.75 $191.75 N/A N/A N/A $177.62 $393.09 330104 T1023 324 940 HC PROGRAM INTAKE ASSESSMENT (BRIEF) O $269.64 N/A N/A $51.96 $134.82 $167.18 $167.18 N/A $51.96 N/A $51.96 N/A $202.23 N/A $175.27 $197.11 $62.35 $51.96 $161.78 $215.71 N/A $134.82 $51.96 N/A $175.27 $72.74 $215.71 $51.96 $51.96 $62.35 N/A $51.96 N/A N/A N/A $215.71 $229.19 $70.15 $202.23 $106.52 $70.15 $134.82 $175.27 $182.01 $182.01 $182.01 $182.01 N/A N/A N/A $179.85 $51.96 $51.96 N/A N/A N/A $51.96 $229.19 330104 G0108 428 942 HC DIAB MANAGE TRN PER INDIV O $308.16 $63.26 $63.26 $42.32 $154.08 $191.06 $191.06 $62.63 $42.32 $120.20 $42.32 $63.26 $231.12 $69.59 $200.30 $225.26 $50.78 $42.32 $184.90 $246.53 $215.09 $154.08 $42.32 $63.26 $200.30 $59.25 $246.53 $42.32 $42.32 $50.78 $88.57 $42.32 $63.26 $63.26 $68.96 $246.53 $261.94 $57.13 $231.12 $86.76 $57.13 $154.08 $200.30 $208.01 $208.01 $208.01 $208.01 N/A $66.43 $63.26 $205.54 $42.32 $42.32 $53.77 $53.77 $63.26 $42.32 $261.94 330104 G0109 429 942 HC DIAB MANAGE TRN IND/GROUP O $206.51 $17.94 $17.94 $11.97 $103.25 $128.04 $128.04 $17.76 $11.97 $34.09 $11.97 $17.94 $154.88 $19.74 $134.23 $150.96 $14.36 $11.97 $123.91 $165.21 $61.00 $103.25 $11.97 $17.94 $134.23 $16.76 $165.21 $11.97 $11.97 $14.36 $25.12 $11.97 $17.94 $17.94 $19.56 $165.21 $175.53 $16.16 $154.88 $24.54 $16.16 $103.25 $134.23 $139.39 $139.39 $139.39 $139.39 N/A $18.84 $17.94 $137.74 $11.97 $11.97 $15.25 $15.25 $17.94 $11.97 $175.53 330104 S9460 2005 942 HC DM PROGRAM NURSE VISIT O $543.56 N/A N/A N/A $271.78 $337.01 $337.01 N/A N/A N/A N/A N/A $407.67 N/A $353.31 $397.34 N/A N/A $326.14 $434.85 N/A $271.78 N/A N/A $353.31 N/A $434.85 N/A N/A N/A N/A N/A N/A N/A N/A $434.85 $462.03 N/A $407.67 N/A N/A $271.78 $353.31 $366.90 $366.90 $366.90 $366.90 N/A N/A N/A $362.55 N/A N/A N/A N/A N/A $271.78 $462.03 330104 97802 118 942 HC MEDICAL NUTRITION INDIV IN O $210.79 $37.00 $37.00 N/A $105.39 $130.69 $130.69 $36.63 N/A $70.30 N/A $37.00 $158.09 $40.70 $137.01 $154.09 N/A N/A $126.47 $168.63 $125.79 $105.39 N/A $37.00 $137.01 N/A $168.63 N/A N/A N/A $51.80 N/A $37.00 $37.00 $40.33 $168.63 $179.17 N/A $158.09 N/A N/A $105.39 $137.01 $142.28 $142.28 $142.28 $142.28 N/A $38.85 $37.00 $140.60 N/A N/A $31.45 $31.45 $37.00 $31.45 $179.17 330104 97803 118 942 HC MED NUTRITION INDIV SUBSEQ O $160.50 $31.26 $31.26 N/A $80.25 $99.51 $99.51 $30.95 N/A $59.39 N/A $31.26 $120.38 $34.39 $104.33 $117.33 N/A N/A $96.30 $128.40 $106.28 $80.25 N/A $31.26 $104.33 N/A $128.40 N/A N/A N/A $43.76 N/A $31.26 $31.26 $34.07 $128.40 $136.42 N/A $120.38 N/A N/A $80.25 $104.33 $108.34 $108.34 $108.34 $108.34 N/A $32.82 $31.26 $107.05 N/A N/A $26.57 $26.57 $31.26 $26.57 $136.42 330104 97804 118 942 HC MEDICAL NUTRITION GROUP O $110.21 $17.94 $17.94 N/A $55.10 $68.33 $68.33 $17.76 N/A $34.09 N/A $17.94 $82.66 $19.74 $71.64 $80.56 N/A N/A $66.13 $88.17 $61.00 $55.10 N/A $17.94 $71.64 N/A $88.17 N/A N/A N/A $25.12 N/A $17.94 $17.94 $19.56 $88.17 $93.68 N/A $82.66 N/A N/A $55.10 $71.64 $74.39 $74.39 $74.39 $74.39 N/A $18.84 $17.94 $73.51 N/A N/A $15.25 $15.25 $17.94 $15.25 $93.68 330104 98975 5012 418 942 HC REMOTE THERAPEUTIC MNTR 1ST SETUP&PT EDUCAJ EQP O $314.58 $145.00 $145.00 $187.76 $157.29 $195.04 $195.04 $143.55 $187.76 $275.50 $187.76 $145.00 $235.94 $159.50 $204.48 $229.96 $225.31 $187.76 $188.75 $251.66 $493.00 $157.29 $187.76 $145.00 $174.00 $262.86 $251.66 $187.76 $187.76 $225.31 $203.00 $187.76 $145.00 $145.00 $158.05 $251.66 $267.39 $187.76 $235.94 $384.90 $187.76 $157.29 $239.25 $212.34 $212.34 $212.34 $212.34 N/A $152.25 $145.00 $209.82 $187.76 $187.76 $123.25 $123.25 $145.00 $123.25 $493.00 330104 93797 5771 94 943 HC CARDIAC REHAB O $606.69 $144.05 $144.05 $4.63 $303.35 $376.15 $376.15 $142.61 $4.63 $273.70 $4.63 $144.05 $455.02 $158.46 $394.35 $408.00 $5.56 $4.63 $364.01 $485.35 $489.78 $303.35 $4.63 $144.05 $172.86 $6.48 $485.35 $4.63 $4.63 $5.56 $201.67 $4.63 $144.05 $144.05 $157.02 $485.35 $515.69 $4.63 $455.02 $9.49 $4.63 $303.35 $237.69 $409.52 $409.52 $409.52 $409.52 N/A $151.26 $144.05 $404.66 $4.63 $4.63 $122.44 $122.44 $144.05 $4.63 $515.69 330104 93798 5771 94 943 HC CARDIAC REHAB/MONITOR O $606.69 $144.05 $144.05 $7.25 $303.35 $376.15 $376.15 $142.61 $7.25 $273.70 $7.25 $144.05 $455.02 $158.46 $394.35 $408.00 $8.70 $7.25 $364.01 $485.35 $489.78 $303.35 $7.25 $144.05 $172.86 $10.15 $485.35 $7.25 $7.25 $8.70 $201.67 $7.25 $144.05 $144.05 $157.02 $485.35 $515.69 $7.25 $455.02 $14.86 $7.25 $303.35 $237.69 $409.52 $409.52 $409.52 $409.52 N/A $151.26 $144.05 $404.66 $7.25 $7.25 $122.44 $122.44 $144.05 $7.25 $515.69 330104 G0424 66 948 HC PULMONARY REHAB W EXER O $242.89 N/A N/A N/A $121.44 $150.59 $150.59 $158.85 N/A N/A N/A N/A $182.17 N/A $157.88 $177.55 N/A N/A $145.73 $194.31 N/A $121.44 N/A N/A N/A N/A $194.31 N/A N/A N/A N/A N/A N/A N/A N/A $194.31 $206.46 N/A $182.17 N/A N/A $121.44 $157.88 $163.95 $163.95 $163.95 $163.95 N/A N/A N/A $162.01 N/A N/A N/A N/A N/A $121.44 $206.46 330104 1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC I N/A N/A "$248,369.09 " N/A "$427,314.09 " "$449,662.09 " "$409,582.05 " "$245,885.40 " N/A "$471,901.27 " N/A "$248,369.09 " "$851,278.79 " "$273,206.00 " "$1,050,547.55 " "$869,433.03 " N/A N/A N/A "$1,750,265.23 " "$1,213,885.00 " "$1,646,209.10 " N/A "$255,820.16 " "$307,977.67 " N/A N/A N/A N/A N/A "$347,716.73 " N/A "$248,369.09 " "$248,369.09 " "$270,722.31 " N/A N/A N/A N/A N/A N/A N/A "$988,491.03 " "$799,124.07 " "$799,124.07 " "$799,124.07 " "$799,124.07 " "$481,579.77 " "$273,206.00 " "$248,369.09 " "$519,379.98 " N/A N/A N/A N/A "$248,369.09 " "$245,885.40 " "$1,750,265.23 " 330104 2 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC I N/A N/A "$119,088.06 " N/A "$204,548.60 " "$215,246.25 " "$196,060.55 " "$117,897.18 " N/A "$226,267.31 " N/A "$119,088.06 " "$407,493.91 " "$130,996.86 " "$502,880.76 " "$416,184.06 " N/A N/A N/A "$837,824.72 " "$581,067.86 " "$788,014.67 " N/A "$122,660.70 " "$147,669.19 " N/A N/A N/A N/A N/A "$166,723.28 " N/A "$119,088.06 " "$119,088.06 " "$129,805.98 " N/A N/A N/A N/A N/A N/A N/A "$473,175.27 " "$382,528.26 " "$382,528.26 " "$382,528.26 " "$382,528.26 " "$230,524.74 " "$130,996.86 " "$119,088.06 " "$248,619.11 " N/A N/A N/A N/A "$119,088.06 " "$117,897.18 " "$837,824.72 " 330104 3 "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES" I N/A N/A "$178,684.38 " N/A "$307,239.65 " "$323,307.91 " "$294,490.28 " "$176,897.54 " N/A "$339,500.33 " N/A "$178,684.38 " "$612,071.09 " "$196,552.82 " "$755,345.71 " "$625,124.02 " N/A N/A N/A "$1,258,444.06 " "$872,785.65 " "$1,183,627.50 " N/A "$184,044.92 " "$221,568.64 " N/A N/A N/A N/A N/A "$250,158.14 " N/A "$178,684.38 " "$178,684.38 " "$194,765.98 " N/A N/A N/A N/A N/A N/A N/A "$710,726.95 " "$574,571.74 " "$574,571.74 " "$574,571.74 " "$574,571.74 " "$346,256.78 " "$196,552.82 " "$178,684.38 " "$373,435.21 " N/A N/A N/A N/A "$178,684.38 " "$176,897.54 " "$1,258,444.06 " 330104 4 "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES" I N/A N/A "$121,366.53 " N/A "$208,474.67 " "$219,377.64 " "$199,823.70 " "$120,152.87 " N/A "$230,596.42 " N/A "$121,366.53 " "$415,315.27 " "$133,503.19 " "$512,532.96 " "$424,172.21 " N/A N/A N/A "$853,905.76 " "$592,220.76 " "$803,139.67 " N/A "$125,007.53 " "$150,494.50 " N/A N/A N/A N/A N/A "$169,913.15 " N/A "$121,366.53 " "$121,366.53 " "$132,289.52 " N/A N/A N/A N/A N/A N/A N/A "$482,257.30 " "$389,870.43 " "$389,870.43 " "$389,870.43 " "$389,870.43 " "$234,949.39 " "$133,503.19 " "$121,366.53 " "$253,391.06 " N/A N/A N/A N/A "$121,366.53 " "$120,152.87 " "$853,905.76 " 330104 5 LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT I N/A N/A "$100,884.04 " N/A "$173,181.07 " "$182,238.23 " "$165,994.66 " "$99,875.20 " N/A "$191,679.68 " N/A "$100,884.04 " "$345,004.72 " "$110,972.45 " "$425,763.99 " "$352,362.23 " N/A N/A N/A "$709,344.30 " "$491,961.10 " "$667,172.62 " N/A "$103,910.56 " "$125,096.21 " N/A N/A N/A N/A N/A "$141,237.66 " N/A "$100,884.04 " "$100,884.04 " "$109,963.61 " N/A N/A N/A N/A N/A N/A N/A "$400,613.84 " "$323,867.54 " "$323,867.54 " "$323,867.54 " "$323,867.54 " "$195,173.77 " "$110,972.45 " "$100,884.04 " "$210,493.37 " N/A N/A N/A N/A "$100,884.04 " "$99,875.20 " "$709,344.30 " 330104 6 LIVER TRANSPLANT WITHOUT MCC I N/A N/A "$42,752.95 " N/A "$73,014.79 " "$76,833.38 " "$69,984.93 " "$42,325.42 " N/A "$81,230.61 " N/A "$42,752.95 " "$145,457.28 " "$47,028.25 " "$179,506.16 " "$148,559.28 " N/A N/A N/A "$299,066.32 " "$207,415.49 " "$281,286.34 " N/A "$44,035.54 " "$53,013.66 " N/A N/A N/A N/A N/A "$59,854.14 " N/A "$42,752.95 " "$42,752.95 " "$46,600.72 " N/A N/A N/A N/A N/A N/A N/A "$168,902.62 " "$136,545.65 " "$136,545.65 " "$136,545.65 " "$136,545.65 " "$82,287.12 " "$47,028.25 " "$42,752.95 " "$88,746.01 " N/A N/A N/A N/A "$42,752.95 " "$42,325.42 " "$299,066.32 " 330104 7 LUNG TRANSPLANT I N/A N/A "$107,935.33 " N/A "$185,331.23 " "$195,023.82 " "$177,640.63 " "$106,855.98 " N/A "$205,077.13 " N/A "$107,935.33 " "$369,209.79 " "$118,728.87 " "$455,635.03 " "$377,083.50 " N/A N/A N/A "$759,110.95 " "$526,476.43 " "$713,980.56 " N/A "$111,173.39 " "$133,839.81 " N/A N/A N/A N/A N/A "$151,109.47 " N/A "$107,935.33 " "$107,935.33 " "$117,649.51 " N/A N/A N/A N/A N/A N/A N/A "$428,720.38 " "$346,589.66 " "$346,589.66 " "$346,589.66 " "$346,589.66 " "$208,866.90 " "$118,728.87 " "$107,935.33 " "$225,261.31 " N/A N/A N/A N/A "$107,935.33 " "$106,855.98 " "$759,110.95 " 330104 8 SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT I N/A N/A "$49,641.25 " N/A "$84,884.08 " "$89,323.41 " "$81,361.69 " "$49,144.83 " N/A "$94,318.37 " N/A "$49,641.25 " "$169,102.82 " "$54,605.37 " "$208,686.69 " "$172,709.08 " N/A N/A N/A "$347,682.55 " "$241,132.96 " "$327,012.26 " N/A "$51,130.48 " "$61,555.14 " N/A N/A N/A N/A N/A "$69,497.74 " N/A "$49,641.25 " "$49,641.25 " "$54,108.96 " N/A N/A N/A N/A N/A N/A N/A "$196,359.43 " "$158,742.51 " "$158,742.51 " "$158,742.51 " "$158,742.51 " "$95,663.72 " "$54,605.37 " "$49,641.25 " "$103,172.57 " N/A N/A N/A N/A "$49,641.25 " "$49,144.83 " "$347,682.55 " 330104 10 PANCREAS TRANSPLANT I N/A N/A "$36,915.79 " N/A "$62,956.72 " "$66,249.28 " "$60,344.23 " "$36,546.63 " N/A "$70,140.00 " N/A "$36,915.79 " "$125,419.97 " "$40,607.37 " "$154,778.48 " "$128,094.65 " N/A N/A N/A "$257,868.76 " "$178,843.19 " "$242,538.04 " N/A "$38,023.27 " "$45,775.58 " N/A N/A N/A N/A N/A "$51,682.11 " N/A "$36,915.79 " "$36,915.79 " "$40,238.21 " N/A N/A N/A N/A N/A N/A N/A "$145,635.62 " "$117,735.95 " "$117,735.95 " "$117,735.95 " "$117,735.95 " "$70,951.75 " "$40,607.37 " "$36,915.79 " "$76,520.90 " N/A N/A N/A N/A "$36,915.79 " "$36,546.63 " "$257,868.76 " 330104 11 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC" I N/A N/A "$45,888.72 " N/A "$78,418.07 " "$82,519.24 " "$75,163.99 " "$45,429.83 " N/A "$87,188.57 " N/A "$45,888.72 " "$156,221.47 " "$50,477.59 " "$192,790.06 " "$159,553.03 " N/A N/A N/A "$321,197.96 " "$222,764.75 " "$302,102.22 " N/A "$47,265.38 " "$56,902.01 " N/A N/A N/A N/A N/A "$64,244.21 " N/A "$45,888.72 " "$45,888.72 " "$50,018.71 " N/A N/A N/A N/A N/A N/A N/A "$181,401.82 " "$146,650.36 " "$146,650.36 " "$146,650.36 " "$146,650.36 " "$88,376.57 " "$50,477.59 " "$45,888.72 " "$95,313.44 " N/A N/A N/A N/A "$45,888.72 " "$45,429.83 " "$321,197.96 " 330104 12 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC" I N/A N/A "$34,824.99 " N/A "$59,354.03 " "$62,458.17 " "$56,891.04 " "$34,476.74 " N/A "$66,167.47 " N/A "$34,824.99 " "$118,242.83 " "$38,307.48 " "$145,921.31 " "$120,764.46 " N/A N/A N/A "$243,112.26 " "$168,608.92 " "$228,658.84 " N/A "$35,869.74 " "$43,182.98 " N/A N/A N/A N/A N/A "$48,754.98 " N/A "$34,824.99 " "$34,824.99 " "$37,959.23 " N/A N/A N/A N/A N/A N/A N/A "$137,301.64 " "$110,998.52 " "$110,998.52 " "$110,998.52 " "$110,998.52 " "$66,891.54 " "$38,307.48 " "$34,824.99 " "$72,142.00 " N/A N/A N/A N/A "$34,824.99 " "$34,476.74 " "$243,112.26 " 330104 13 "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC" I N/A N/A "$25,298.74 " N/A "$42,939.25 " "$45,184.92 " "$41,157.42 " "$25,045.75 " N/A "$48,067.60 " N/A "$25,298.74 " "$85,541.93 " "$27,828.61 " "$105,565.73 " "$87,366.19 " N/A N/A N/A "$175,877.84 " "$121,978.92 " "$165,421.61 " N/A "$26,057.70 " "$31,370.43 " N/A N/A N/A N/A N/A "$35,418.23 " N/A "$25,298.74 " "$25,298.74 " "$27,575.62 " N/A N/A N/A N/A N/A N/A N/A "$99,329.90 " "$80,301.09 " "$80,301.09 " "$80,301.09 " "$80,301.09 " "$48,392.21 " "$27,828.61 " "$25,298.74 " "$52,190.62 " N/A N/A N/A N/A "$25,298.74 " "$25,045.75 " "$175,877.84 " 330104 14 ALLOGENEIC BONE MARROW TRANSPLANT I N/A N/A "$98,998.53 " N/A "$169,932.13 " "$178,819.37 " "$162,880.54 " "$98,008.54 " N/A "$188,097.20 " N/A "$98,998.53 " "$338,532.28 " "$108,898.38 " "$417,776.49 " "$345,751.77 " N/A N/A N/A "$696,036.70 " "$482,731.70 " "$654,656.18 " N/A "$101,968.48 " "$122,758.18 " N/A N/A N/A N/A N/A "$138,597.94 " N/A "$98,998.53 " "$98,998.53 " "$107,908.40 " N/A N/A N/A N/A N/A N/A N/A "$393,098.16 " "$317,791.66 " "$317,791.66 " "$317,791.66 " "$317,791.66 " "$191,512.23 " "$108,898.38 " "$98,998.53 " "$206,544.43 " N/A N/A N/A N/A "$98,998.53 " "$98,008.54 " "$696,036.70 " 330104 16 AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC I N/A N/A "$53,987.62 " N/A "$92,373.36 " "$97,204.37 " "$88,540.19 " "$53,447.74 " N/A "$102,576.48 " N/A "$53,987.62 " "$184,022.68 " "$59,386.38 " "$227,099.01 " "$187,947.12 " N/A N/A N/A "$378,358.41 " "$262,408.00 " "$355,864.39 " N/A "$55,607.25 " "$66,944.65 " N/A N/A N/A N/A N/A "$75,582.67 " N/A "$53,987.62 " "$53,987.62 " "$58,846.50 " N/A N/A N/A N/A N/A N/A N/A "$213,684.13 " "$172,748.28 " "$172,748.28 " "$172,748.28 " "$172,748.28 " "$104,104.08 " "$59,386.38 " "$53,987.62 " "$112,275.43 " N/A N/A N/A N/A "$53,987.62 " "$53,447.74 " "$378,358.41 " 330104 17 AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC I N/A N/A "$38,883.25 " N/A "$66,346.86 " "$69,816.72 " "$63,593.70 " "$38,494.41 " N/A "$73,878.17 " N/A "$38,883.25 " "$132,173.67 " "$42,771.57 " "$163,113.11 " "$134,992.39 " N/A N/A N/A "$271,754.67 " "$188,473.67 " "$255,598.41 " N/A "$40,049.74 " "$48,215.22 " N/A N/A N/A N/A N/A "$54,436.54 " N/A "$38,883.25 " "$38,883.25 " "$42,382.74 " N/A N/A N/A N/A N/A N/A N/A "$153,477.91 " "$124,075.88 " "$124,075.88 " "$124,075.88 " "$124,075.88 " "$74,772.41 " "$42,771.57 " "$38,883.25 " "$80,641.46 " N/A N/A N/A N/A "$38,883.25 " "$38,494.41 " "$271,754.67 " 330104 18 CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES I N/A N/A "$318,847.65 " N/A "$548,756.43 " "$577,455.72 " "$525,984.95 " "$315,659.17 " N/A "$605,810.53 " N/A "$318,847.65 " "$1,093,211.57 " "$350,732.41 " "$1,349,112.36 " "$1,116,525.23 " N/A N/A N/A "$2,247,689.26 " "$1,558,870.19 " "$2,114,060.46 " N/A "$328,413.08 " "$395,371.08 " N/A N/A N/A N/A N/A "$446,386.71 " N/A "$318,847.65 " "$318,847.65 " "$347,543.94 " N/A N/A N/A N/A N/A N/A N/A "$1,269,419.42 " "$1,026,234.52 " "$1,026,234.52 " "$1,026,234.52 " "$1,026,234.52 " "$618,444.37 " "$350,732.41 " "$318,847.65 " "$666,987.38 " N/A N/A N/A N/A "$318,847.65 " "$315,659.17 " "$2,247,689.26 " 330104 19 SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS I N/A N/A "$63,240.73 " N/A "$108,317.50 " "$113,982.37 " "$103,822.70 " "$62,608.33 " N/A "$120,157.39 " N/A "$63,240.73 " "$215,785.98 " "$69,564.81 " "$266,297.52 " "$220,387.79 " N/A N/A N/A "$443,665.10 " "$307,701.03 " "$417,288.48 " N/A "$65,137.95 " "$78,418.51 " N/A N/A N/A N/A N/A "$88,537.03 " N/A "$63,240.73 " "$63,240.73 " "$68,932.40 " N/A N/A N/A N/A N/A N/A N/A "$250,567.15 " "$202,565.56 " "$202,565.56 " "$202,565.56 " "$202,565.56 " "$122,073.01 " "$69,564.81 " "$63,240.73 " "$131,654.77 " N/A N/A N/A N/A "$63,240.73 " "$62,608.33 " "$443,665.10 " 330104 20 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC I N/A N/A "$82,348.74 " N/A "$141,242.70 " "$148,629.52 " "$135,381.62 " "$81,525.25 " N/A "$156,462.60 " N/A "$82,348.74 " "$281,378.31 " "$90,583.61 " "$347,243.81 " "$287,378.94 " N/A N/A N/A "$578,525.71 " "$401,232.72 " "$544,131.41 " N/A "$84,819.20 " "$102,112.44 " N/A N/A N/A N/A N/A "$115,288.23 " N/A "$82,348.74 " "$82,348.74 " "$89,760.13 " N/A N/A N/A N/A N/A N/A N/A "$326,731.90 " "$264,139.29 " "$264,139.29 " "$264,139.29 " "$264,139.29 " "$159,179.46 " "$90,583.61 " "$82,348.74 " "$171,673.79 " N/A N/A N/A N/A "$82,348.74 " "$81,525.25 " "$578,525.71 " 330104 21 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC I N/A N/A "$60,197.48 " N/A "$103,073.63 " "$108,464.26 " "$98,796.44 " "$59,595.50 " N/A "$114,375.21 " N/A "$60,197.48 " "$205,339.35 " "$66,217.23 " "$253,405.53 " "$209,718.39 " N/A N/A N/A "$422,186.40 " "$292,804.62 " "$397,086.73 " N/A "$62,003.40 " "$74,644.87 " N/A N/A N/A N/A N/A "$84,276.47 " N/A "$60,197.48 " "$60,197.48 " "$65,615.25 " N/A N/A N/A N/A N/A N/A N/A "$238,436.70 " "$192,758.97 " "$192,758.97 " "$192,758.97 " "$192,758.97 " "$116,163.21 " "$66,217.23 " "$60,197.48 " "$125,281.11 " N/A N/A N/A N/A "$60,197.48 " "$59,595.50 " "$422,186.40 " 330104 22 INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC I N/A N/A "$38,781.04 " N/A "$66,170.75 " "$69,631.40 " "$63,424.89 " "$38,393.23 " N/A "$73,683.98 " N/A "$38,781.04 " "$131,822.83 " "$42,659.14 " "$162,680.14 " "$134,634.07 " N/A N/A N/A "$271,033.32 " "$187,973.39 " "$254,919.95 " N/A "$39,944.47 " "$48,088.49 " N/A N/A N/A N/A N/A "$54,293.46 " N/A "$38,781.04 " "$38,781.04 " "$42,271.33 " N/A N/A N/A N/A N/A N/A N/A "$153,070.52 " "$123,746.53 " "$123,746.53 " "$123,746.53 " "$123,746.53 " "$74,573.93 " "$42,659.14 " "$38,781.04 " "$80,427.40 " N/A N/A N/A N/A "$38,781.04 " "$38,393.23 " "$271,033.32 " 330104 23 CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR I N/A N/A "$50,877.40 " N/A "$87,014.11 " "$91,564.85 " "$83,403.33 " "$50,368.63 " N/A "$96,667.06 " N/A "$50,877.40 " "$173,346.19 " "$55,965.14 " "$213,923.36 " "$177,042.95 " N/A N/A N/A "$356,407.11 " "$247,183.82 " "$335,218.12 " N/A "$52,403.72 " "$63,087.98 " N/A N/A N/A N/A N/A "$71,228.36 " N/A "$50,877.40 " "$50,877.40 " "$55,456.37 " N/A N/A N/A N/A N/A N/A N/A "$201,286.77 " "$162,725.91 " "$162,725.91 " "$162,725.91 " "$162,725.91 " "$98,064.25 " "$55,965.14 " "$50,877.40 " "$105,761.52 " N/A N/A N/A N/A "$50,877.40 " "$50,368.63 " "$356,407.11 " 330104 24 CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC I N/A N/A "$35,171.25 " N/A "$59,950.68 " "$63,086.03 " "$57,462.94 " "$34,819.54 " N/A "$66,825.38 " N/A "$35,171.25 " "$119,431.46 " "$38,688.38 " "$147,388.17 " "$121,978.43 " N/A N/A N/A "$245,556.13 " "$170,303.85 " "$230,957.41 " N/A "$36,226.39 " "$43,612.35 " N/A N/A N/A N/A N/A "$49,239.75 " N/A "$35,171.25 " "$35,171.25 " "$38,336.66 " N/A N/A N/A N/A N/A N/A N/A "$138,681.86 " "$112,114.33 " "$112,114.33 " "$112,114.33 " "$112,114.33 " "$67,563.97 " "$38,688.38 " "$35,171.25 " "$72,867.21 " N/A N/A N/A N/A "$35,171.25 " "$34,819.54 " "$245,556.13 " 330104 25 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC I N/A N/A "$40,384.61 " N/A "$68,933.87 " "$72,539.03 " "$66,073.36 " "$39,980.76 " N/A "$76,730.75 " N/A "$40,384.61 " "$137,327.42 " "$44,423.07 " "$169,473.25 " "$140,256.04 " N/A N/A N/A "$282,350.99 " "$195,822.68 " "$265,564.76 " N/A "$41,596.15 " "$50,076.91 " N/A N/A N/A N/A N/A "$56,538.45 " N/A "$40,384.61 " "$40,384.61 " "$44,019.22 " N/A N/A N/A N/A N/A N/A N/A "$159,462.36 " "$128,913.88 " "$128,913.88 " "$128,913.88 " "$128,913.88 " "$77,687.96 " "$44,423.07 " "$40,384.61 " "$83,785.85 " N/A N/A N/A N/A "$40,384.61 " "$39,980.76 " "$282,350.99 " 330104 26 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC I N/A N/A "$27,018.61 " N/A "$45,902.78 " "$48,303.44 " "$43,997.97 " "$26,748.42 " N/A "$51,335.35 " N/A "$27,018.61 " "$91,445.76 " "$29,720.47 " "$112,851.53 " "$93,395.91 " N/A N/A N/A "$188,016.35 " "$130,397.51 " "$176,838.47 " N/A "$27,829.17 " "$33,503.07 " N/A N/A N/A N/A N/A "$37,826.05 " N/A "$27,018.61 " "$27,018.61 " "$29,450.28 " N/A N/A N/A N/A N/A N/A N/A "$106,185.32 " "$85,843.21 " "$85,843.21 " "$85,843.21 " "$85,843.21 " "$51,732.08 " "$29,720.47 " "$27,018.61 " "$55,792.65 " N/A N/A N/A N/A "$27,018.61 " "$26,748.42 " "$188,016.35 " 330104 27 CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC I N/A N/A "$22,365.62 " N/A "$37,885.16 " "$39,866.51 " "$36,313.06 " "$22,141.96 " N/A "$42,494.67 " N/A "$22,365.62 " "$75,473.37 " "$24,602.18 " "$93,140.31 " "$77,082.91 " N/A N/A N/A "$155,176.45 " "$107,621.61 " "$145,950.96 " N/A "$23,036.59 " "$27,733.37 " N/A N/A N/A N/A N/A "$31,311.87 " N/A "$22,365.62 " "$22,365.62 " "$24,378.52 " N/A N/A N/A N/A N/A N/A N/A "$87,638.45 " "$70,849.40 " "$70,849.40 " "$70,849.40 " "$70,849.40 " "$42,696.29 " "$24,602.18 " "$22,365.62 " "$46,047.62 " N/A N/A N/A N/A "$22,365.62 " "$22,141.96 " "$155,176.45 " 330104 28 SPINAL PROCEDURES WITH MCC I N/A N/A "$52,164.66 " N/A "$89,232.21 " "$93,898.94 " "$85,529.38 " "$51,643.02 " N/A "$99,112.86 " N/A "$52,164.66 " "$177,764.99 " "$57,381.13 " "$219,376.51 " "$181,555.98 " N/A N/A N/A "$365,492.34 " "$253,484.82 " "$343,763.22 " N/A "$53,729.60 " "$64,684.18 " N/A N/A N/A N/A N/A "$73,030.53 " N/A "$52,164.66 " "$52,164.66 " "$56,859.48 " N/A N/A N/A N/A N/A N/A N/A "$206,417.80 " "$166,873.98 " "$166,873.98 " "$166,873.98 " "$166,873.98 " "$100,564.03 " "$57,381.13 " "$52,164.66 " "$108,457.51 " N/A N/A N/A N/A "$52,164.66 " "$51,643.02 " "$365,492.34 " 330104 29 SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS I N/A N/A "$30,490.95 " N/A "$51,886.00 " "$54,599.58 " "$49,732.92 " "$30,186.04 " N/A "$57,932.80 " N/A "$30,490.95 " "$103,365.31 " "$33,540.04 " "$127,561.24 " "$105,569.66 " N/A N/A N/A "$212,523.46 " "$147,394.25 " "$199,888.59 " N/A "$31,405.68 " "$37,808.78 " N/A N/A N/A N/A N/A "$42,687.33 " N/A "$30,490.95 " "$30,490.95 " "$33,235.13 " N/A N/A N/A N/A N/A N/A N/A "$120,026.11 " "$97,032.50 " "$97,032.50 " "$97,032.50 " "$97,032.50 " "$58,475.14 " "$33,540.04 " "$30,490.95 " "$63,064.97 " N/A N/A N/A N/A "$30,490.95 " "$30,186.04 " "$212,523.46 " 330104 30 SPINAL PROCEDURES WITHOUT CC/MCC I N/A N/A "$21,006.99 " N/A "$35,544.10 " "$37,403.01 " "$34,069.14 " "$20,796.92 " N/A "$39,913.28 " N/A "$21,006.99 " "$70,809.59 " "$23,107.69 " "$87,384.82 " "$72,319.67 " N/A N/A N/A "$145,587.52 " "$100,971.27 " "$136,932.11 " N/A "$21,637.20 " "$26,048.67 " N/A N/A N/A N/A N/A "$29,409.79 " N/A "$21,006.99 " "$21,006.99 " "$22,897.62 " N/A N/A N/A N/A N/A N/A N/A "$82,222.94 " "$66,471.35 " "$66,471.35 " "$66,471.35 " "$66,471.35 " "$40,057.93 " "$23,107.69 " "$21,006.99 " "$43,202.16 " N/A N/A N/A N/A "$21,006.99 " "$20,796.92 " "$145,587.52 " 330104 31 VENTRICULAR SHUNT PROCEDURES WITH MCC I N/A N/A "$36,688.47 " N/A "$62,565.02 " "$65,837.10 " "$59,968.79 " "$36,321.59 " N/A "$69,708.10 " N/A "$36,688.47 " "$124,639.65 " "$40,357.32 " "$153,815.50 " "$127,297.69 " N/A N/A N/A "$256,264.39 " "$177,730.49 " "$241,029.05 " N/A "$37,789.13 " "$45,493.71 " N/A N/A N/A N/A N/A "$51,363.86 " N/A "$36,688.47 " "$36,688.47 " "$39,990.43 " N/A N/A N/A N/A N/A N/A N/A "$144,729.52 " "$117,003.43 " "$117,003.43 " "$117,003.43 " "$117,003.43 " "$70,510.31 " "$40,357.32 " "$36,688.47 " "$76,044.81 " N/A N/A N/A N/A "$36,688.47 " "$36,321.59 " "$256,264.39 " 330104 32 VENTRICULAR SHUNT PROCEDURES WITH CC I N/A N/A "$18,480.93 " N/A "$31,191.42 " "$32,822.69 " "$29,897.08 " "$18,296.12 " N/A "$35,113.77 " N/A "$18,480.93 " "$62,138.35 " "$20,329.02 " "$76,683.80 " "$63,463.50 " N/A N/A N/A "$127,759.08 " "$88,606.48 " "$120,163.60 " N/A "$19,035.36 " "$22,916.35 " N/A N/A N/A N/A N/A "$25,873.30 " N/A "$18,480.93 " "$18,480.93 " "$20,144.22 " N/A N/A N/A N/A N/A N/A N/A "$72,154.04 " "$58,331.36 " "$58,331.36 " "$58,331.36 " "$58,331.36 " "$35,152.50 " "$20,329.02 " "$18,480.93 " "$37,911.69 " N/A N/A N/A N/A "$18,480.93 " "$18,296.12 " "$127,759.08 " 330104 33 VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC I N/A N/A "$15,344.28 " N/A "$25,786.63 " "$27,135.24 " "$24,716.57 " "$15,190.84 " N/A "$29,154.14 " N/A "$15,344.28 " "$51,371.13 " "$16,878.71 " "$63,396.17 " "$52,466.66 " N/A N/A N/A "$105,621.22 " "$73,252.91 " "$99,341.87 " N/A "$15,804.61 " "$19,026.91 " N/A N/A N/A N/A N/A "$21,482.00 " N/A "$15,344.28 " "$15,344.28 " "$16,725.27 " N/A N/A N/A N/A N/A N/A N/A "$59,651.32 " "$48,223.81 " "$48,223.81 " "$48,223.81 " "$48,223.81 " "$29,061.33 " "$16,878.71 " "$15,344.28 " "$31,342.42 " N/A N/A N/A N/A "$15,344.28 " "$15,190.84 " "$105,621.22 " 330104 34 CAROTID ARTERY STENT PROCEDURES WITH MCC I N/A N/A "$35,617.08 " N/A "$60,718.89 " "$63,894.41 " "$58,199.27 " "$35,260.91 " N/A "$67,672.45 " N/A "$35,617.08 " "$120,961.85 " "$39,178.79 " "$149,276.81 " "$123,541.47 " N/A N/A N/A "$248,702.69 " "$172,486.12 " "$233,916.91 " N/A "$36,685.59 " "$44,165.18 " N/A N/A N/A N/A N/A "$49,863.91 " N/A "$35,617.08 " "$35,617.08 " "$38,822.61 " N/A N/A N/A N/A N/A N/A N/A "$140,458.93 " "$113,550.96 " "$113,550.96 " "$113,550.96 " "$113,550.96 " "$68,429.73 " "$39,178.79 " "$35,617.08 " "$73,800.93 " N/A N/A N/A N/A "$35,617.08 " "$35,260.91 " "$248,702.69 " 330104 35 CAROTID ARTERY STENT PROCEDURES WITH CC I N/A N/A "$20,501.25 " N/A "$34,672.65 " "$36,485.99 " "$33,233.86 " "$20,296.24 " N/A "$38,952.38 " N/A "$20,501.25 " "$69,073.53 " "$22,551.38 " "$85,242.38 " "$70,546.58 " N/A N/A N/A "$142,018.10 " "$98,495.73 " "$133,574.89 " N/A "$21,116.29 " "$25,421.55 " N/A N/A N/A N/A N/A "$28,701.75 " N/A "$20,501.25 " "$20,501.25 " "$22,346.36 " N/A N/A N/A N/A N/A N/A N/A "$80,207.06 " "$64,841.65 " "$64,841.65 " "$64,841.65 " "$64,841.65 " "$39,075.82 " "$22,551.38 " "$20,501.25 " "$42,142.96 " N/A N/A N/A N/A "$20,501.25 " "$20,296.24 " "$142,018.10 " 330104 36 CAROTID ARTERY STENT PROCEDURES WITHOUT CC/MCC I N/A N/A "$16,949.61 " N/A "$28,552.79 " "$30,046.06 " "$27,367.95 " "$16,780.12 " N/A "$32,204.26 " N/A "$16,949.61 " "$56,881.77 " "$18,644.57 " "$70,196.75 " "$58,094.82 " N/A N/A N/A "$116,951.33 " "$81,110.83 " "$109,998.38 " N/A "$17,458.10 " "$21,017.52 " N/A N/A N/A N/A N/A "$23,729.46 " N/A "$16,949.61 " "$16,949.61 " "$18,475.08 " N/A N/A N/A N/A N/A N/A N/A "$66,050.18 " "$53,396.83 " "$53,396.83 " "$53,396.83 " "$53,396.83 " "$32,178.78 " "$18,644.57 " "$16,949.61 " "$34,704.56 " N/A N/A N/A N/A "$16,949.61 " "$16,780.12 " "$116,951.33 " 330104 37 EXTRACRANIAL PROCEDURES WITH MCC I N/A N/A "$30,097.99 " N/A "$51,208.89 " "$53,887.05 " "$49,083.90 " "$29,797.01 " N/A "$57,186.17 " N/A "$30,097.99 " "$102,016.39 " "$33,107.78 " "$125,896.55 " "$104,191.97 " N/A N/A N/A "$209,750.01 " "$145,470.74 " "$197,280.02 " N/A "$31,000.93 " "$37,321.50 " N/A N/A N/A N/A N/A "$42,137.18 " N/A "$30,097.99 " "$30,097.99 " "$32,806.80 " N/A N/A N/A N/A N/A N/A N/A "$118,459.76 " "$95,766.22 " "$95,766.22 " "$95,766.22 " "$95,766.22 " "$57,712.03 " "$33,107.78 " "$30,097.99 " "$62,241.97 " N/A N/A N/A N/A "$30,097.99 " "$29,797.01 " "$209,750.01 " 330104 38 EXTRACRANIAL PROCEDURES WITH CC I N/A N/A "$14,789.20 " N/A "$24,830.16 " "$26,128.75 " "$23,799.80 " "$14,641.31 " N/A "$28,099.48 " N/A "$14,789.20 " "$49,465.70 " "$16,268.12 " "$61,044.71 " "$50,520.60 " N/A N/A N/A "$101,703.57 " "$70,535.84 " "$95,657.12 " N/A "$15,232.88 " "$18,338.61 " N/A N/A N/A N/A N/A "$20,704.88 " N/A "$14,789.20 " "$14,789.20 " "$16,120.23 " N/A N/A N/A N/A N/A N/A N/A "$57,438.76 " "$46,435.12 " "$46,435.12 " "$46,435.12 " "$46,435.12 " "$27,983.40 " "$16,268.12 " "$14,789.20 " "$30,179.88 " N/A N/A N/A N/A "$14,789.20 " "$14,641.31 " "$101,703.57 " 330104 39 EXTRACRANIAL PROCEDURES WITHOUT CC/MCC I N/A N/A "$10,535.34 " N/A "$17,500.29 " "$18,415.54 " "$16,774.09 " "$10,429.99 " N/A "$20,017.15 " N/A "$10,535.34 " "$34,863.41 " "$11,588.88 " "$43,024.30 " "$35,606.90 " N/A N/A N/A "$71,680.65 " "$49,713.65 " "$67,419.12 " N/A "$10,851.40 " "$13,063.82 " N/A N/A N/A N/A N/A "$14,749.48 " N/A "$10,535.34 " "$10,535.34 " "$11,483.52 " N/A N/A N/A N/A N/A N/A N/A "$40,482.82 " "$32,727.46 " "$32,727.46 " "$32,727.46 " "$32,727.46 " "$19,722.70 " "$11,588.88 " "$10,535.34 " "$21,270.77 " N/A N/A N/A N/A "$10,535.34 " "$10,429.99 " "$71,680.65 " 330104 40 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC" I N/A N/A "$33,758.00 " N/A "$57,515.49 " "$60,523.48 " "$55,128.80 " "$33,420.42 " N/A "$64,140.19 " N/A "$33,758.00 " "$114,580.16 " "$37,133.80 " "$141,401.27 " "$117,023.68 " N/A N/A N/A "$235,581.65 " "$163,386.12 " "$221,575.94 " N/A "$34,770.74 " "$41,859.92 " N/A N/A N/A N/A N/A "$47,261.20 " N/A "$33,758.00 " "$33,758.00 " "$36,796.22 " N/A N/A N/A N/A N/A N/A N/A "$133,048.61 " "$107,560.25 " "$107,560.25 " "$107,560.25 " "$107,560.25 " "$64,819.52 " "$37,133.80 " "$33,758.00 " "$69,907.35 " N/A N/A N/A N/A "$33,758.00 " "$33,420.42 " "$235,581.65 " 330104 41 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR" I N/A N/A "$20,979.68 " N/A "$35,497.03 " "$37,353.49 " "$34,024.03 " "$20,769.88 " N/A "$39,861.39 " N/A "$20,979.68 " "$70,715.83 " "$23,077.65 " "$87,269.11 " "$72,223.91 " N/A N/A N/A "$145,394.75 " "$100,837.58 " "$136,750.79 " N/A "$21,609.07 " "$26,014.80 " N/A N/A N/A N/A N/A "$29,371.55 " N/A "$20,979.68 " "$20,979.68 " "$22,867.85 " N/A N/A N/A N/A N/A N/A N/A "$82,114.07 " "$66,383.34 " "$66,383.34 " "$66,383.34 " "$66,383.34 " "$40,004.89 " "$23,077.65 " "$20,979.68 " "$43,144.96 " N/A N/A N/A N/A "$20,979.68 " "$20,769.88 " "$145,394.75 " 330104 42 "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC" I N/A N/A "$16,676.48 " N/A "$28,082.15 " "$29,550.81 " "$26,916.83 " "$16,509.71 " N/A "$31,685.31 " N/A "$16,676.48 " "$55,944.18 " "$18,344.12 " "$69,039.68 " "$57,137.23 " N/A N/A N/A "$115,023.59 " "$79,773.86 " "$108,185.25 " N/A "$17,176.77 " "$20,678.83 " N/A N/A N/A N/A N/A "$23,347.07 " N/A "$16,676.48 " "$16,676.48 " "$18,177.36 " N/A N/A N/A N/A N/A N/A N/A "$64,961.46 " "$52,516.68 " "$52,516.68 " "$52,516.68 " "$52,516.68 " "$31,648.37 " "$18,344.12 " "$16,676.48 " "$34,132.51 " N/A N/A N/A N/A "$16,676.48 " "$16,509.71 " "$115,023.59 " 330104 52 SPINAL DISORDERS AND INJURIES WITH CC/MCC I N/A N/A "$16,065.01 " N/A "$27,028.51 " "$28,442.07 " "$25,906.93 " "$15,904.36 " N/A "$30,523.51 " N/A "$16,065.01 " "$53,845.17 " "$17,671.51 " "$66,449.34 " "$54,993.47 " N/A N/A N/A "$110,707.96 " "$76,780.78 " "$104,126.19 " N/A "$16,546.96 " "$19,920.61 " N/A N/A N/A N/A N/A "$22,491.01 " N/A "$16,065.01 " "$16,065.01 " "$17,510.86 " N/A N/A N/A N/A N/A N/A N/A "$62,524.14 " "$50,546.28 " "$50,546.28 " "$50,546.28 " "$50,546.28 " "$30,460.93 " "$17,671.51 " "$16,065.01 " "$32,851.88 " N/A N/A N/A N/A "$16,065.01 " "$15,904.36 " "$110,707.96 " 330104 53 SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC I N/A N/A "$9,390.82 " N/A "$15,528.15 " "$16,340.25 " "$14,883.79 " "$9,296.91 " N/A "$17,842.55 " N/A "$9,390.82 " "$30,934.59 " "$10,329.90 " "$38,175.81 " "$31,594.29 " N/A N/A N/A "$63,602.82 " "$44,111.32 " "$59,821.53 " N/A "$9,672.54 " "$11,644.61 " N/A N/A N/A N/A N/A "$13,147.14 " N/A "$9,390.82 " "$9,390.82 " "$10,235.99 " N/A N/A N/A N/A N/A N/A N/A "$35,920.74 " "$29,039.34 " "$29,039.34 " "$29,039.34 " "$29,039.34 " "$17,500.11 " "$10,329.90 " "$9,390.82 " "$18,873.73 " N/A N/A N/A N/A "$9,390.82 " "$9,296.91 " "$63,602.82 " 330104 54 NERVOUS SYSTEM NEOPLASMS WITH MCC I N/A N/A "$12,599.71 " N/A "$21,057.43 " "$22,158.71 " "$20,183.62 " "$12,473.72 " N/A "$23,939.46 " N/A "$12,599.71 " "$41,949.81 " "$13,859.69 " "$51,769.50 " "$42,844.43 " N/A N/A N/A "$86,250.59 " "$59,818.54 " "$81,122.86 " N/A "$12,977.71 " "$15,623.65 " N/A N/A N/A N/A N/A "$17,639.60 " N/A "$12,599.71 " "$12,599.71 " "$13,733.69 " N/A N/A N/A N/A N/A N/A N/A "$48,711.44 " "$39,379.70 " "$39,379.70 " "$39,379.70 " "$39,379.70 " "$23,731.57 " "$13,859.69 " "$12,599.71 " "$25,594.31 " N/A N/A N/A N/A "$12,599.71 " "$12,473.72 " "$86,250.59 " 330104 55 NERVOUS SYSTEM NEOPLASMS WITHOUT MCC I N/A N/A "$9,263.06 " N/A "$15,308.01 " "$16,108.60 " "$14,672.78 " "$9,170.43 " N/A "$17,599.82 " N/A "$9,263.06 " "$30,496.03 " "$10,189.37 " "$37,634.60 " "$31,146.39 " N/A N/A N/A "$62,701.14 " "$43,485.96 " "$58,973.45 " N/A "$9,540.95 " "$11,486.20 " N/A N/A N/A N/A N/A "$12,968.29 " N/A "$9,263.06 " "$9,263.06 " "$10,096.74 " N/A N/A N/A N/A N/A N/A N/A "$35,411.50 " "$28,627.65 " "$28,627.65 " "$28,627.65 " "$28,627.65 " "$17,252.01 " "$10,189.37 " "$9,263.06 " "$18,606.16 " N/A N/A N/A N/A "$9,263.06 " "$9,170.43 " "$62,701.14 " 330104 56 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC I N/A N/A "$20,034.28 " N/A "$33,868.01 " "$35,639.26 " "$32,462.60 " "$19,833.93 " N/A "$38,065.13 " N/A "$20,034.28 " "$67,470.55 " "$22,037.71 " "$83,264.16 " "$68,909.41 " N/A N/A N/A "$138,722.30 " "$96,209.94 " "$130,475.03 " N/A "$20,635.31 " "$24,842.50 " N/A N/A N/A N/A N/A "$28,047.99 " N/A "$20,034.28 " "$20,034.28 " "$21,837.36 " N/A N/A N/A N/A N/A N/A N/A "$78,345.70 " "$63,336.87 " "$63,336.87 " "$63,336.87 " "$63,336.87 " "$38,168.99 " "$22,037.71 " "$20,034.28 " "$41,164.95 " N/A N/A N/A N/A "$20,034.28 " "$19,833.93 " "$138,722.30 " 330104 57 DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC I N/A N/A "$11,846.39 " N/A "$19,759.37 " "$20,792.76 " "$18,939.43 " "$11,727.93 " N/A "$22,508.14 " N/A "$11,846.39 " "$39,363.87 " "$13,031.03 " "$48,578.23 " "$40,203.34 " N/A N/A N/A "$80,933.78 " "$56,131.09 " "$76,122.13 " N/A "$12,201.78 " "$14,689.52 " N/A N/A N/A N/A N/A "$16,584.95 " N/A "$11,846.39 " "$11,846.39 " "$12,912.57 " N/A N/A N/A N/A N/A N/A N/A "$45,708.68 " "$36,952.19 " "$36,952.19 " "$36,952.19 " "$36,952.19 " "$22,268.67 " "$13,031.03 " "$11,846.39 " "$24,016.58 " N/A N/A N/A N/A "$11,846.39 " "$11,727.93 " "$80,933.78 " 330104 58 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC I N/A N/A "$15,580.41 " N/A "$26,193.50 " "$27,563.39 " "$25,106.57 " "$15,424.61 " N/A "$29,602.78 " N/A "$15,580.41 " "$52,181.70 " "$17,138.45 " "$64,396.48 " "$53,294.52 " N/A N/A N/A "$107,287.78 " "$74,408.74 " "$100,909.35 " N/A "$16,047.82 " "$19,319.71 " N/A N/A N/A N/A N/A "$21,812.58 " N/A "$15,580.41 " "$15,580.41 " "$16,982.65 " N/A N/A N/A N/A N/A N/A N/A "$60,592.54 " "$48,984.72 " "$48,984.72 " "$48,984.72 " "$48,984.72 " "$29,519.88 " "$17,138.45 " "$15,580.41 " "$31,836.96 " N/A N/A N/A N/A "$15,580.41 " "$15,424.61 " "$107,287.78 " 330104 59 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC I N/A N/A "$10,454.28 " N/A "$17,360.62 " "$18,268.56 " "$16,640.21 " "$10,349.74 " N/A "$19,863.14 " N/A "$10,454.28 " "$34,585.16 " "$11,499.71 " "$42,680.91 " "$35,322.71 " N/A N/A N/A "$71,108.55 " "$49,316.87 " "$66,881.03 " N/A "$10,767.91 " "$12,963.31 " N/A N/A N/A N/A N/A "$14,636.00 " N/A "$10,454.28 " "$10,454.28 " "$11,395.17 " N/A N/A N/A N/A N/A N/A N/A "$40,159.72 " "$32,466.25 " "$32,466.25 " "$32,466.25 " "$32,466.25 " "$19,565.28 " "$11,499.71 " "$10,454.28 " "$21,101.01 " N/A N/A N/A N/A "$10,454.28 " "$10,349.74 " "$71,108.55 " 330104 60 MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC I N/A N/A "$8,364.36 " N/A "$13,759.45 " "$14,479.05 " "$13,188.48 " "$8,280.71 " N/A "$15,892.28 " N/A "$8,364.36 " "$27,411.04 " "$9,200.79 " "$33,827.47 " "$27,995.61 " N/A N/A N/A "$56,358.27 " "$39,086.91 " "$53,007.67 " N/A "$8,615.29 " "$10,371.80 " N/A N/A N/A N/A N/A "$11,710.10 " N/A "$8,364.36 " "$8,364.36 " "$9,117.15 " N/A N/A N/A N/A N/A N/A N/A "$31,829.26 " "$25,731.67 " "$25,731.67 " "$25,731.67 " "$25,731.67 " "$15,506.79 " "$9,200.79 " "$8,364.36 " "$16,723.95 " N/A N/A N/A N/A "$8,364.36 " "$8,280.71 " "$56,358.27 " 330104 61 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC" I N/A N/A "$26,217.70 " N/A "$44,522.73 " "$46,851.22 " "$42,675.20 " "$25,955.53 " N/A "$49,813.64 " N/A "$26,217.70 " "$88,696.49 " "$28,839.48 " "$109,458.71 " "$90,588.01 " N/A N/A N/A "$182,363.73 " "$126,477.17 " "$171,521.91 " N/A "$27,004.24 " "$32,509.95 " N/A N/A N/A N/A N/A "$36,704.79 " N/A "$26,217.70 " "$26,217.70 " "$28,577.30 " N/A N/A N/A N/A N/A N/A N/A "$102,992.91 " "$83,262.38 " "$83,262.38 " "$83,262.38 " "$83,262.38 " "$50,176.79 " "$28,839.48 " "$26,217.70 " "$54,115.27 " N/A N/A N/A N/A "$26,217.70 " "$25,955.53 " "$182,363.73 " 330104 62 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC" I N/A N/A "$17,271.21 " N/A "$29,106.93 " "$30,629.19 " "$27,899.09 " "$17,098.49 " N/A "$32,815.29 " N/A "$17,271.21 " "$57,985.71 " "$18,998.33 " "$71,559.11 " "$59,222.31 " N/A N/A N/A "$119,221.08 " "$82,685.00 " "$112,133.19 " N/A "$17,789.34 " "$21,416.30 " N/A N/A N/A N/A N/A "$24,179.69 " N/A "$17,271.21 " "$17,271.21 " "$18,825.62 " N/A N/A N/A N/A N/A N/A N/A "$67,332.06 " "$54,433.14 " "$54,433.14 " "$54,433.14 " "$54,433.14 " "$32,803.29 " "$18,998.33 " "$17,271.21 " "$35,378.09 " N/A N/A N/A N/A "$17,271.21 " "$17,098.49 " "$119,221.08 " 330104 63 "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC" I N/A N/A "$14,309.01 " N/A "$24,002.74 " "$25,258.06 " "$23,006.71 " "$14,165.92 " N/A "$27,187.12 " N/A "$14,309.01 " "$47,817.35 " "$15,739.91 " "$59,010.51 " "$48,837.09 " N/A N/A N/A "$98,314.49 " "$68,185.37 " "$92,469.53 " N/A "$14,738.28 " "$17,743.18 " N/A N/A N/A N/A N/A "$20,032.62 " N/A "$14,309.01 " "$14,309.01 " "$15,596.82 " N/A N/A N/A N/A N/A N/A N/A "$55,524.72 " "$44,887.75 " "$44,887.75 " "$44,887.75 " "$44,887.75 " "$27,050.91 " "$15,739.91 " "$14,309.01 " "$29,174.19 " N/A N/A N/A N/A "$14,309.01 " "$14,165.92 " "$98,314.49 " 330104 64 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC I N/A N/A "$17,754.04 " N/A "$29,938.90 " "$31,504.67 " "$28,696.54 " "$17,576.50 " N/A "$33,732.67 " N/A "$17,754.04 " "$59,643.14 " "$19,529.44 " "$73,604.51 " "$60,915.08 " N/A N/A N/A "$122,628.82 " "$85,048.42 " "$115,338.34 " N/A "$18,286.66 " "$22,015.01 " N/A N/A N/A N/A N/A "$24,855.66 " N/A "$17,754.04 " "$17,754.04 " "$19,351.90 " N/A N/A N/A N/A N/A N/A N/A "$69,256.64 " "$55,989.02 " "$55,989.02 " "$55,989.02 " "$55,989.02 " "$33,740.92 " "$19,529.44 " "$17,754.04 " "$36,389.32 " N/A N/A N/A N/A "$17,754.04 " "$17,576.50 " "$122,628.82 " 330104 65 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS I N/A N/A "$9,334.43 " N/A "$15,430.98 " "$16,238.01 " "$14,790.65 " "$9,241.08 " N/A "$17,735.41 " N/A "$9,334.43 " "$30,741.02 " "$10,267.87 " "$37,936.93 " "$31,396.60 " N/A N/A N/A "$63,204.83 " "$43,835.30 " "$59,447.20 " N/A "$9,614.46 " "$11,574.69 " N/A N/A N/A N/A N/A "$13,068.20 " N/A "$9,334.43 " "$9,334.43 " "$10,174.53 " N/A N/A N/A N/A N/A N/A N/A "$35,695.97 " "$28,857.63 " "$28,857.63 " "$28,857.63 " "$28,857.63 " "$17,390.60 " "$10,267.87 " "$9,334.43 " "$18,755.63 " N/A N/A N/A N/A "$9,334.43 " "$9,241.08 " "$63,204.83 " 330104 66 INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC I N/A N/A "$6,533.47 " N/A "$10,604.63 " "$11,159.24 " "$10,164.57 " "$6,468.14 " N/A "$12,413.60 " N/A "$6,533.47 " "$21,126.13 " "$7,186.82 " "$26,071.37 " "$21,576.67 " N/A N/A N/A "$43,436.22 " "$30,124.91 " "$40,853.87 " N/A "$6,729.48 " "$8,101.50 " N/A N/A N/A N/A N/A "$9,146.86 " N/A "$6,533.47 " "$6,533.47 " "$7,121.48 " N/A N/A N/A N/A N/A N/A N/A "$24,531.32 " "$19,831.81 " "$19,831.81 " "$19,831.81 " "$19,831.81 " "$11,951.34 " "$7,186.82 " "$6,533.47 " "$12,889.42 " N/A N/A N/A N/A "$6,533.47 " "$6,468.14 " "$43,436.22 " 330104 67 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC I N/A N/A "$12,838.49 " N/A "$21,468.87 " "$22,591.66 " "$20,577.98 " "$12,710.10 " N/A "$24,393.13 " N/A "$12,838.49 " "$42,769.45 " "$14,122.34 " "$52,781.00 " "$43,681.55 " N/A N/A N/A "$87,935.81 " "$60,987.30 " "$82,707.88 " N/A "$13,223.64 " "$15,919.73 " N/A N/A N/A N/A N/A "$17,973.88 " N/A "$12,838.49 " "$12,838.49 " "$13,993.95 " N/A N/A N/A N/A N/A N/A N/A "$49,663.19 " "$40,149.13 " "$40,149.13 " "$40,149.13 " "$40,149.13 " "$24,195.25 " "$14,122.34 " "$12,838.49 " "$26,094.39 " N/A N/A N/A N/A "$12,838.49 " "$12,710.10 " "$87,935.81 " 330104 68 NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC I N/A N/A "$8,341.45 " N/A "$13,719.97 " "$14,437.51 " "$13,150.64 " "$8,258.04 " N/A "$15,848.75 " N/A "$8,341.45 " "$27,332.41 " "$9,175.59 " "$33,730.42 " "$27,915.29 " N/A N/A N/A "$56,196.58 " "$38,974.77 " "$52,855.61 " N/A "$8,591.69 " "$10,343.40 " N/A N/A N/A N/A N/A "$11,678.03 " N/A "$8,341.45 " "$8,341.45 " "$9,092.18 " N/A N/A N/A N/A N/A N/A N/A "$31,737.94 " "$25,657.85 " "$25,657.85 " "$25,657.85 " "$25,657.85 " "$15,462.31 " "$9,175.59 " "$8,341.45 " "$16,675.98 " N/A N/A N/A N/A "$8,341.45 " "$8,258.04 " "$56,196.58 " 330104 69 TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC I N/A N/A "$7,409.27 " N/A "$12,113.72 " "$12,747.25 " "$11,611.04 " "$7,335.17 " N/A "$14,077.61 " N/A "$7,409.27 " "$24,132.49 " "$8,150.19 " "$29,781.46 " "$24,647.13 " N/A N/A N/A "$49,617.41 " "$34,411.83 " "$46,667.58 " N/A "$7,631.54 " "$9,187.49 " N/A N/A N/A N/A N/A "$10,372.97 " N/A "$7,409.27 " "$7,409.27 " "$8,076.10 " N/A N/A N/A N/A N/A N/A N/A "$28,022.25 " "$22,653.98 " "$22,653.98 " "$22,653.98 " "$22,653.98 " "$13,652.07 " "$8,150.19 " "$7,409.27 " "$14,723.65 " N/A N/A N/A N/A "$7,409.27 " "$7,335.17 " "$49,617.41 " 330104 70 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC I N/A N/A "$15,570.72 " N/A "$26,176.80 " "$27,545.82 " "$25,090.56 " "$15,415.01 " N/A "$29,584.37 " N/A "$15,570.72 " "$52,148.43 " "$17,127.79 " "$64,355.42 " "$53,260.54 " N/A N/A N/A "$107,219.38 " "$74,361.30 " "$100,845.01 " N/A "$16,037.84 " "$19,307.69 " N/A N/A N/A N/A N/A "$21,799.01 " N/A "$15,570.72 " "$15,570.72 " "$16,972.09 " N/A N/A N/A N/A N/A N/A N/A "$60,553.90 " "$48,953.49 " "$48,953.49 " "$48,953.49 " "$48,953.49 " "$29,501.06 " "$17,127.79 " "$15,570.72 " "$31,816.66 " N/A N/A N/A N/A "$15,570.72 " "$15,415.01 " "$107,219.38 " 330104 71 NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC I N/A N/A "$9,797.88 " N/A "$16,229.56 " "$17,078.34 " "$15,556.09 " "$9,699.90 " N/A "$18,615.97 " N/A "$9,797.88 " "$32,331.90 " "$10,777.66 " "$39,900.21 " "$33,021.41 " N/A N/A N/A "$66,475.76 " "$46,103.83 " "$62,523.67 " N/A "$10,091.81 " "$12,149.37 " N/A N/A N/A N/A N/A "$13,717.03 " N/A "$9,797.88 " "$9,797.88 " "$10,679.69 " N/A N/A N/A N/A N/A N/A N/A "$37,543.28 " "$30,351.05 " "$30,351.05 " "$30,351.05 " "$30,351.05 " "$18,290.59 " "$10,777.66 " "$9,797.88 " "$19,726.26 " N/A N/A N/A N/A "$9,797.88 " "$9,699.90 " "$66,475.76 " 330104 72 NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC I N/A N/A "$7,181.07 " N/A "$11,720.50 " "$12,333.47 " "$11,234.14 " "$7,109.26 " N/A "$13,644.03 " N/A "$7,181.07 " "$23,349.14 " "$7,899.17 " "$28,814.75 " "$23,847.08 " N/A N/A N/A "$48,006.82 " "$33,294.82 " "$45,152.74 " N/A "$7,396.50 " "$8,904.52 " N/A N/A N/A N/A N/A "$10,053.49 " N/A "$7,181.07 " "$7,181.07 " "$7,827.36 " N/A N/A N/A N/A N/A N/A N/A "$27,112.64 " "$21,918.62 " "$21,918.62 " "$21,918.62 " "$21,918.62 " "$13,208.92 " "$7,899.17 " "$7,181.07 " "$14,245.72 " N/A N/A N/A N/A "$7,181.07 " "$7,109.26 " "$48,006.82 " 330104 73 CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC I N/A N/A "$13,589.17 " N/A "$22,762.37 " "$23,952.82 " "$21,817.81 " "$13,453.28 " N/A "$25,819.42 " N/A "$13,589.17 " "$45,346.33 " "$14,948.09 " "$55,961.07 " "$46,313.38 " N/A N/A N/A "$93,233.97 " "$64,661.81 " "$87,691.06 " N/A "$13,996.84 " "$16,850.57 " N/A N/A N/A N/A N/A "$19,024.84 " N/A "$13,589.17 " "$13,589.17 " "$14,812.19 " N/A N/A N/A N/A N/A N/A N/A "$52,655.42 " "$42,568.13 " "$42,568.13 " "$42,568.13 " "$42,568.13 " "$25,653.02 " "$14,948.09 " "$13,589.17 " "$27,666.58 " N/A N/A N/A N/A "$13,589.17 " "$13,453.28 " "$93,233.97 " 330104 74 CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC I N/A N/A "$9,397.87 " N/A "$15,540.30 " "$16,353.03 " "$14,895.43 " "$9,303.89 " N/A "$17,855.95 " N/A "$9,397.87 " "$30,958.78 " "$10,337.65 " "$38,205.67 " "$31,619.00 " N/A N/A N/A "$63,652.57 " "$44,145.82 " "$59,868.32 " N/A "$9,679.80 " "$11,653.35 " N/A N/A N/A N/A N/A "$13,157.01 " N/A "$9,397.87 " "$9,397.87 " "$10,243.67 " N/A N/A N/A N/A N/A N/A N/A "$35,948.83 " "$29,062.05 " "$29,062.05 " "$29,062.05 " "$29,062.05 " "$17,513.80 " "$10,337.65 " "$9,397.87 " "$18,888.49 " N/A N/A N/A N/A "$9,397.87 " "$9,303.89 " "$63,652.57 " 330104 75 VIRAL MENINGITIS WITH CC/MCC I N/A N/A "$16,458.85 " N/A "$27,707.15 " "$29,156.20 " "$26,557.40 " "$16,294.26 " N/A "$31,271.82 " N/A "$16,458.85 " "$55,197.12 " "$18,104.74 " "$68,117.76 " "$56,374.25 " N/A N/A N/A "$113,487.62 " "$78,708.60 " "$106,740.60 " N/A "$16,952.62 " "$20,408.97 " N/A N/A N/A N/A N/A "$23,042.39 " N/A "$16,458.85 " "$16,458.85 " "$17,940.15 " N/A N/A N/A N/A N/A N/A N/A "$64,094.00 " "$51,815.40 " "$51,815.40 " "$51,815.40 " "$51,815.40 " "$31,225.75 " "$18,104.74 " "$16,458.85 " "$33,676.72 " N/A N/A N/A N/A "$16,458.85 " "$16,294.26 " "$113,487.62 " 330104 76 VIRAL MENINGITIS WITHOUT CC/MCC I N/A N/A "$9,078.03 " N/A "$14,989.19 " "$15,773.10 " "$14,367.19 " "$8,987.25 " N/A "$17,248.26 " N/A "$9,078.03 " "$29,860.89 " "$9,985.84 " "$36,850.78 " "$30,497.70 " N/A N/A N/A "$61,395.25 " "$42,580.27 " "$57,745.20 " N/A "$9,350.37 " "$11,256.76 " N/A N/A N/A N/A N/A "$12,709.25 " N/A "$9,078.03 " "$9,078.03 " "$9,895.06 " N/A N/A N/A N/A N/A N/A N/A "$34,673.98 " "$28,031.42 " "$28,031.42 " "$28,031.42 " "$28,031.42 " "$16,892.70 " "$9,985.84 " "$9,078.03 " "$18,218.65 " N/A N/A N/A N/A "$9,078.03 " "$8,987.25 " "$61,395.25 " 330104 77 HYPERTENSIVE ENCEPHALOPATHY WITH MCC I N/A N/A "$14,160.99 " N/A "$23,747.68 " "$24,989.66 " "$22,762.24 " "$14,019.38 " N/A "$26,905.88 " N/A "$14,160.99 " "$47,309.23 " "$15,577.09 " "$58,383.45 " "$48,318.14 " N/A N/A N/A "$97,269.78 " "$67,460.82 " "$91,486.93 " N/A "$14,585.82 " "$17,559.63 " N/A N/A N/A N/A N/A "$19,825.39 " N/A "$14,160.99 " "$14,160.99 " "$15,435.48 " N/A N/A N/A N/A N/A N/A N/A "$54,934.70 " "$44,410.77 " "$44,410.77 " "$44,410.77 " "$44,410.77 " "$26,763.46 " "$15,577.09 " "$14,160.99 " "$28,864.18 " N/A N/A N/A N/A "$14,160.99 " "$14,019.38 " "$97,269.78 " 330104 78 HYPERTENSIVE ENCEPHALOPATHY WITH CC I N/A N/A "$9,126.49 " N/A "$15,072.69 " "$15,860.97 " "$14,447.23 " "$9,035.23 " N/A "$17,340.34 " N/A "$9,126.49 " "$30,027.24 " "$10,039.14 " "$37,056.06 " "$30,667.59 " N/A N/A N/A "$61,737.27 " "$42,817.48 " "$58,066.89 " N/A "$9,400.29 " "$11,316.85 " N/A N/A N/A N/A N/A "$12,777.09 " N/A "$9,126.49 " "$9,126.49 " "$9,947.88 " N/A N/A N/A N/A N/A N/A N/A "$34,867.14 " "$28,187.58 " "$28,187.58 " "$28,187.58 " "$28,187.58 " "$16,986.81 " "$10,039.14 " "$9,126.49 " "$18,320.14 " N/A N/A N/A N/A "$9,126.49 " "$9,035.23 " "$61,737.27 " 330104 79 HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC I N/A N/A "$6,845.37 " N/A "$11,142.07 " "$11,724.79 " "$10,679.71 " "$6,776.92 " N/A "$13,006.21 " N/A "$6,845.37 " "$22,196.81 " "$7,529.91 " "$27,392.67 " "$22,670.17 " N/A N/A N/A "$45,637.57 " "$31,651.64 " "$42,924.34 " N/A "$7,050.74 " "$8,488.26 " N/A N/A N/A N/A N/A "$9,583.52 " N/A "$6,845.37 " "$6,845.37 " "$7,461.46 " N/A N/A N/A N/A N/A N/A N/A "$25,774.57 " "$20,836.89 " "$20,836.89 " "$20,836.89 " "$20,836.89 " "$12,557.03 " "$7,529.91 " "$6,845.37 " "$13,542.66 " N/A N/A N/A N/A "$6,845.37 " "$6,776.92 " "$45,637.57 " 330104 80 NONTRAUMATIC STUPOR AND COMA WITH MCC I N/A N/A "$18,351.41 " N/A "$30,968.24 " "$32,587.84 " "$29,683.17 " "$18,167.90 " N/A "$34,867.68 " N/A "$18,351.41 " "$61,693.75 " "$20,186.55 " "$76,135.13 " "$63,009.42 " N/A N/A N/A "$126,844.96 " "$87,972.49 " "$119,303.82 " N/A "$18,901.95 " "$22,755.75 " N/A N/A N/A N/A N/A "$25,691.98 " N/A "$18,351.41 " "$18,351.41 " "$20,003.04 " N/A N/A N/A N/A N/A N/A N/A "$71,637.78 " "$57,914.00 " "$57,914.00 " "$57,914.00 " "$57,914.00 " "$34,900.98 " "$20,186.55 " "$18,351.41 " "$37,640.43 " N/A N/A N/A N/A "$18,351.41 " "$18,167.90 " "$126,844.96 " 330104 81 NONTRAUMATIC STUPOR AND COMA WITHOUT MCC I N/A N/A "$8,295.63 " N/A "$13,641.03 " "$14,354.44 " "$13,074.97 " "$8,212.68 " N/A "$15,761.70 " N/A "$8,295.63 " "$27,175.13 " "$9,125.20 " "$33,536.33 " "$27,754.66 " N/A N/A N/A "$55,873.22 " "$38,750.51 " "$52,551.47 " N/A "$8,544.50 " "$10,286.59 " N/A N/A N/A N/A N/A "$11,613.89 " N/A "$8,295.63 " "$8,295.63 " "$9,042.24 " N/A N/A N/A N/A N/A N/A N/A "$31,555.32 " "$25,510.21 " "$25,510.21 " "$25,510.21 " "$25,510.21 " "$15,373.33 " "$9,125.20 " "$8,295.63 " "$16,580.02 " N/A N/A N/A N/A "$8,295.63 " "$8,212.68 " "$55,873.22 " 330104 82 TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC I N/A N/A "$20,338.25 " N/A "$34,391.78 " "$36,190.43 " "$32,964.65 " "$20,134.87 " N/A "$38,642.68 " N/A "$20,338.25 " "$68,514.00 " "$22,372.08 " "$84,551.87 " "$69,975.12 " N/A N/A N/A "$140,867.68 " "$97,697.86 " "$132,492.87 " N/A "$20,948.40 " "$25,219.43 " N/A N/A N/A N/A N/A "$28,473.55 " N/A "$20,338.25 " "$20,338.25 " "$22,168.69 " N/A N/A N/A N/A N/A N/A N/A "$79,557.34 " "$64,316.40 " "$64,316.40 " "$64,316.40 " "$64,316.40 " "$38,759.28 " "$22,372.08 " "$20,338.25 " "$41,801.58 " N/A N/A N/A N/A "$20,338.25 " "$20,134.87 " "$140,867.68 " 330104 83 TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC I N/A N/A "$12,257.86 " N/A "$20,468.37 " "$21,538.84 " "$19,619.01 " "$12,135.28 " N/A "$23,289.93 " N/A "$12,257.86 " "$40,776.31 " "$13,483.64 " "$50,321.30 " "$41,645.90 " N/A N/A N/A "$83,837.82 " "$58,145.17 " "$78,853.52 " N/A "$12,625.59 " "$15,199.74 " N/A N/A N/A N/A N/A "$17,161.00 " N/A "$12,257.86 " "$12,257.86 " "$13,361.06 " N/A N/A N/A N/A N/A N/A N/A "$47,348.78 " "$38,278.09 " "$38,278.09 " "$38,278.09 " "$38,278.09 " "$23,067.70 " "$13,483.64 " "$12,257.86 " "$24,878.33 " N/A N/A N/A N/A "$12,257.86 " "$12,135.28 " "$83,837.82 " 330104 84 TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC I N/A N/A "$8,454.23 " N/A "$13,914.30 " "$14,642.00 " "$13,336.91 " "$8,369.69 " N/A "$16,063.03 " N/A "$8,454.23 " "$27,719.54 " "$9,299.65 " "$34,208.18 " "$28,310.68 " N/A N/A N/A "$56,992.55 " "$39,526.81 " "$53,604.25 " N/A "$8,707.86 " "$10,483.24 " N/A N/A N/A N/A N/A "$11,835.92 " N/A "$8,454.23 " "$8,454.23 " "$9,215.11 " N/A N/A N/A N/A N/A N/A N/A "$32,187.48 " "$26,021.27 " "$26,021.27 " "$26,021.27 " "$26,021.27 " "$15,681.32 " "$9,299.65 " "$8,454.23 " "$16,912.17 " N/A N/A N/A N/A "$8,454.23 " "$8,369.69 " "$56,992.55 " 330104 85 TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC I N/A N/A "$20,958.53 " N/A "$35,460.60 " "$37,315.14 " "$33,989.11 " "$20,748.95 " N/A "$39,821.21 " N/A "$20,958.53 " "$70,643.25 " "$23,054.38 " "$87,179.54 " "$72,149.77 " N/A N/A N/A "$145,245.50 " "$100,734.07 " "$136,610.42 " N/A "$21,587.29 " "$25,988.58 " N/A N/A N/A N/A N/A "$29,341.94 " N/A "$20,958.53 " "$20,958.53 " "$22,844.80 " N/A N/A N/A N/A N/A N/A N/A "$82,029.78 " "$66,315.19 " "$66,315.19 " "$66,315.19 " "$66,315.19 " "$39,963.83 " "$23,054.38 " "$20,958.53 " "$43,100.67 " N/A N/A N/A N/A "$20,958.53 " "$20,748.95 " "$145,245.50 " 330104 86 TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC I N/A N/A "$11,830.53 " N/A "$19,732.05 " "$20,764.01 " "$18,913.23 " "$11,712.23 " N/A "$22,478.01 " N/A "$11,830.53 " "$39,309.43 " "$13,013.58 " "$48,511.04 " "$40,147.73 " N/A N/A N/A "$80,821.84 " "$56,053.46 " "$76,016.85 " N/A "$12,185.45 " "$14,669.86 " N/A N/A N/A N/A N/A "$16,562.74 " N/A "$11,830.53 " "$11,830.53 " "$12,895.28 " N/A N/A N/A N/A N/A N/A N/A "$45,645.46 " "$36,901.08 " "$36,901.08 " "$36,901.08 " "$36,901.08 " "$22,237.87 " "$13,013.58 " "$11,830.53 " "$23,983.36 " N/A N/A N/A N/A "$11,830.53 " "$11,712.23 " "$80,821.84 " 330104 87 TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC I N/A N/A "$8,065.67 " N/A "$13,244.78 " "$13,937.46 " "$12,695.16 " "$7,985.01 " N/A "$15,324.78 " N/A "$8,065.67 " "$26,385.74 " "$8,872.24 " "$32,562.16 " "$26,948.44 " N/A N/A N/A "$54,250.19 " "$37,624.87 " "$51,024.93 " N/A "$8,307.64 " "$10,001.43 " N/A N/A N/A N/A N/A "$11,291.94 " N/A "$8,065.67 " "$8,065.67 " "$8,791.58 " N/A N/A N/A N/A N/A N/A N/A "$30,638.69 " "$24,769.18 " "$24,769.18 " "$24,769.18 " "$24,769.18 " "$14,926.76 " "$8,872.24 " "$8,065.67 " "$16,098.40 " N/A N/A N/A N/A "$8,065.67 " "$7,985.01 " "$54,250.19 " 330104 88 CONCUSSION WITH MCC I N/A N/A "$14,267.60 " N/A "$23,931.39 " "$25,182.97 " "$22,938.32 " "$14,124.93 " N/A "$27,108.44 " N/A "$14,267.60 " "$47,675.19 " "$15,694.36 " "$58,835.08 " "$48,691.91 " N/A N/A N/A "$98,022.22 " "$67,982.67 " "$92,194.63 " N/A "$14,695.63 " "$17,691.83 " N/A N/A N/A N/A N/A "$19,974.64 " N/A "$14,267.60 " "$14,267.60 " "$15,551.69 " N/A N/A N/A N/A N/A N/A N/A "$55,359.66 " "$44,754.31 " "$44,754.31 " "$44,754.31 " "$44,754.31 " "$26,970.49 " "$15,694.36 " "$14,267.60 " "$29,087.46 " N/A N/A N/A N/A "$14,267.60 " "$14,124.93 " "$98,022.22 " 330104 89 CONCUSSION WITH CC I N/A N/A "$10,667.50 " N/A "$17,728.02 " "$18,655.18 " "$16,992.37 " "$10,560.83 " N/A "$20,268.26 " N/A "$10,667.50 " "$35,317.09 " "$11,734.25 " "$43,584.17 " "$36,070.25 " N/A N/A N/A "$72,613.42 " "$50,360.57 " "$68,296.44 " N/A "$10,987.53 " "$13,227.71 " N/A N/A N/A N/A N/A "$14,934.51 " N/A "$10,667.50 " "$10,667.50 " "$11,627.58 " N/A N/A N/A N/A N/A N/A N/A "$41,009.62 " "$33,153.34 " "$33,153.34 " "$33,153.34 " "$33,153.34 " "$19,979.35 " "$11,734.25 " "$10,667.50 " "$21,547.57 " N/A N/A N/A N/A "$10,667.50 " "$10,560.83 " "$72,613.42 " 330104 90 CONCUSSION WITHOUT CC/MCC I N/A N/A "$7,631.30 " N/A "$12,496.30 " "$13,149.85 " "$11,977.75 " "$7,554.99 " N/A "$14,499.47 " N/A "$7,631.30 " "$24,894.66 " "$8,394.43 " "$30,722.04 " "$25,425.56 " N/A N/A N/A "$51,184.47 " "$35,498.66 " "$48,141.47 " N/A "$7,860.24 " "$9,462.81 " N/A N/A N/A N/A N/A "$10,683.82 " N/A "$7,631.30 " "$7,631.30 " "$8,318.12 " N/A N/A N/A N/A N/A N/A N/A "$28,907.27 " "$23,369.46 " "$23,369.46 " "$23,369.46 " "$23,369.46 " "$14,083.24 " "$8,394.43 " "$7,631.30 " "$15,188.66 " N/A N/A N/A N/A "$7,631.30 " "$7,554.99 " "$51,184.47 " 330104 91 OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC I N/A N/A "$15,598.92 " N/A "$26,225.39 " "$27,596.94 " "$25,137.12 " "$15,442.93 " N/A "$29,637.94 " N/A "$15,598.92 " "$52,245.21 " "$17,158.81 " "$64,474.86 " "$53,359.39 " N/A N/A N/A "$107,418.37 " "$74,499.31 " "$101,032.17 " N/A "$16,066.88 " "$19,342.65 " N/A N/A N/A N/A N/A "$21,838.48 " N/A "$15,598.92 " "$15,598.92 " "$17,002.82 " N/A N/A N/A N/A N/A N/A N/A "$60,666.29 " "$49,044.34 " "$49,044.34 " "$49,044.34 " "$49,044.34 " "$29,555.81 " "$17,158.81 " "$15,598.92 " "$31,875.71 " N/A N/A N/A N/A "$15,598.92 " "$15,442.93 " "$107,418.37 " 330104 92 OTHER DISORDERS OF NERVOUS SYSTEM WITH CC I N/A N/A "$9,139.71 " N/A "$15,095.46 " "$15,884.94 " "$14,469.05 " "$9,048.31 " N/A "$17,365.45 " N/A "$9,139.71 " "$30,072.60 " "$10,053.68 " "$37,112.05 " "$30,713.93 " N/A N/A N/A "$61,830.55 " "$42,882.17 " "$58,154.62 " N/A "$9,413.90 " "$11,333.24 " N/A N/A N/A N/A N/A "$12,795.59 " N/A "$9,139.71 " "$9,139.71 " "$9,962.28 " N/A N/A N/A N/A N/A N/A N/A "$34,919.82 " "$28,230.17 " "$28,230.17 " "$28,230.17 " "$28,230.17 " "$17,012.47 " "$10,053.68 " "$9,139.71 " "$18,347.82 " N/A N/A N/A N/A "$9,139.71 " "$9,048.31 " "$61,830.55 " 330104 93 OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC I N/A N/A "$7,117.63 " N/A "$11,611.19 " "$12,218.44 " "$11,129.37 " "$7,046.45 " N/A "$13,523.49 " N/A "$7,117.63 " "$23,131.38 " "$7,829.39 " "$28,546.01 " "$23,624.67 " N/A N/A N/A "$47,559.09 " "$32,984.29 " "$44,731.62 " N/A "$7,331.16 " "$8,825.86 " N/A N/A N/A N/A N/A "$9,964.68 " N/A "$7,117.63 " "$7,117.63 " "$7,758.21 " N/A N/A N/A N/A N/A N/A N/A "$26,859.78 " "$21,714.20 " "$21,714.20 " "$21,714.20 " "$21,714.20 " "$13,085.73 " "$7,829.39 " "$7,117.63 " "$14,112.85 " N/A N/A N/A N/A "$7,117.63 " "$7,046.45 " "$47,559.09 " 330104 94 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC I N/A N/A "$31,864.55 " N/A "$54,252.88 " "$57,090.24 " "$52,001.57 " "$31,545.91 " N/A "$60,542.65 " N/A "$31,864.55 " "$108,080.51 " "$35,051.01 " "$133,380.17 " "$110,385.42 " N/A N/A N/A "$222,218.10 " "$154,117.91 " "$209,006.87 " N/A "$32,820.49 " "$39,512.05 " N/A N/A N/A N/A N/A "$44,610.37 " N/A "$31,864.55 " "$31,864.55 " "$34,732.36 " N/A N/A N/A N/A N/A N/A N/A "$125,501.32 " "$101,458.81 " "$101,458.81 " "$101,458.81 " "$101,458.81 " "$61,142.58 " "$35,051.01 " "$31,864.55 " "$65,941.80 " N/A N/A N/A N/A "$31,864.55 " "$31,545.91 " "$222,218.10 " 330104 95 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC I N/A N/A "$22,906.60 " N/A "$38,817.34 " "$40,847.44 " "$37,206.55 " "$22,677.54 " N/A "$43,522.54 " N/A "$22,906.60 " "$77,330.42 " "$25,197.26 " "$95,432.05 " "$78,979.55 " N/A N/A N/A "$158,994.61 " "$110,269.67 " "$149,542.12 " N/A "$23,593.80 " "$28,404.19 " N/A N/A N/A N/A N/A "$32,069.24 " N/A "$22,906.60 " "$22,906.60 " "$24,968.20 " N/A N/A N/A N/A N/A N/A N/A "$89,794.82 " "$72,592.67 " "$72,592.67 " "$72,592.67 " "$72,592.67 " "$43,746.85 " "$25,197.26 " "$22,906.60 " "$47,180.63 " N/A N/A N/A N/A "$22,906.60 " "$22,677.54 " "$158,994.61 " 330104 96 BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC I N/A N/A "$20,505.66 " N/A "$34,680.24 " "$36,493.98 " "$33,241.13 " "$20,300.60 " N/A "$38,960.75 " N/A "$20,505.66 " "$69,088.65 " "$22,556.22 " "$85,261.04 " "$70,562.03 " N/A N/A N/A "$142,049.20 " "$98,517.29 " "$133,604.14 " N/A "$21,120.83 " "$25,427.01 " N/A N/A N/A N/A N/A "$28,707.92 " N/A "$20,505.66 " "$20,505.66 " "$22,351.16 " N/A N/A N/A N/A N/A N/A N/A "$80,224.62 " "$64,855.85 " "$64,855.85 " "$64,855.85 " "$64,855.85 " "$39,084.37 " "$22,556.22 " "$20,505.66 " "$42,152.19 " N/A N/A N/A N/A "$20,505.66 " "$20,300.60 " "$142,049.20 " 330104 97 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC I N/A N/A "$34,637.32 " N/A "$59,030.65 " "$62,117.88 " "$56,581.09 " "$34,290.94 " N/A "$65,810.90 " N/A "$34,637.32 " "$117,598.61 " "$38,101.05 " "$145,126.29 " "$120,106.50 " N/A N/A N/A "$241,787.72 " "$167,690.29 " "$227,413.04 " N/A "$35,676.44 " "$42,950.27 " N/A N/A N/A N/A N/A "$48,492.24 " N/A "$34,637.32 " "$34,637.32 " "$37,754.67 " N/A N/A N/A N/A N/A N/A N/A "$136,553.58 " "$110,393.77 " "$110,393.77 " "$110,393.77 " "$110,393.77 " "$66,527.10 " "$38,101.05 " "$34,637.32 " "$71,748.95 " N/A N/A N/A N/A "$34,637.32 " "$34,290.94 " "$241,787.72 " 330104 98 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC I N/A N/A "$18,742.61 " N/A "$31,642.32 " "$33,297.18 " "$30,329.28 " "$18,555.19 " N/A "$35,610.96 " N/A "$18,742.61 " "$63,036.63 " "$20,616.87 " "$77,792.35 " "$64,380.94 " N/A N/A N/A "$129,605.98 " "$89,887.38 " "$121,900.69 " N/A "$19,304.89 " "$23,240.84 " N/A N/A N/A N/A N/A "$26,239.66 " N/A "$18,742.61 " "$18,742.61 " "$20,429.45 " N/A N/A N/A N/A N/A N/A N/A "$73,197.10 " "$59,174.61 " "$59,174.61 " "$59,174.61 " "$59,174.61 " "$35,660.66 " "$20,616.87 " "$18,742.61 " "$38,459.74 " N/A N/A N/A N/A "$18,742.61 " "$18,555.19 " "$129,605.98 " 330104 99 NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC I N/A N/A "$12,701.04 " N/A "$21,232.03 " "$22,342.44 " "$20,350.97 " "$12,574.03 " N/A "$24,131.97 " N/A "$12,701.04 " "$42,297.63 " "$13,971.14 " "$52,198.73 " "$43,199.67 " N/A N/A N/A "$86,965.72 " "$60,314.51 " "$81,795.47 " N/A "$13,082.07 " "$15,749.29 " N/A N/A N/A N/A N/A "$17,781.45 " N/A "$12,701.04 " "$12,701.04 " "$13,844.13 " N/A N/A N/A N/A N/A N/A N/A "$49,115.32 " "$39,706.21 " "$39,706.21 " "$39,706.21 " "$39,706.21 " "$23,928.34 " "$13,971.14 " "$12,701.04 " "$25,806.52 " N/A N/A N/A N/A "$12,701.04 " "$12,574.03 " "$86,965.72 " 330104 100 SEIZURES WITH MCC I N/A N/A "$17,304.69 " N/A "$29,164.62 " "$30,689.90 " "$27,954.39 " "$17,131.64 " N/A "$32,878.91 " N/A "$17,304.69 " "$58,100.65 " "$19,035.16 " "$71,700.94 " "$59,339.69 " N/A N/A N/A "$119,457.39 " "$82,848.89 " "$112,355.45 " N/A "$17,823.83 " "$21,457.81 " N/A N/A N/A N/A N/A "$24,226.56 " N/A "$17,304.69 " "$17,304.69 " "$18,862.11 " N/A N/A N/A N/A N/A N/A N/A "$67,465.52 " "$54,541.03 " "$54,541.03 " "$54,541.03 " "$54,541.03 " "$32,868.31 " "$19,035.16 " "$17,304.69 " "$35,448.21 " N/A N/A N/A N/A "$17,304.69 " "$17,131.64 " "$119,457.39 " 330104 101 SEIZURES WITHOUT MCC I N/A N/A "$8,322.07 " N/A "$13,686.57 " "$14,402.36 " "$13,118.63 " "$8,238.85 " N/A "$15,811.93 " N/A "$8,322.07 " "$27,265.87 " "$9,154.27 " "$33,648.31 " "$27,847.33 " N/A N/A N/A "$56,059.78 " "$38,879.89 " "$52,726.93 " N/A "$8,571.73 " "$10,319.36 " N/A N/A N/A N/A N/A "$11,650.89 " N/A "$8,322.07 " "$8,322.07 " "$9,071.05 " N/A N/A N/A N/A N/A N/A N/A "$31,660.68 " "$25,595.39 " "$25,595.39 " "$25,595.39 " "$25,595.39 " "$15,424.66 " "$9,154.27 " "$8,322.07 " "$16,635.38 " N/A N/A N/A N/A "$8,322.07 " "$8,238.85 " "$56,059.78 " 330104 102 HEADACHES WITH MCC I N/A N/A "$10,510.67 " N/A "$17,457.78 " "$18,370.80 " "$16,733.34 " "$10,405.56 " N/A "$19,970.28 " N/A "$10,510.67 " "$34,778.73 " "$11,561.74 " "$42,919.79 " "$35,520.41 " N/A N/A N/A "$71,506.53 " "$49,592.89 " "$67,255.35 " N/A "$10,825.99 " "$13,033.23 " N/A N/A N/A N/A N/A "$14,714.94 " N/A "$10,510.67 " "$10,510.67 " "$11,456.63 " N/A N/A N/A N/A N/A N/A N/A "$40,384.49 " "$32,647.96 " "$32,647.96 " "$32,647.96 " "$32,647.96 " "$19,674.79 " "$11,561.74 " "$10,510.67 " "$21,219.10 " N/A N/A N/A N/A "$10,510.67 " "$10,405.56 " "$71,506.53 " 330104 103 HEADACHES WITHOUT MCC I N/A N/A "$7,714.12 " N/A "$12,639.01 " "$13,300.02 " "$12,114.54 " "$7,636.98 " N/A "$14,656.83 " N/A "$7,714.12 " "$25,178.96 " "$8,485.53 " "$31,072.90 " "$25,715.92 " N/A N/A N/A "$51,769.01 " "$35,904.06 " "$48,691.26 " N/A "$7,945.54 " "$9,565.51 " N/A N/A N/A N/A N/A "$10,799.77 " N/A "$7,714.12 " "$7,714.12 " "$8,408.39 " N/A N/A N/A N/A N/A N/A N/A "$29,237.40 " "$23,636.34 " "$23,636.34 " "$23,636.34 " "$23,636.34 " "$14,244.08 " "$8,485.53 " "$7,714.12 " "$15,362.12 " N/A N/A N/A N/A "$7,714.12 " "$7,636.98 " "$51,769.01 " 330104 113 ORBITAL PROCEDURES WITH CC/MCC I N/A N/A "$20,162.03 " N/A "$34,088.14 " "$35,870.91 " "$32,673.61 " "$19,960.41 " N/A "$38,307.86 " N/A "$20,162.03 " "$67,909.10 " "$22,178.24 " "$83,805.37 " "$69,357.32 " N/A N/A N/A "$139,623.98 " "$96,835.30 " "$131,323.11 " N/A "$20,766.90 " "$25,000.92 " N/A N/A N/A N/A N/A "$28,226.85 " N/A "$20,162.03 " "$20,162.03 " "$21,976.62 " N/A N/A N/A N/A N/A N/A N/A "$78,854.94 " "$63,748.56 " "$63,748.56 " "$63,748.56 " "$63,748.56 " "$38,417.08 " "$22,178.24 " "$20,162.03 " "$41,432.52 " N/A N/A N/A N/A "$20,162.03 " "$19,960.41 " "$139,623.98 " 330104 114 ORBITAL PROCEDURES WITHOUT CC/MCC I N/A N/A "$11,857.84 " N/A "$19,779.11 " "$20,813.53 " "$18,958.35 " "$11,739.27 " N/A "$22,529.90 " N/A "$11,857.84 " "$39,403.19 " "$13,043.63 " "$48,626.75 " "$40,243.49 " N/A N/A N/A "$81,014.62 " "$56,187.16 " "$76,198.17 " N/A "$12,213.58 " "$14,703.73 " N/A N/A N/A N/A N/A "$16,600.98 " N/A "$11,857.84 " "$11,857.84 " "$12,925.05 " N/A N/A N/A N/A N/A N/A N/A "$45,754.34 " "$36,989.10 " "$36,989.10 " "$36,989.10 " "$36,989.10 " "$22,290.91 " "$13,043.63 " "$11,857.84 " "$24,040.57 " N/A N/A N/A N/A "$11,857.84 " "$11,739.27 " "$81,014.62 " 330104 115 EXTRAOCULAR PROCEDURES EXCEPT ORBIT I N/A N/A "$13,763.62 " N/A "$23,062.98 " "$24,269.14 " "$22,105.94 " "$13,625.99 " N/A "$26,150.88 " N/A "$13,763.62 " "$45,945.18 " "$15,139.99 " "$56,700.10 " "$46,925.00 " N/A N/A N/A "$94,465.23 " "$65,515.74 " "$88,849.12 " N/A "$14,176.53 " "$17,066.89 " N/A N/A N/A N/A N/A "$19,269.07 " N/A "$13,763.62 " "$13,763.62 " "$15,002.35 " N/A N/A N/A N/A N/A N/A N/A "$53,350.79 " "$43,130.29 " "$43,130.29 " "$43,130.29 " "$43,130.29 " "$25,991.80 " "$15,139.99 " "$13,763.62 " "$28,031.95 " N/A N/A N/A N/A "$13,763.62 " "$13,625.99 " "$94,465.23 " 330104 116 INTRAOCULAR PROCEDURES WITH CC/MCC I N/A N/A "$17,000.72 " N/A "$28,640.84 " "$30,138.72 " "$27,452.35 " "$16,830.71 " N/A "$32,301.36 " N/A "$17,000.72 " "$57,057.19 " "$18,700.79 " "$70,413.24 " "$58,273.99 " N/A N/A N/A "$117,312.00 " "$81,360.97 " "$110,337.61 " N/A "$17,510.74 " "$21,080.89 " N/A N/A N/A N/A N/A "$23,801.00 " N/A "$17,000.72 " "$17,000.72 " "$18,530.78 " N/A N/A N/A N/A N/A N/A N/A "$66,253.88 " "$53,561.51 " "$53,561.51 " "$53,561.51 " "$53,561.51 " "$32,278.01 " "$18,700.79 " "$17,000.72 " "$34,811.58 " N/A N/A N/A N/A "$17,000.72 " "$16,830.71 " "$117,312.00 " 330104 117 INTRAOCULAR PROCEDURES WITHOUT CC/MCC I N/A N/A "$9,126.49 " N/A "$15,072.69 " "$15,860.97 " "$14,447.23 " "$9,035.23 " N/A "$17,340.34 " N/A "$9,126.49 " "$30,027.24 " "$10,039.14 " "$37,056.06 " "$30,667.59 " N/A N/A N/A "$61,737.27 " "$42,817.48 " "$58,066.89 " N/A "$9,400.29 " "$11,316.85 " N/A N/A N/A N/A N/A "$12,777.09 " N/A "$9,126.49 " "$9,126.49 " "$9,947.88 " N/A N/A N/A N/A N/A N/A N/A "$34,867.14 " "$28,187.58 " "$28,187.58 " "$28,187.58 " "$28,187.58 " "$16,986.81 " "$10,039.14 " "$9,126.49 " "$18,320.14 " N/A N/A N/A N/A "$9,126.49 " "$9,035.23 " "$61,737.27 " 330104 121 ACUTE MAJOR EYE INFECTIONS WITH CC/MCC I N/A N/A "$11,175.01 " N/A "$18,602.50 " "$19,575.39 " "$17,830.57 " "$11,063.26 " N/A "$21,232.51 " N/A "$11,175.01 " "$37,059.20 " "$12,292.51 " "$45,734.08 " "$37,849.52 " N/A N/A N/A "$76,195.28 " "$52,844.74 " "$71,665.35 " N/A "$11,510.26 " "$13,857.01 " N/A N/A N/A N/A N/A "$15,645.01 " N/A "$11,175.01 " "$11,175.01 " "$12,180.76 " N/A N/A N/A N/A N/A N/A N/A "$43,032.54 " "$34,788.72 " "$34,788.72 " "$34,788.72 " "$34,788.72 " "$20,964.88 " "$12,292.51 " "$11,175.01 " "$22,610.46 " N/A N/A N/A N/A "$11,175.01 " "$11,063.26 " "$76,195.28 " 330104 122 ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC I N/A N/A "$6,465.63 " N/A "$10,487.73 " "$11,036.22 " "$10,052.52 " "$6,400.97 " N/A "$12,284.69 " N/A "$6,465.63 " "$20,893.25 " "$7,112.19 " "$25,783.97 " "$21,338.81 " N/A N/A N/A "$42,957.40 " "$29,792.82 " "$40,403.51 " N/A "$6,659.60 " "$8,017.38 " N/A N/A N/A N/A N/A "$9,051.88 " N/A "$6,465.63 " "$6,465.63 " "$7,047.53 " N/A N/A N/A N/A N/A N/A N/A "$24,260.90 " "$19,613.19 " "$19,613.19 " "$19,613.19 " "$19,613.19 " "$11,819.59 " "$7,112.19 " "$6,465.63 " "$12,747.33 " N/A N/A N/A N/A "$6,465.63 " "$6,400.97 " "$42,957.40 " 330104 123 NEUROLOGICAL EYE DISORDERS I N/A N/A "$7,373.14 " N/A "$12,051.47 " "$12,681.75 " "$11,551.38 " "$7,299.41 " N/A "$14,008.97 " N/A "$7,373.14 " "$24,008.48 " "$8,110.46 " "$29,628.43 " "$24,520.48 " N/A N/A N/A "$49,362.45 " "$34,235.01 " "$46,427.77 " N/A "$7,594.34 " "$9,142.70 " N/A N/A N/A N/A N/A "$10,322.40 " N/A "$7,373.14 " "$7,373.14 " "$8,036.72 " N/A N/A N/A N/A N/A N/A N/A "$27,878.26 " "$22,537.57 " "$22,537.57 " "$22,537.57 " "$22,537.57 " "$13,581.92 " "$8,110.46 " "$7,373.14 " "$14,647.99 " N/A N/A N/A N/A "$7,373.14 " "$7,299.41 " "$49,362.45 " 330104 124 OTHER DISORDERS OF THE EYE WITH MCC I N/A N/A "$12,720.42 " N/A "$21,265.43 " "$22,377.58 " "$20,382.99 " "$12,593.22 " N/A "$24,168.80 " N/A "$12,720.42 " "$42,364.17 " "$13,992.47 " "$52,280.85 " "$43,267.62 " N/A N/A N/A "$87,102.53 " "$60,409.39 " "$81,924.14 " N/A "$13,102.04 " "$15,773.32 " N/A N/A N/A N/A N/A "$17,808.59 " N/A "$12,720.42 " "$12,720.42 " "$13,865.26 " N/A N/A N/A N/A N/A N/A N/A "$49,192.58 " "$39,768.67 " "$39,768.67 " "$39,768.67 " "$39,768.67 " "$23,965.98 " "$13,992.47 " "$12,720.42 " "$25,847.12 " N/A N/A N/A N/A "$12,720.42 " "$12,593.22 " "$87,102.53 " 330104 125 OTHER DISORDERS OF THE EYE WITHOUT MCC I N/A N/A "$7,974.92 " N/A "$13,088.40 " "$13,772.91 " "$12,545.28 " "$7,895.17 " N/A "$15,152.35 " N/A "$7,974.92 " "$26,074.21 " "$8,772.41 " "$32,177.71 " "$26,630.27 " N/A N/A N/A "$53,609.69 " "$37,180.65 " "$50,422.50 " N/A "$8,214.17 " "$9,888.90 " N/A N/A N/A N/A N/A "$11,164.89 " N/A "$7,974.92 " "$7,974.92 " "$8,692.66 " N/A N/A N/A N/A N/A N/A N/A "$30,276.95 " "$24,476.74 " "$24,476.74 " "$24,476.74 " "$24,476.74 " "$14,750.53 " "$8,772.41 " "$7,974.92 " "$15,908.33 " N/A N/A N/A N/A "$7,974.92 " "$7,895.17 " "$53,609.69 " 330104 135 SINUS AND MASTOID PROCEDURES WITH CC/MCC I N/A N/A "$21,971.77 " N/A "$37,206.53 " "$39,152.38 " "$35,662.59 " "$21,752.06 " N/A "$41,746.37 " N/A "$21,971.77 " "$74,121.42 " "$24,168.95 " "$91,471.89 " "$75,702.12 " N/A N/A N/A "$152,396.78 " "$105,693.79 " "$143,336.54 " N/A "$22,630.93 " "$27,245.00 " N/A N/A N/A N/A N/A "$30,760.48 " N/A "$21,971.77 " "$21,971.77 " "$23,949.23 " N/A N/A N/A N/A N/A N/A N/A "$86,068.58 " "$69,580.27 " "$69,580.27 " "$69,580.27 " "$69,580.27 " "$41,931.48 " "$24,168.95 " "$21,971.77 " "$45,222.77 " N/A N/A N/A N/A "$21,971.77 " "$21,752.06 " "$152,396.78 " 330104 136 SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC I N/A N/A "$10,602.30 " N/A "$17,615.67 " "$18,536.95 " "$16,884.69 " "$10,496.28 " N/A "$20,144.38 " N/A "$10,602.30 " "$35,093.27 " "$11,662.53 " "$43,307.97 " "$35,841.67 " N/A N/A N/A "$72,153.26 " "$50,041.42 " "$67,863.63 " N/A "$10,920.37 " "$13,146.86 " N/A N/A N/A N/A N/A "$14,843.23 " N/A "$10,602.30 " "$10,602.30 " "$11,556.51 " N/A N/A N/A N/A N/A N/A N/A "$40,749.74 " "$32,943.24 " "$32,943.24 " "$32,943.24 " "$32,943.24 " "$19,852.73 " "$11,662.53 " "$10,602.30 " "$21,411.02 " N/A N/A N/A N/A "$10,602.30 " "$10,496.28 " "$72,153.26 " 330104 137 MOUTH PROCEDURES WITH CC/MCC I N/A N/A "$13,591.81 " N/A "$22,766.93 " "$23,957.61 " "$21,822.18 " "$13,455.89 " N/A "$25,824.44 " N/A "$13,591.81 " "$45,355.40 " "$14,950.99 " "$55,972.27 " "$46,322.64 " N/A N/A N/A "$93,252.63 " "$64,674.75 " "$87,708.60 " N/A "$13,999.57 " "$16,853.85 " N/A N/A N/A N/A N/A "$19,028.54 " N/A "$13,591.81 " "$13,591.81 " "$14,815.08 " N/A N/A N/A N/A N/A N/A N/A "$52,665.95 " "$42,576.64 " "$42,576.64 " "$42,576.64 " "$42,576.64 " "$25,658.16 " "$14,950.99 " "$13,591.81 " "$27,672.12 " N/A N/A N/A N/A "$13,591.81 " "$13,455.89 " "$93,252.63 " 330104 138 MOUTH PROCEDURES WITHOUT CC/MCC I N/A N/A "$8,170.52 " N/A "$13,425.44 " "$14,127.58 " "$12,868.33 " "$8,088.82 " N/A "$15,523.99 " N/A "$8,170.52 " "$26,745.65 " "$8,987.57 " "$33,006.32 " "$27,316.03 " N/A N/A N/A "$54,990.20 " "$38,138.09 " "$51,720.94 " N/A "$8,415.64 " "$10,131.45 " N/A N/A N/A N/A N/A "$11,438.73 " N/A "$8,170.52 " "$8,170.52 " "$8,905.87 " N/A N/A N/A N/A N/A N/A N/A "$31,056.62 " "$25,107.05 " "$25,107.05 " "$25,107.05 " "$25,107.05 " "$15,130.37 " "$8,987.57 " "$8,170.52 " "$16,317.99 " N/A N/A N/A N/A "$8,170.52 " "$8,088.82 " "$54,990.20 " 330104 139 SALIVARY GLAND PROCEDURES I N/A N/A "$11,458.71 " N/A "$19,091.37 " "$20,089.82 " "$18,299.14 " "$11,344.13 " N/A "$21,771.56 " N/A "$11,458.71 " "$38,033.09 " "$12,604.59 " "$46,935.94 " "$38,844.18 " N/A N/A N/A "$78,197.64 " "$54,233.46 " "$73,548.66 " N/A "$11,802.48 " "$14,208.81 " N/A N/A N/A N/A N/A "$16,042.20 " N/A "$11,458.71 " "$11,458.71 " "$12,490.00 " N/A N/A N/A N/A N/A N/A N/A "$44,163.40 " "$35,702.94 " "$35,702.94 " "$35,702.94 " "$35,702.94 " "$21,515.83 " "$12,604.59 " "$11,458.71 " "$23,204.65 " N/A N/A N/A N/A "$11,458.71 " "$11,344.13 " "$78,197.64 " 330104 140 MAJOR HEAD AND NECK PROCEDURES WITH MCC I N/A N/A "$36,999.49 " N/A "$63,100.95 " "$66,401.05 " "$60,482.48 " "$36,629.50 " N/A "$70,299.04 " N/A "$36,999.49 " "$125,707.29 " "$40,699.44 " "$155,133.07 " "$128,388.11 " N/A N/A N/A "$258,459.52 " "$179,252.91 " "$243,093.67 " N/A "$38,109.48 " "$45,879.37 " N/A N/A N/A N/A N/A "$51,799.29 " N/A "$36,999.49 " "$36,999.49 " "$40,329.45 " N/A N/A N/A N/A N/A N/A N/A "$145,969.26 " "$118,005.67 " "$118,005.67 " "$118,005.67 " "$118,005.67 " "$71,114.29 " "$40,699.44 " "$36,999.49 " "$76,696.20 " N/A N/A N/A N/A "$36,999.49 " "$36,629.50 " "$258,459.52 " 330104 141 MAJOR HEAD AND NECK PROCEDURES WITH CC I N/A N/A "$20,050.14 " N/A "$33,895.33 " "$35,668.02 " "$32,488.80 " "$19,849.64 " N/A "$38,095.26 " N/A "$20,050.14 " "$67,524.99 " "$22,055.15 " "$83,331.35 " "$68,965.01 " N/A N/A N/A "$138,834.23 " "$96,287.57 " "$130,580.31 " N/A "$20,651.64 " "$24,862.17 " N/A N/A N/A N/A N/A "$28,070.19 " N/A "$20,050.14 " "$20,050.14 " "$21,854.65 " N/A N/A N/A N/A N/A N/A N/A "$78,408.91 " "$63,387.98 " "$63,387.98 " "$63,387.98 " "$63,387.98 " "$38,199.79 " "$22,055.15 " "$20,050.14 " "$41,198.17 " N/A N/A N/A N/A "$20,050.14 " "$19,849.64 " "$138,834.23 " 330104 142 MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC I N/A N/A "$15,372.48 " N/A "$25,835.21 " "$27,186.36 " "$24,763.14 " "$15,218.75 " N/A "$29,207.71 " N/A "$15,372.48 " "$51,467.92 " "$16,909.72 " "$63,515.61 " "$52,565.51 " N/A N/A N/A "$105,820.21 " "$73,390.92 " "$99,529.03 " N/A "$15,833.65 " "$19,061.87 " N/A N/A N/A N/A N/A "$21,521.47 " N/A "$15,372.48 " "$15,372.48 " "$16,756.00 " N/A N/A N/A N/A N/A N/A N/A "$59,763.70 " "$48,314.67 " "$48,314.67 " "$48,314.67 " "$48,314.67 " "$29,116.09 " "$16,909.72 " "$15,372.48 " "$31,401.47 " N/A N/A N/A N/A "$15,372.48 " "$15,218.75 " "$105,820.21 " 330104 143 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC" I N/A N/A "$28,332.30 " N/A "$48,166.41 " "$50,685.46 " "$46,167.68 " "$28,048.98 " N/A "$53,831.37 " N/A "$28,332.30 " "$95,955.29 " "$31,165.53 " "$118,416.66 " "$98,001.61 " N/A N/A N/A "$197,288.13 " "$136,827.89 " "$185,559.03 " N/A "$29,182.27 " "$35,132.05 " N/A N/A N/A N/A N/A "$39,665.22 " N/A "$28,332.30 " "$28,332.30 " "$30,882.21 " N/A N/A N/A N/A N/A N/A N/A "$111,421.71 " "$90,076.46 " "$90,076.46 " "$90,076.46 " "$90,076.46 " "$54,283.19 " "$31,165.53 " "$28,332.30 " "$58,543.99 " N/A N/A N/A N/A "$28,332.30 " "$28,048.98 " "$197,288.13 " 330104 144 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC" I N/A N/A "$16,320.52 " N/A "$27,468.79 " "$28,905.38 " "$26,328.93 " "$16,157.32 " N/A "$31,008.99 " N/A "$16,320.52 " "$54,722.28 " "$17,952.57 " "$67,531.76 " "$55,889.28 " N/A N/A N/A "$112,511.32 " "$78,031.49 " "$105,822.34 " N/A "$16,810.14 " "$20,237.45 " N/A N/A N/A N/A N/A "$22,848.73 " N/A "$16,320.52 " "$16,320.52 " "$17,789.37 " N/A N/A N/A N/A N/A N/A N/A "$63,542.62 " "$51,369.65 " "$51,369.65 " "$51,369.65 " "$51,369.65 " "$30,957.12 " "$17,952.57 " "$16,320.52 " "$33,387.01 " N/A N/A N/A N/A "$16,320.52 " "$16,157.32 " "$112,511.32 " 330104 145 "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC" I N/A N/A "$11,020.82 " N/A "$18,336.82 " "$19,295.81 " "$17,575.91 " "$10,910.61 " N/A "$20,939.55 " N/A "$11,020.82 " "$36,529.91 " "$12,122.90 " "$45,080.89 " "$37,308.94 " N/A N/A N/A "$75,107.04 " "$52,090.00 " "$70,641.81 " N/A "$11,351.44 " "$13,665.81 " N/A N/A N/A N/A N/A "$15,429.14 " N/A "$11,020.82 " "$11,020.82 " "$12,012.69 " N/A N/A N/A N/A N/A N/A N/A "$42,417.94 " "$34,291.86 " "$34,291.86 " "$34,291.86 " "$34,291.86 " "$20,665.46 " "$12,122.90 " "$11,020.82 " "$22,287.53 " N/A N/A N/A N/A "$11,020.82 " "$10,910.61 " "$75,107.04 " 330104 146 "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC" I N/A N/A "$18,125.86 " N/A "$30,579.58 " "$32,178.86 " "$29,310.64 " "$17,944.60 " N/A "$34,439.13 " N/A "$18,125.86 " "$60,919.48 " "$19,938.44 " "$75,179.61 " "$62,218.64 " N/A N/A N/A "$125,253.03 " "$86,868.42 " "$117,806.53 " N/A "$18,669.63 " "$22,476.06 " N/A N/A N/A N/A N/A "$25,376.20 " N/A "$18,125.86 " "$18,125.86 " "$19,757.18 " N/A N/A N/A N/A N/A N/A N/A "$70,738.70 " "$57,187.17 " "$57,187.17 " "$57,187.17 " "$57,187.17 " "$34,462.96 " "$19,938.44 " "$18,125.86 " "$37,168.03 " N/A N/A N/A N/A "$18,125.86 " "$17,944.60 " "$125,253.03 " 330104 147 "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC" I N/A N/A "$11,049.89 " N/A "$18,386.92 " "$19,348.53 " "$17,623.93 " "$10,939.39 " N/A "$20,994.80 " N/A "$11,049.89 " "$36,629.72 " "$12,154.88 " "$45,204.07 " "$37,410.88 " N/A N/A N/A "$75,312.25 " "$52,232.32 " "$70,834.82 " N/A "$11,381.39 " "$13,701.87 " N/A N/A N/A N/A N/A "$15,469.85 " N/A "$11,049.89 " "$11,049.89 " "$12,044.38 " N/A N/A N/A N/A N/A N/A N/A "$42,533.83 " "$34,385.55 " "$34,385.55 " "$34,385.55 " "$34,385.55 " "$20,721.92 " "$12,154.88 " "$11,049.89 " "$22,348.43 " N/A N/A N/A N/A "$11,049.89 " "$10,939.39 " "$75,312.25 " 330104 148 "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC" I N/A N/A "$7,582.84 " N/A "$12,412.80 " "$13,061.98 " "$11,897.72 " "$7,507.01 " N/A "$14,407.39 " N/A "$7,582.84 " "$24,728.31 " "$8,341.12 " "$30,516.76 " "$25,255.66 " N/A N/A N/A "$50,842.46 " "$35,261.45 " "$47,819.79 " N/A "$7,810.32 " "$9,402.72 " N/A N/A N/A N/A N/A "$10,615.97 " N/A "$7,582.84 " "$7,582.84 " "$8,265.29 " N/A N/A N/A N/A N/A N/A N/A "$28,714.11 " "$23,213.30 " "$23,213.30 " "$23,213.30 " "$23,213.30 " "$13,989.14 " "$8,341.12 " "$7,582.84 " "$15,087.17 " N/A N/A N/A N/A "$7,582.84 " "$7,507.01 " "$50,842.46 " 330104 149 DYSEQUILIBRIUM I N/A N/A "$7,031.28 " N/A "$11,462.41 " "$12,061.88 " "$10,986.76 " "$6,960.97 " N/A "$13,359.44 " N/A "$7,031.28 " "$22,834.97 " "$7,734.41 " "$28,180.22 " "$23,321.95 " N/A N/A N/A "$46,949.68 " "$32,561.64 " "$44,158.44 " N/A "$7,242.22 " "$8,718.79 " N/A N/A N/A N/A N/A "$9,843.80 " N/A "$7,031.28 " "$7,031.28 " "$7,664.10 " N/A N/A N/A N/A N/A N/A N/A "$26,515.60 " "$21,435.96 " "$21,435.96 " "$21,435.96 " "$21,435.96 " "$12,918.05 " "$7,734.41 " "$7,031.28 " "$13,932.01 " N/A N/A N/A N/A "$7,031.28 " "$6,960.97 " "$46,949.68 " 330104 150 EPISTAXIS WITH MCC I N/A N/A "$12,531.87 " N/A "$20,940.53 " "$22,035.70 " "$20,071.57 " "$12,406.55 " N/A "$23,810.56 " N/A "$12,531.87 " "$41,716.93 " "$13,785.06 " "$51,482.10 " "$42,606.58 " N/A N/A N/A "$85,771.77 " "$59,486.45 " "$80,672.50 " N/A "$12,907.83 " "$15,539.52 " N/A N/A N/A N/A N/A "$17,544.62 " N/A "$12,531.87 " "$12,531.87 " "$13,659.74 " N/A N/A N/A N/A N/A N/A N/A "$48,441.02 " "$39,161.09 " "$39,161.09 " "$39,161.09 " "$39,161.09 " "$23,599.82 " "$13,785.06 " "$12,531.87 " "$25,452.22 " N/A N/A N/A N/A "$12,531.87 " "$12,406.55 " "$85,771.77 " 330104 151 EPISTAXIS WITHOUT MCC I N/A N/A "$7,172.26 " N/A "$11,705.32 " "$12,317.50 " "$11,219.59 " "$7,100.53 " N/A "$13,627.29 " N/A "$7,172.26 " "$23,318.89 " "$7,889.48 " "$28,777.42 " "$23,816.19 " N/A N/A N/A "$47,944.63 " "$33,251.69 " "$45,094.25 " N/A "$7,387.42 " "$8,893.60 " N/A N/A N/A N/A N/A "$10,041.16 " N/A "$7,172.26 " "$7,172.26 " "$7,817.76 " N/A N/A N/A N/A N/A N/A N/A "$27,077.52 " "$21,890.23 " "$21,890.23 " "$21,890.23 " "$21,890.23 " "$13,191.81 " "$7,889.48 " "$7,172.26 " "$14,227.26 " N/A N/A N/A N/A "$7,172.26 " "$7,100.53 " "$47,944.63 " 330104 152 OTITIS MEDIA AND URI WITH MCC I N/A N/A "$10,931.83 " N/A "$18,183.48 " "$19,134.46 " "$17,428.93 " "$10,822.51 " N/A "$20,770.47 " N/A "$10,931.83 " "$36,224.44 " "$12,025.01 " "$44,703.91 " "$36,996.95 " N/A N/A N/A "$74,478.97 " "$51,654.41 " "$70,051.08 " N/A "$11,259.78 " "$13,555.47 " N/A N/A N/A N/A N/A "$15,304.56 " N/A "$10,931.83 " "$10,931.83 " "$11,915.69 " N/A N/A N/A N/A N/A N/A N/A "$42,063.22 " "$34,005.10 " "$34,005.10 " "$34,005.10 " "$34,005.10 " "$20,492.65 " "$12,025.01 " "$10,931.83 " "$22,101.16 " N/A N/A N/A N/A "$10,931.83 " "$10,822.51 " "$74,478.97 " 330104 153 OTITIS MEDIA AND URI WITHOUT MCC I N/A N/A "$6,462.99 " N/A "$10,483.17 " "$11,031.43 " "$10,048.16 " "$6,398.36 " N/A "$12,279.67 " N/A "$6,462.99 " "$20,884.17 " "$7,109.28 " "$25,772.77 " "$21,329.55 " N/A N/A N/A "$42,938.74 " "$29,779.88 " "$40,385.96 " N/A "$6,656.87 " "$8,014.10 " N/A N/A N/A N/A N/A "$9,048.18 " N/A "$6,462.99 " "$6,462.99 " "$7,044.65 " N/A N/A N/A N/A N/A N/A N/A "$24,250.36 " "$19,604.68 " "$19,604.68 " "$19,604.68 " "$19,604.68 " "$11,814.45 " "$7,109.28 " "$6,462.99 " "$12,741.80 " N/A N/A N/A N/A "$6,462.99 " "$6,398.36 " "$42,938.74 " 330104 154 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC" I N/A N/A "$13,620.89 " N/A "$22,817.03 " "$24,010.33 " "$21,870.20 " "$13,484.68 " N/A "$25,879.69 " N/A "$13,620.89 " "$45,455.21 " "$14,982.98 " "$56,095.44 " "$46,424.58 " N/A N/A N/A "$93,457.84 " "$64,817.07 " "$87,901.62 " N/A "$14,029.51 " "$16,889.90 " N/A N/A N/A N/A N/A "$19,069.24 " N/A "$13,620.89 " "$13,620.89 " "$14,846.77 " N/A N/A N/A N/A N/A N/A N/A "$52,781.85 " "$42,670.34 " "$42,670.34 " "$42,670.34 " "$42,670.34 " "$25,714.62 " "$14,982.98 " "$13,620.89 " "$27,733.01 " N/A N/A N/A N/A "$13,620.89 " "$13,484.68 " "$93,457.84 " 330104 155 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC" I N/A N/A "$8,478.90 " N/A "$13,956.81 " "$14,686.74 " "$13,377.65 " "$8,394.11 " N/A "$16,109.91 " N/A "$8,478.90 " "$27,804.23 " "$9,326.79 " "$34,312.69 " "$28,397.18 " N/A N/A N/A "$57,166.67 " "$39,647.57 " "$53,768.02 " N/A "$8,733.27 " "$10,513.83 " N/A N/A N/A N/A N/A "$11,870.46 " N/A "$8,478.90 " "$8,478.90 " "$9,242.00 " N/A N/A N/A N/A N/A N/A N/A "$32,285.82 " "$26,100.77 " "$26,100.77 " "$26,100.77 " "$26,100.77 " "$15,729.22 " "$9,326.79 " "$8,478.90 " "$16,963.84 " N/A N/A N/A N/A "$8,478.90 " "$8,394.11 " "$57,166.67 " 330104 156 "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC" I N/A N/A "$6,385.45 " N/A "$10,349.57 " "$10,890.84 " "$9,920.10 " "$6,321.60 " N/A "$12,132.35 " N/A "$6,385.45 " "$20,618.02 " "$7,023.99 " "$25,444.32 " "$21,057.71 " N/A N/A N/A "$42,391.51 " "$29,400.36 " "$39,871.27 " N/A "$6,577.01 " "$7,917.96 " N/A N/A N/A N/A N/A "$8,939.63 " N/A "$6,385.45 " "$6,385.45 " "$6,960.14 " N/A N/A N/A N/A N/A N/A N/A "$23,941.30 " "$19,354.83 " "$19,354.83 " "$19,354.83 " "$19,354.83 " "$11,663.89 " "$7,023.99 " "$6,385.45 " "$12,579.41 " N/A N/A N/A N/A "$6,385.45 " "$6,321.60 " "$42,391.51 " 330104 157 DENTAL AND ORAL DISEASES WITH MCC I N/A N/A "$15,109.03 " N/A "$25,381.27 " "$26,708.68 " "$24,328.03 " "$14,957.94 " N/A "$28,707.16 " N/A "$15,109.03 " "$50,563.59 " "$16,619.94 " "$62,399.60 " "$51,641.90 " N/A N/A N/A "$103,960.88 " "$72,101.39 " "$97,780.24 " N/A "$15,562.30 " "$18,735.20 " N/A N/A N/A N/A N/A "$21,152.65 " N/A "$15,109.03 " "$15,109.03 " "$16,468.85 " N/A N/A N/A N/A N/A N/A N/A "$58,713.62 " "$47,465.75 " "$47,465.75 " "$47,465.75 " "$47,465.75 " "$28,604.50 " "$16,619.94 " "$15,109.03 " "$30,849.73 " N/A N/A N/A N/A "$15,109.03 " "$14,957.94 " "$103,960.88 " 330104 158 DENTAL AND ORAL DISEASES WITH CC I N/A N/A "$8,565.24 " N/A "$14,105.60 " "$14,843.30 " "$13,520.26 " "$8,479.59 " N/A "$16,273.96 " N/A "$8,565.24 " "$28,100.63 " "$9,421.77 " "$34,678.47 " "$28,699.90 " N/A N/A N/A "$57,776.08 " "$40,070.22 " "$54,341.20 " N/A "$8,822.20 " "$10,620.90 " N/A N/A N/A N/A N/A "$11,991.34 " N/A "$8,565.24 " "$8,565.24 " "$9,336.12 " N/A N/A N/A N/A N/A N/A N/A "$32,629.99 " "$26,379.01 " "$26,379.01 " "$26,379.01 " "$26,379.01 " "$15,896.90 " "$9,421.77 " "$8,565.24 " "$17,144.68 " N/A N/A N/A N/A "$8,565.24 " "$8,479.59 " "$57,776.08 " 330104 159 DENTAL AND ORAL DISEASES WITHOUT CC/MCC I N/A N/A "$6,986.35 " N/A "$11,384.98 " "$11,980.40 " "$10,912.54 " "$6,916.48 " N/A "$13,274.06 " N/A "$6,986.35 " "$22,680.73 " "$7,684.98 " "$27,989.87 " "$23,164.41 " N/A N/A N/A "$46,632.53 " "$32,341.69 " "$43,860.15 " N/A "$7,195.94 " "$8,663.07 " N/A N/A N/A N/A N/A "$9,780.89 " N/A "$6,986.35 " "$6,986.35 " "$7,615.12 " N/A N/A N/A N/A N/A N/A N/A "$26,336.49 " "$21,291.16 " "$21,291.16 " "$21,291.16 " "$21,291.16 " "$12,830.79 " "$7,684.98 " "$6,986.35 " "$13,837.90 " N/A N/A N/A N/A "$6,986.35 " "$6,916.48 " "$46,632.53 " 330104 163 MAJOR CHEST PROCEDURES WITH MCC I N/A N/A "$43,056.05 " N/A "$73,537.05 " "$77,382.95 " "$70,485.52 " "$42,625.49 " N/A "$81,806.49 " N/A "$43,056.05 " "$146,497.71 " "$47,361.65 " "$180,790.13 " "$149,621.89 " N/A N/A N/A "$301,205.48 " "$208,899.09 " "$283,298.33 " N/A "$44,347.73 " "$53,389.50 " N/A N/A N/A N/A N/A "$60,278.46 " N/A "$43,056.05 " "$43,056.05 " "$46,931.09 " N/A N/A N/A N/A N/A N/A N/A "$170,110.74 " "$137,522.33 " "$137,522.33 " "$137,522.33 " "$137,522.33 " "$82,875.71 " "$47,361.65 " "$43,056.05 " "$89,380.80 " N/A N/A N/A N/A "$43,056.05 " "$42,625.49 " "$301,205.48 " 330104 164 MAJOR CHEST PROCEDURES WITH CC I N/A N/A "$23,134.80 " N/A "$39,210.55 " "$41,261.22 " "$37,583.45 " "$22,903.45 " N/A "$43,956.12 " N/A "$23,134.80 " "$78,113.76 " "$25,448.28 " "$96,398.76 " "$79,779.60 " N/A N/A N/A "$160,605.20 " "$111,386.69 " "$151,056.96 " N/A "$23,828.85 " "$28,687.15 " N/A N/A N/A N/A N/A "$32,388.72 " N/A "$23,134.80 " "$23,134.80 " "$25,216.93 " N/A N/A N/A N/A N/A N/A N/A "$90,704.42 " "$73,328.02 " "$73,328.02 " "$73,328.02 " "$73,328.02 " "$44,190.00 " "$25,448.28 " "$23,134.80 " "$47,658.56 " N/A N/A N/A N/A "$23,134.80 " "$22,903.45 " "$160,605.20 " 330104 165 MAJOR CHEST PROCEDURES WITHOUT CC/MCC I N/A N/A "$17,356.67 " N/A "$29,254.20 " "$30,784.15 " "$28,040.25 " "$17,183.11 " N/A "$32,977.68 " N/A "$17,356.67 " "$58,279.09 " "$19,092.34 " "$71,921.16 " "$59,521.94 " N/A N/A N/A "$119,824.28 " "$83,103.34 " "$112,700.53 " N/A "$17,877.37 " "$21,522.27 " N/A N/A N/A N/A N/A "$24,299.34 " N/A "$17,356.67 " "$17,356.67 " "$18,918.77 " N/A N/A N/A N/A N/A N/A N/A "$67,672.73 " "$54,708.54 " "$54,708.54 " "$54,708.54 " "$54,708.54 " "$32,969.26 " "$19,092.34 " "$17,356.67 " "$35,557.09 " N/A N/A N/A N/A "$17,356.67 " "$17,183.11 " "$119,824.28 " 330104 166 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC I N/A N/A "$32,677.79 " N/A "$55,654.18 " "$58,564.82 " "$53,344.72 " "$32,351.01 " N/A "$62,087.80 " N/A "$32,677.79 " "$110,872.12 " "$35,945.57 " "$136,825.25 " "$113,236.56 " N/A N/A N/A "$227,957.77 " "$158,098.62 " "$214,405.31 " N/A "$33,658.12 " "$40,520.46 " N/A N/A N/A N/A N/A "$45,748.91 " N/A "$32,677.79 " "$32,677.79 " "$35,618.79 " N/A N/A N/A N/A N/A N/A N/A "$128,742.90 " "$104,079.39 " "$104,079.39 " "$104,079.39 " "$104,079.39 " "$62,721.84 " "$35,945.57 " "$32,677.79 " "$67,645.01 " N/A N/A N/A N/A "$32,677.79 " "$32,351.01 " "$227,957.77 " 330104 167 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC I N/A N/A "$17,129.35 " N/A "$28,862.50 " "$30,371.97 " "$27,664.81 " "$16,958.06 " N/A "$32,545.77 " N/A "$17,129.35 " "$57,498.77 " "$18,842.29 " "$70,958.18 " "$58,724.98 " N/A N/A N/A "$118,219.90 " "$81,990.64 " "$111,191.54 " N/A "$17,643.23 " "$21,240.40 " N/A N/A N/A N/A N/A "$23,981.09 " N/A "$17,129.35 " "$17,129.35 " "$18,670.99 " N/A N/A N/A N/A N/A N/A N/A "$66,766.63 " "$53,976.03 " "$53,976.03 " "$53,976.03 " "$53,976.03 " "$32,527.82 " "$18,842.29 " "$17,129.35 " "$35,081.00 " N/A N/A N/A N/A "$17,129.35 " "$16,958.06 " "$118,219.90 " 330104 168 OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$12,869.33 " N/A "$21,522.00 " "$22,647.58 " "$20,628.92 " "$12,740.63 " N/A "$24,451.72 " N/A "$12,869.33 " "$42,875.31 " "$14,156.26 " "$52,911.64 " "$43,789.66 " N/A N/A N/A "$88,153.46 " "$61,138.25 " "$82,912.59 " N/A "$13,255.41 " "$15,957.96 " N/A N/A N/A N/A N/A "$18,017.06 " N/A "$12,869.33 " "$12,869.33 " "$14,027.57 " N/A N/A N/A N/A N/A N/A N/A "$49,786.11 " "$40,248.50 " "$40,248.50 " "$40,248.50 " "$40,248.50 " "$24,255.14 " "$14,156.26 " "$12,869.33 " "$26,158.97 " N/A N/A N/A N/A "$12,869.33 " "$12,740.63 " "$88,153.46 " 330104 175 PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE I N/A N/A "$12,686.06 " N/A "$21,206.22 " "$22,315.28 " "$20,326.23 " "$12,559.20 " N/A "$24,103.52 " N/A "$12,686.06 " "$42,246.22 " "$13,954.67 " "$52,135.28 " "$43,147.15 " N/A N/A N/A "$86,860.01 " "$60,241.19 " "$81,696.04 " N/A "$13,066.64 " "$15,730.72 " N/A N/A N/A N/A N/A "$17,760.49 " N/A "$12,686.06 " "$12,686.06 " "$13,827.81 " N/A N/A N/A N/A N/A N/A N/A "$49,055.62 " "$39,657.95 " "$39,657.95 " "$39,657.95 " "$39,657.95 " "$23,899.25 " "$13,954.67 " "$12,686.06 " "$25,775.15 " N/A N/A N/A N/A "$12,686.06 " "$12,559.20 " "$86,860.01 " 330104 176 PULMONARY EMBOLISM WITHOUT MCC I N/A N/A "$7,582.84 " N/A "$12,412.80 " "$13,061.98 " "$11,897.72 " "$7,507.01 " N/A "$14,407.39 " N/A "$7,582.84 " "$24,728.31 " "$8,341.12 " "$30,516.76 " "$25,255.66 " N/A N/A N/A "$50,842.46 " "$35,261.45 " "$47,819.79 " N/A "$7,810.32 " "$9,402.72 " N/A N/A N/A N/A N/A "$10,615.97 " N/A "$7,582.84 " "$7,582.84 " "$8,265.29 " N/A N/A N/A N/A N/A N/A N/A "$28,714.11 " "$23,213.30 " "$23,213.30 " "$23,213.30 " "$23,213.30 " "$13,989.14 " "$8,341.12 " "$7,582.84 " "$15,087.17 " N/A N/A N/A N/A "$7,582.84 " "$7,507.01 " "$50,842.46 " 330104 177 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC I N/A N/A "$16,061.48 " N/A "$27,022.44 " "$28,435.68 " "$25,901.10 " "$15,900.87 " N/A "$30,516.82 " N/A "$16,061.48 " "$53,833.08 " "$17,667.63 " "$66,434.41 " "$54,981.11 " N/A N/A N/A "$110,683.08 " "$76,763.53 " "$104,102.79 " N/A "$16,543.33 " "$19,916.24 " N/A N/A N/A N/A N/A "$22,486.08 " N/A "$16,061.48 " "$16,061.48 " "$17,507.02 " N/A N/A N/A N/A N/A N/A N/A "$62,510.09 " "$50,534.92 " "$50,534.92 " "$50,534.92 " "$50,534.92 " "$30,454.09 " "$17,667.63 " "$16,061.48 " "$32,844.49 " N/A N/A N/A N/A "$16,061.48 " "$15,900.87 " "$110,683.08 " 330104 178 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC I N/A N/A "$9,956.47 " N/A "$16,502.83 " "$17,365.91 " "$15,818.02 " "$9,856.91 " N/A "$18,917.30 " N/A "$9,956.47 " "$32,876.32 " "$10,952.12 " "$40,572.06 " "$33,577.43 " N/A N/A N/A "$67,595.10 " "$46,880.14 " "$63,576.46 " N/A "$10,255.17 " "$12,346.02 " N/A N/A N/A N/A N/A "$13,939.06 " N/A "$9,956.47 " "$9,956.47 " "$10,852.55 " N/A N/A N/A N/A N/A N/A N/A "$38,175.44 " "$30,862.10 " "$30,862.10 " "$30,862.10 " "$30,862.10 " "$18,598.57 " "$10,952.12 " "$9,956.47 " "$20,058.41 " N/A N/A N/A N/A "$9,956.47 " "$9,856.91 " "$67,595.10 " 330104 179 RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC I N/A N/A "$7,299.13 " N/A "$11,923.94 " "$12,547.55 " "$11,429.14 " "$7,226.14 " N/A "$13,868.35 " N/A "$7,299.13 " "$23,754.42 " "$8,029.04 " "$29,314.90 " "$24,261.01 " N/A N/A N/A "$48,840.10 " "$33,872.73 " "$45,936.48 " N/A "$7,518.10 " "$9,050.92 " N/A N/A N/A N/A N/A "$10,218.78 " N/A "$7,299.13 " "$7,299.13 " "$7,956.05 " N/A N/A N/A N/A N/A N/A N/A "$27,583.25 " "$22,299.08 " "$22,299.08 " "$22,299.08 " "$22,299.08 " "$13,438.19 " "$8,029.04 " "$7,299.13 " "$14,492.99 " N/A N/A N/A N/A "$7,299.13 " "$7,226.14 " "$48,840.10 " 330104 180 RESPIRATORY NEOPLASMS WITH MCC I N/A N/A "$15,303.75 " N/A "$25,716.79 " "$27,061.75 " "$24,649.63 " "$15,150.72 " N/A "$29,077.13 " N/A "$15,303.75 " "$51,232.01 " "$16,834.13 " "$63,224.48 " "$52,324.57 " N/A N/A N/A "$105,335.17 " "$73,054.52 " "$99,072.82 " N/A "$15,762.87 " "$18,976.65 " N/A N/A N/A N/A N/A "$21,425.25 " N/A "$15,303.75 " "$15,303.75 " "$16,681.09 " N/A N/A N/A N/A N/A N/A N/A "$59,489.77 " "$48,093.21 " "$48,093.21 " "$48,093.21 " "$48,093.21 " "$28,982.63 " "$16,834.13 " "$15,303.75 " "$31,257.54 " N/A N/A N/A N/A "$15,303.75 " "$15,150.72 " "$105,335.17 " 330104 181 RESPIRATORY NEOPLASMS WITH CC I N/A N/A "$10,367.94 " N/A "$17,211.83 " "$18,111.99 " "$16,497.60 " "$10,264.26 " N/A "$19,699.08 " N/A "$10,367.94 " "$34,288.76 " "$11,404.73 " "$42,315.13 " "$35,019.99 " N/A N/A N/A "$70,499.13 " "$48,894.21 " "$66,307.85 " N/A "$10,678.97 " "$12,856.24 " N/A N/A N/A N/A N/A "$14,515.11 " N/A "$10,367.94 " "$10,367.94 " "$11,301.05 " N/A N/A N/A N/A N/A N/A N/A "$39,815.54 " "$32,188.01 " "$32,188.01 " "$32,188.01 " "$32,188.01 " "$19,397.61 " "$11,404.73 " "$10,367.94 " "$20,920.17 " N/A N/A N/A N/A "$10,367.94 " "$10,264.26 " "$70,499.13 " 330104 182 RESPIRATORY NEOPLASMS WITHOUT CC/MCC I N/A N/A "$8,198.71 " N/A "$13,474.02 " "$14,178.70 " "$12,914.90 " "$8,116.73 " N/A "$15,577.56 " N/A "$8,198.71 " "$26,842.44 " "$9,018.59 " "$33,125.76 " "$27,414.88 " N/A N/A N/A "$55,189.19 " "$38,276.10 " "$51,908.10 " N/A "$8,444.68 " "$10,166.41 " N/A N/A N/A N/A N/A "$11,478.20 " N/A "$8,198.71 " "$8,198.71 " "$8,936.60 " N/A N/A N/A N/A N/A N/A N/A "$31,169.00 " "$25,197.90 " "$25,197.90 " "$25,197.90 " "$25,197.90 " "$15,185.12 " "$9,018.59 " "$8,198.71 " "$16,377.04 " N/A N/A N/A N/A "$8,198.71 " "$8,116.73 " "$55,189.19 " 330104 183 MAJOR CHEST TRAUMA WITH MCC I N/A N/A "$13,614.72 " N/A "$22,806.40 " "$23,999.15 " "$21,860.01 " "$13,478.57 " N/A "$25,867.97 " N/A "$13,614.72 " "$45,434.04 " "$14,976.19 " "$56,069.31 " "$46,402.96 " N/A N/A N/A "$93,414.31 " "$64,786.88 " "$87,860.67 " N/A "$14,023.16 " "$16,882.25 " N/A N/A N/A N/A N/A "$19,060.61 " N/A "$13,614.72 " "$13,614.72 " "$14,840.05 " N/A N/A N/A N/A N/A N/A N/A "$52,757.26 " "$42,650.46 " "$42,650.46 " "$42,650.46 " "$42,650.46 " "$25,702.64 " "$14,976.19 " "$13,614.72 " "$27,720.10 " N/A N/A N/A N/A "$13,614.72 " "$13,478.57 " "$93,414.31 " 330104 184 MAJOR CHEST TRAUMA WITH CC I N/A N/A "$9,588.18 " N/A "$15,868.23 " "$16,698.12 " "$15,209.75 " "$9,492.30 " N/A "$18,217.54 " N/A "$9,588.18 " "$31,612.07 " "$10,547.00 " "$39,011.88 " "$32,286.23 " N/A N/A N/A "$64,995.76 " "$45,077.39 " "$61,131.66 " N/A "$9,875.83 " "$11,889.34 " N/A N/A N/A N/A N/A "$13,423.45 " N/A "$9,588.18 " "$9,588.18 " "$10,451.12 " N/A N/A N/A N/A N/A N/A N/A "$36,707.42 " "$29,675.32 " "$29,675.32 " "$29,675.32 " "$29,675.32 " "$17,883.37 " "$10,547.00 " "$9,588.18 " "$19,287.08 " N/A N/A N/A N/A "$9,588.18 " "$9,492.30 " "$64,995.76 " 330104 185 MAJOR CHEST TRAUMA WITHOUT CC/MCC I N/A N/A "$7,031.28 " N/A "$11,462.41 " "$12,061.88 " "$10,986.76 " "$6,960.97 " N/A "$13,359.44 " N/A "$7,031.28 " "$22,834.97 " "$7,734.41 " "$28,180.22 " "$23,321.95 " N/A N/A N/A "$46,949.68 " "$32,561.64 " "$44,158.44 " N/A "$7,242.22 " "$8,718.79 " N/A N/A N/A N/A N/A "$9,843.80 " N/A "$7,031.28 " "$7,031.28 " "$7,664.10 " N/A N/A N/A N/A N/A N/A N/A "$26,515.60 " "$21,435.96 " "$21,435.96 " "$21,435.96 " "$21,435.96 " "$12,918.05 " "$7,734.41 " "$7,031.28 " "$13,932.01 " N/A N/A N/A N/A "$7,031.28 " "$6,960.97 " "$46,949.68 " 330104 186 PLEURAL EFFUSION WITH MCC I N/A N/A "$13,831.47 " N/A "$23,179.88 " "$24,392.16 " "$22,217.99 " "$13,693.15 " N/A "$26,279.79 " N/A "$13,831.47 " "$46,178.07 " "$15,214.61 " "$56,987.50 " "$47,162.85 " N/A N/A N/A "$94,944.06 " "$65,847.83 " "$89,299.48 " N/A "$14,246.41 " "$17,151.02 " N/A N/A N/A N/A N/A "$19,364.05 " N/A "$13,831.47 " "$13,831.47 " "$15,076.30 " N/A N/A N/A N/A N/A N/A N/A "$53,621.22 " "$43,348.91 " "$43,348.91 " "$43,348.91 " "$43,348.91 " "$26,123.55 " "$15,214.61 " "$13,831.47 " "$28,174.04 " N/A N/A N/A N/A "$13,831.47 " "$13,693.15 " "$94,944.06 " 330104 187 PLEURAL EFFUSION WITH CC I N/A N/A "$9,594.35 " N/A "$15,878.85 " "$16,709.30 " "$15,219.94 " "$9,498.40 " N/A "$18,229.26 " N/A "$9,594.35 " "$31,633.25 " "$10,553.78 " "$39,038.01 " "$32,307.85 " N/A N/A N/A "$65,039.29 " "$45,107.58 " "$61,172.60 " N/A "$9,882.18 " "$11,896.99 " N/A N/A N/A N/A N/A "$13,432.09 " N/A "$9,594.35 " "$9,594.35 " "$10,457.84 " N/A N/A N/A N/A N/A N/A N/A "$36,732.01 " "$29,695.19 " "$29,695.19 " "$29,695.19 " "$29,695.19 " "$17,895.35 " "$10,553.78 " "$9,594.35 " "$19,299.99 " N/A N/A N/A N/A "$9,594.35 " "$9,498.40 " "$65,039.29 " 330104 188 PLEURAL EFFUSION WITHOUT CC/MCC I N/A N/A "$6,758.15 " N/A "$10,991.77 " "$11,566.62 " "$10,535.65 " "$6,690.57 " N/A "$12,840.48 " N/A "$6,758.15 " "$21,897.38 " "$7,433.96 " "$27,023.16 " "$22,364.36 " N/A N/A N/A "$45,021.94 " "$31,224.67 " "$42,345.31 " N/A "$6,960.89 " "$8,380.10 " N/A N/A N/A N/A N/A "$9,461.41 " N/A "$6,758.15 " "$6,758.15 " "$7,366.38 " N/A N/A N/A N/A N/A N/A N/A "$25,426.88 " "$20,555.81 " "$20,555.81 " "$20,555.81 " "$20,555.81 " "$12,387.64 " "$7,433.96 " "$6,758.15 " "$13,359.97 " N/A N/A N/A N/A "$6,758.15 " "$6,690.57 " "$45,021.94 " 330104 189 PULMONARY EDEMA AND RESPIRATORY FAILURE I N/A N/A "$11,013.77 " N/A "$18,324.67 " "$19,283.03 " "$17,564.26 " "$10,903.63 " N/A "$20,926.16 " N/A "$11,013.77 " "$36,505.72 " "$12,115.15 " "$45,051.03 " "$37,284.23 " N/A N/A N/A "$75,057.29 " "$52,055.50 " "$70,595.02 " N/A "$11,344.18 " "$13,657.07 " N/A N/A N/A N/A N/A "$15,419.28 " N/A "$11,013.77 " "$11,013.77 " "$12,005.01 " N/A N/A N/A N/A N/A N/A N/A "$42,389.84 " "$34,269.14 " "$34,269.14 " "$34,269.14 " "$34,269.14 " "$20,651.77 " "$12,115.15 " "$11,013.77 " "$22,272.77 " N/A N/A N/A N/A "$11,013.77 " "$10,903.63 " "$75,057.29 " 330104 190 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC I N/A N/A "$9,943.26 " N/A "$16,480.06 " "$17,341.95 " "$15,796.20 " "$9,843.82 " N/A "$18,892.19 " N/A "$9,943.26 " "$32,830.95 " "$10,937.58 " "$40,516.07 " "$33,531.09 " N/A N/A N/A "$67,501.82 " "$46,815.44 " "$63,488.72 " N/A "$10,241.55 " "$12,329.64 " N/A N/A N/A N/A N/A "$13,920.56 " N/A "$9,943.26 " "$9,943.26 " "$10,838.15 " N/A N/A N/A N/A N/A N/A N/A "$38,122.76 " "$30,819.52 " "$30,819.52 " "$30,819.52 " "$30,819.52 " "$18,572.90 " "$10,937.58 " "$9,943.26 " "$20,030.73 " N/A N/A N/A N/A "$9,943.26 " "$9,843.82 " "$67,501.82 " 330104 191 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC I N/A N/A "$7,993.42 " N/A "$13,120.28 " "$13,806.46 " "$12,575.84 " "$7,913.49 " N/A "$15,187.50 " N/A "$7,993.42 " "$26,137.73 " "$8,792.77 " "$32,256.09 " "$26,695.14 " N/A N/A N/A "$53,740.28 " "$37,271.22 " "$50,545.33 " N/A "$8,233.23 " "$9,911.84 " N/A N/A N/A N/A N/A "$11,190.79 " N/A "$7,993.42 " "$7,993.42 " "$8,712.83 " N/A N/A N/A N/A N/A N/A N/A "$30,350.70 " "$24,536.37 " "$24,536.37 " "$24,536.37 " "$24,536.37 " "$14,786.46 " "$8,792.77 " "$7,993.42 " "$15,947.08 " N/A N/A N/A N/A "$7,993.42 " "$7,913.49 " "$53,740.28 " 330104 192 CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC I N/A N/A "$6,124.65 " N/A "$9,900.18 " "$10,417.95 " "$9,489.36 " "$6,063.40 " N/A "$11,636.83 " N/A "$6,124.65 " "$19,722.76 " "$6,737.11 " "$24,339.50 " "$20,143.37 " N/A N/A N/A "$40,550.84 " "$28,123.77 " "$38,140.02 " N/A "$6,308.39 " "$7,594.57 " N/A N/A N/A N/A N/A "$8,574.51 " N/A "$6,124.65 " "$6,124.65 " "$6,675.87 " N/A N/A N/A N/A N/A N/A N/A "$22,901.75 " "$18,514.42 " "$18,514.42 " "$18,514.42 " "$18,514.42 " "$11,157.43 " "$6,737.11 " "$6,124.65 " "$12,033.20 " N/A N/A N/A N/A "$6,124.65 " "$6,063.40 " "$40,550.84 " 330104 193 SIMPLE PNEUMONIA AND PLEURISY WITH MCC I N/A N/A "$11,821.72 " N/A "$19,716.86 " "$20,748.03 " "$18,898.68 " "$11,703.50 " N/A "$22,461.27 " N/A "$11,821.72 " "$39,279.18 " "$13,003.89 " "$48,473.72 " "$40,116.84 " N/A N/A N/A "$80,759.66 " "$56,010.33 " "$75,958.37 " N/A "$12,176.37 " "$14,658.93 " N/A N/A N/A N/A N/A "$16,550.41 " N/A "$11,821.72 " "$11,821.72 " "$12,885.68 " N/A N/A N/A N/A N/A N/A N/A "$45,610.34 " "$36,872.69 " "$36,872.69 " "$36,872.69 " "$36,872.69 " "$22,220.76 " "$13,003.89 " "$11,821.72 " "$23,964.91 " N/A N/A N/A N/A "$11,821.72 " "$11,703.50 " "$80,759.66 " 330104 194 SIMPLE PNEUMONIA AND PLEURISY WITH CC I N/A N/A "$7,781.96 " N/A "$12,755.92 " "$13,423.04 " "$12,226.59 " "$7,704.14 " N/A "$14,785.73 " N/A "$7,781.96 " "$25,411.85 " "$8,560.16 " "$31,360.30 " "$25,953.78 " N/A N/A N/A "$52,247.84 " "$36,236.15 " "$49,141.62 " N/A "$8,015.42 " "$9,649.63 " N/A N/A N/A N/A N/A "$10,894.75 " N/A "$7,781.96 " "$7,781.96 " "$8,482.34 " N/A N/A N/A N/A N/A N/A N/A "$29,507.82 " "$23,854.96 " "$23,854.96 " "$23,854.96 " "$23,854.96 " "$14,375.82 " "$8,560.16 " "$7,781.96 " "$15,504.21 " N/A N/A N/A N/A "$7,781.96 " "$7,704.14 " "$52,247.84 " 330104 195 SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC I N/A N/A "$6,033.90 " N/A "$9,743.81 " "$10,253.40 " "$9,339.47 " "$5,973.56 " N/A "$11,464.41 " N/A "$6,033.90 " "$19,411.24 " "$6,637.29 " "$23,955.06 " "$19,825.20 " N/A N/A N/A "$39,910.33 " "$27,679.55 " "$37,537.60 " N/A "$6,214.92 " "$7,482.03 " N/A N/A N/A N/A N/A "$8,447.46 " N/A "$6,033.90 " "$6,033.90 " "$6,576.95 " N/A N/A N/A N/A N/A N/A N/A "$22,540.02 " "$18,221.99 " "$18,221.99 " "$18,221.99 " "$18,221.99 " "$10,981.20 " "$6,637.29 " "$6,033.90 " "$11,843.14 " N/A N/A N/A N/A "$6,033.90 " "$5,973.56 " "$39,910.33 " 330104 196 INTERSTITIAL LUNG DISEASE WITH MCC I N/A N/A "$15,689.67 " N/A "$26,381.76 " "$27,761.50 " "$25,287.01 " "$15,532.77 " N/A "$29,810.37 " N/A "$15,689.67 " "$52,556.74 " "$17,258.63 " "$64,859.30 " "$53,677.55 " N/A N/A N/A "$108,058.87 " "$74,943.53 " "$101,634.60 " N/A "$16,160.36 " "$19,455.19 " N/A N/A N/A N/A N/A "$21,965.53 " N/A "$15,689.67 " "$15,689.67 " "$17,101.74 " N/A N/A N/A N/A N/A N/A N/A "$61,028.02 " "$49,336.78 " "$49,336.78 " "$49,336.78 " "$49,336.78 " "$29,732.05 " "$17,258.63 " "$15,689.67 " "$32,065.78 " N/A N/A N/A N/A "$15,689.67 " "$15,532.77 " "$108,058.87 " 330104 197 INTERSTITIAL LUNG DISEASE WITH CC I N/A N/A "$9,045.43 " N/A "$14,933.02 " "$15,713.99 " "$14,313.35 " "$8,954.98 " N/A "$17,186.32 " N/A "$9,045.43 " "$29,748.98 " "$9,949.98 " "$36,712.67 " "$30,383.40 " N/A N/A N/A "$61,165.17 " "$42,420.70 " "$57,528.80 " N/A "$9,316.80 " "$11,216.34 " N/A N/A N/A N/A N/A "$12,663.61 " N/A "$9,045.43 " "$9,045.43 " "$9,859.52 " N/A N/A N/A N/A N/A N/A N/A "$34,544.03 " "$27,926.37 " "$27,926.37 " "$27,926.37 " "$27,926.37 " "$16,829.40 " "$9,949.98 " "$9,045.43 " "$18,150.37 " N/A N/A N/A N/A "$9,045.43 " "$8,954.98 " "$61,165.17 " 330104 198 INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC I N/A N/A "$6,642.73 " N/A "$10,792.88 " "$11,357.34 " "$10,345.02 " "$6,576.30 " N/A "$12,621.18 " N/A "$6,642.73 " "$21,501.17 " "$7,307.00 " "$26,534.20 " "$21,959.70 " N/A N/A N/A "$44,207.32 " "$30,659.70 " "$41,579.12 " N/A "$6,842.01 " "$8,236.98 " N/A N/A N/A N/A N/A "$9,299.82 " N/A "$6,642.73 " "$6,642.73 " "$7,240.57 " N/A N/A N/A N/A N/A N/A N/A "$24,966.81 " "$20,183.87 " "$20,183.87 " "$20,183.87 " "$20,183.87 " "$12,163.50 " "$7,307.00 " "$6,642.73 " "$13,118.24 " N/A N/A N/A N/A "$6,642.73 " "$6,576.30 " "$44,207.32 " 330104 199 PNEUMOTHORAX WITH MCC I N/A N/A "$15,873.81 " N/A "$26,699.07 " "$28,095.39 " "$25,591.15 " "$15,715.07 " N/A "$30,160.24 " N/A "$15,873.81 " "$53,188.86 " "$17,461.19 " "$65,639.39 " "$54,323.15 " N/A N/A N/A "$109,358.54 " "$75,844.90 " "$102,857.00 " N/A "$16,350.03 " "$19,683.53 " N/A N/A N/A N/A N/A "$22,223.34 " N/A "$15,873.81 " "$15,873.81 " "$17,302.46 " N/A N/A N/A N/A N/A N/A N/A "$61,762.03 " "$49,930.17 " "$49,930.17 " "$49,930.17 " "$49,930.17 " "$30,089.65 " "$17,461.19 " "$15,873.81 " "$32,451.45 " N/A N/A N/A N/A "$15,873.81 " "$15,715.07 " "$109,358.54 " 330104 200 PNEUMOTHORAX WITH CC I N/A N/A "$9,824.31 " N/A "$16,275.10 " "$17,126.27 " "$15,599.74 " "$9,726.07 " N/A "$18,666.19 " N/A "$9,824.31 " "$32,422.64 " "$10,806.74 " "$40,012.19 " "$33,114.08 " N/A N/A N/A "$66,662.32 " "$46,233.22 " "$62,699.14 " N/A "$10,119.04 " "$12,182.14 " N/A N/A N/A N/A N/A "$13,754.03 " N/A "$9,824.31 " "$9,824.31 " "$10,708.50 " N/A N/A N/A N/A N/A N/A N/A "$37,648.64 " "$30,436.22 " "$30,436.22 " "$30,436.22 " "$30,436.22 " "$18,341.92 " "$10,806.74 " "$9,824.31 " "$19,781.62 " N/A N/A N/A N/A "$9,824.31 " "$9,726.07 " "$66,662.32 " 330104 201 PNEUMOTHORAX WITHOUT CC/MCC I N/A N/A "$6,792.51 " N/A "$11,050.98 " "$11,628.93 " "$10,592.40 " "$6,724.58 " N/A "$12,905.77 " N/A "$6,792.51 " "$22,015.34 " "$7,471.76 " "$27,168.72 " "$22,484.83 " N/A N/A N/A "$45,264.46 " "$31,392.87 " "$42,573.42 " N/A "$6,996.28 " "$8,422.71 " N/A N/A N/A N/A N/A "$9,509.51 " N/A "$6,792.51 " "$6,792.51 " "$7,403.84 " N/A N/A N/A N/A N/A N/A N/A "$25,563.85 " "$20,666.54 " "$20,666.54 " "$20,666.54 " "$20,666.54 " "$12,454.37 " "$7,471.76 " "$6,792.51 " "$13,431.94 " N/A N/A N/A N/A "$6,792.51 " "$6,724.58 " "$45,264.46 " 330104 202 BRONCHITIS AND ASTHMA WITH CC/MCC I N/A N/A "$8,536.17 " N/A "$14,055.50 " "$14,790.58 " "$13,472.24 " "$8,450.81 " N/A "$16,218.72 " N/A "$8,536.17 " "$28,000.82 " "$9,389.79 " "$34,555.30 " "$28,597.96 " N/A N/A N/A "$57,570.87 " "$39,927.90 " "$54,148.19 " N/A "$8,792.25 " "$10,584.85 " N/A N/A N/A N/A N/A "$11,950.64 " N/A "$8,536.17 " "$8,536.17 " "$9,304.42 " N/A N/A N/A N/A N/A N/A N/A "$32,514.10 " "$26,285.31 " "$26,285.31 " "$26,285.31 " "$26,285.31 " "$15,840.44 " "$9,389.79 " "$8,536.17 " "$17,083.79 " N/A N/A N/A N/A "$8,536.17 " "$8,450.81 " "$57,570.87 " 330104 203 BRONCHITIS AND ASTHMA WITHOUT CC/MCC I N/A N/A "$6,256.81 " N/A "$10,127.91 " "$10,657.59 " "$9,707.64 " "$6,194.24 " N/A "$11,887.94 " N/A "$6,256.81 " "$20,176.44 " "$6,882.49 " "$24,899.37 " "$20,606.72 " N/A N/A N/A "$41,483.61 " "$28,770.69 " "$39,017.34 " N/A "$6,444.52 " "$7,758.45 " N/A N/A N/A N/A N/A "$8,759.54 " N/A "$6,256.81 " "$6,256.81 " "$6,819.93 " N/A N/A N/A N/A N/A N/A N/A "$23,428.55 " "$18,940.30 " "$18,940.30 " "$18,940.30 " "$18,940.30 " "$11,414.08 " "$6,882.49 " "$6,256.81 " "$12,310.00 " N/A N/A N/A N/A "$6,256.81 " "$6,194.24 " "$41,483.61 " 330104 204 RESPIRATORY SIGNS AND SYMPTOMS I N/A N/A "$7,510.59 " N/A "$12,288.31 " "$12,930.97 " "$11,778.39 " "$7,435.48 " N/A "$14,270.12 " N/A "$7,510.59 " "$24,480.30 " "$8,261.65 " "$30,210.69 " "$25,002.37 " N/A N/A N/A "$50,332.54 " "$34,907.80 " "$47,340.19 " N/A "$7,735.91 " "$9,313.13 " N/A N/A N/A N/A N/A "$10,514.83 " N/A "$7,510.59 " "$7,510.59 " "$8,186.54 " N/A N/A N/A N/A N/A N/A N/A "$28,426.13 " "$22,980.48 " "$22,980.48 " "$22,980.48 " "$22,980.48 " "$13,848.83 " "$8,261.65 " "$7,510.59 " "$14,935.86 " N/A N/A N/A N/A "$7,510.59 " "$7,435.48 " "$50,332.54 " 330104 205 OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC I N/A N/A "$16,071.17 " N/A "$27,039.14 " "$28,453.26 " "$25,917.11 " "$15,910.46 " N/A "$30,535.23 " N/A "$16,071.17 " "$53,866.34 " "$17,678.29 " "$66,475.47 " "$55,015.09 " N/A N/A N/A "$110,751.49 " "$76,810.97 " "$104,167.13 " N/A "$16,553.31 " "$19,928.26 " N/A N/A N/A N/A N/A "$22,499.64 " N/A "$16,071.17 " "$16,071.17 " "$17,517.58 " N/A N/A N/A N/A N/A N/A N/A "$62,548.72 " "$50,566.15 " "$50,566.15 " "$50,566.15 " "$50,566.15 " "$30,472.91 " "$17,678.29 " "$16,071.17 " "$32,864.79 " N/A N/A N/A N/A "$16,071.17 " "$15,910.46 " "$110,751.49 " 330104 206 OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC I N/A N/A "$8,250.70 " N/A "$13,563.60 " "$14,272.96 " "$13,000.76 " "$8,168.19 " N/A "$15,676.33 " N/A "$8,250.70 " "$27,020.88 " "$9,075.77 " "$33,345.98 " "$27,597.13 " N/A N/A N/A "$55,556.08 " "$38,530.56 " "$52,253.18 " N/A "$8,498.22 " "$10,230.87 " N/A N/A N/A N/A N/A "$11,550.98 " N/A "$8,250.70 " "$8,250.70 " "$8,993.26 " N/A N/A N/A N/A N/A N/A N/A "$31,376.21 " "$25,365.41 " "$25,365.41 " "$25,365.41 " "$25,365.41 " "$15,286.07 " "$9,075.77 " "$8,250.70 " "$16,485.91 " N/A N/A N/A N/A "$8,250.70 " "$8,168.19 " "$55,556.08 " 330104 207 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS I N/A N/A "$58,230.02 " N/A "$99,683.49 " "$104,896.82 " "$95,546.98 " "$57,647.72 " N/A "$110,637.05 " N/A "$58,230.02 " "$198,585.65 " "$64,053.03 " "$245,070.90 " "$202,820.65 " N/A N/A N/A "$408,300.49 " "$283,174.14 " "$384,026.36 " N/A "$59,976.93 " "$72,205.23 " N/A N/A N/A N/A N/A "$81,522.03 " N/A "$58,230.02 " "$58,230.02 " "$63,470.73 " N/A N/A N/A N/A N/A N/A N/A "$230,594.41 " "$186,419.03 " "$186,419.03 " "$186,419.03 " "$186,419.03 " "$112,342.55 " "$64,053.03 " "$58,230.02 " "$121,160.55 " N/A N/A N/A N/A "$58,230.02 " "$57,647.72 " "$408,300.49 " 330104 208 RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS I N/A N/A "$23,288.11 " N/A "$39,474.72 " "$41,539.20 " "$37,836.66 " "$23,055.23 " N/A "$44,247.41 " N/A "$23,288.11 " "$78,640.02 " "$25,616.92 " "$97,048.21 " "$80,317.09 " N/A N/A N/A "$161,687.22 " "$112,137.11 " "$152,074.65 " N/A "$23,986.75 " "$28,877.26 " N/A N/A N/A N/A N/A "$32,603.35 " N/A "$23,288.11 " "$23,288.11 " "$25,384.04 " N/A N/A N/A N/A N/A N/A N/A "$91,315.51 " "$73,822.04 " "$73,822.04 " "$73,822.04 " "$73,822.04 " "$44,487.71 " "$25,616.92 " "$23,288.11 " "$47,979.65 " N/A N/A N/A N/A "$23,288.11 " "$23,055.23 " "$161,687.22 " 330104 215 OTHER HEART ASSIST SYSTEM IMPLANT I N/A N/A "$91,158.67 " N/A "$156,423.18 " "$164,603.92 " "$149,932.17 " "$90,247.08 " N/A "$173,201.47 " N/A "$91,158.67 " "$311,620.28 " "$100,274.54 " "$384,564.88 " "$318,265.85 " N/A N/A N/A "$640,704.49 " "$444,356.41 " "$602,613.56 " N/A "$93,893.43 " "$113,036.75 " N/A N/A N/A N/A N/A "$127,622.14 " N/A "$91,158.67 " "$91,158.67 " "$99,362.95 " N/A N/A N/A N/A N/A N/A N/A "$361,848.38 " "$292,528.45 " "$292,528.45 " "$292,528.45 " "$292,528.45 " "$176,287.75 " "$100,274.54 " "$91,158.67 " "$190,124.95 " N/A N/A N/A N/A "$91,158.67 " "$90,247.08 " "$640,704.49 " 330104 216 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC I N/A N/A "$86,213.16 " N/A "$147,901.53 " "$155,636.59 " "$141,764.13 " "$85,351.03 " N/A "$163,805.00 " N/A "$86,213.16 " "$294,643.77 " "$94,834.48 " "$363,614.47 " "$300,927.29 " N/A N/A N/A "$605,800.05 " "$420,148.66 " "$569,784.25 " N/A "$88,799.56 " "$106,904.32 " N/A N/A N/A N/A N/A "$120,698.42 " N/A "$86,213.16 " "$86,213.16 " "$93,972.34 " N/A N/A N/A N/A N/A N/A N/A "$342,135.53 " "$276,592.02 " "$276,592.02 " "$276,592.02 " "$276,592.02 " "$166,683.91 " "$94,834.48 " "$86,213.16 " "$179,767.28 " N/A N/A N/A N/A "$86,213.16 " "$85,351.03 " "$605,800.05 " 330104 217 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC I N/A N/A "$56,317.20 " N/A "$96,387.48 " "$101,428.43 " "$92,387.74 " "$55,754.03 " N/A "$107,002.67 " N/A "$56,317.20 " "$192,019.46 " "$61,948.92 " "$236,967.69 " "$196,114.43 " N/A N/A N/A "$394,800.13 " "$273,811.05 " "$371,328.61 " N/A "$58,006.71 " "$69,833.32 " N/A N/A N/A N/A N/A "$78,844.08 " N/A "$56,317.20 " "$56,317.20 " "$61,385.75 " N/A N/A N/A N/A N/A N/A N/A "$222,969.86 " "$180,255.13 " "$180,255.13 " "$180,255.13 " "$180,255.13 " "$108,627.97 " "$61,948.92 " "$56,317.20 " "$117,154.41 " N/A N/A N/A N/A "$56,317.20 " "$55,754.03 " "$394,800.13 " 330104 218 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CC/MCC I N/A N/A "$52,703.88 " N/A "$90,161.34 " "$94,876.67 " "$86,419.96 " "$52,176.84 " N/A "$100,137.38 " N/A "$52,703.88 " "$179,615.98 " "$57,974.27 " "$221,660.79 " "$183,446.44 " N/A N/A N/A "$369,298.06 " "$256,124.25 " "$347,342.69 " N/A "$54,285.00 " "$65,352.82 " N/A N/A N/A N/A N/A "$73,785.44 " N/A "$52,703.88 " "$52,703.88 " "$57,447.23 " N/A N/A N/A N/A N/A N/A N/A "$208,567.14 " "$168,611.57 " "$168,611.57 " "$168,611.57 " "$168,611.57 " "$101,611.16 " "$57,974.27 " "$52,703.88 " "$109,586.83 " N/A N/A N/A N/A "$52,703.88 " "$52,176.84 " "$369,298.06 " 330104 219 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC I N/A N/A "$71,996.04 " N/A "$123,403.85 " "$129,857.72 " "$118,283.02 " "$71,276.08 " N/A "$136,792.47 " N/A "$71,996.04 " "$245,840.43 " "$79,195.64 " "$303,387.17 " "$251,083.19 " N/A N/A N/A "$505,458.34 " "$350,557.32 " "$475,408.01 " N/A "$74,155.92 " "$89,275.08 " N/A N/A N/A N/A N/A "$100,794.45 " N/A "$71,996.04 " "$71,996.04 " "$78,475.68 " N/A N/A N/A N/A N/A N/A N/A "$285,465.90 " "$230,778.69 " "$230,778.69 " "$230,778.69 " "$230,778.69 " "$139,075.21 " "$79,195.64 " "$71,996.04 " "$149,991.52 " N/A N/A N/A N/A "$71,996.04 " "$71,276.08 " "$505,458.34 " 330104 220 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC I N/A N/A "$48,266.76 " N/A "$82,515.69 " "$86,831.16 " "$79,091.58 " "$47,784.09 " N/A "$91,706.84 " N/A "$48,266.76 " "$164,384.60 " "$53,093.44 " "$202,864.02 " "$167,890.24 " N/A N/A N/A "$337,981.69 " "$234,404.99 " "$317,888.13 " N/A "$49,714.76 " "$59,850.78 " N/A N/A N/A N/A N/A "$67,573.46 " N/A "$48,266.76 " "$48,266.76 " "$52,610.77 " N/A N/A N/A N/A N/A N/A N/A "$190,880.71 " "$154,313.36 " "$154,313.36 " "$154,313.36 " "$154,313.36 " "$92,994.56 " "$53,093.44 " "$48,266.76 " "$100,293.90 " N/A N/A N/A N/A "$48,266.76 " "$47,784.09 " "$337,981.69 " 330104 221 CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC I N/A N/A "$42,068.35 " N/A "$71,835.15 " "$75,592.04 " "$68,854.24 " "$41,647.67 " N/A "$79,929.87 " N/A "$42,068.35 " "$143,107.24 " "$46,275.19 " "$176,606.02 " "$146,159.12 " N/A N/A N/A "$294,234.55 " "$204,064.44 " "$276,741.82 " N/A "$43,330.40 " "$52,164.76 " N/A N/A N/A N/A N/A "$58,895.70 " N/A "$42,068.35 " "$42,068.35 " "$45,854.51 " N/A N/A N/A N/A N/A N/A N/A "$166,173.79 " "$134,339.59 " "$134,339.59 " "$134,339.59 " "$134,339.59 " "$80,957.68 " "$46,275.19 " "$42,068.35 " "$87,312.21 " N/A N/A N/A N/A "$42,068.35 " "$41,647.67 " "$294,234.55 " 330104 222 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITH MCC" I N/A N/A "$67,839.98 " N/A "$116,242.50 " "$122,321.84 " "$111,418.84 " "$67,161.58 " N/A "$128,895.95 " N/A "$67,839.98 " "$231,573.87 " "$74,623.97 " "$285,781.06 " "$236,512.37 " N/A N/A N/A "$476,125.67 " "$330,213.84 " "$447,819.22 " N/A "$69,875.18 " "$84,121.57 " N/A N/A N/A N/A N/A "$94,975.97 " N/A "$67,839.98 " "$67,839.98 " "$73,945.57 " N/A N/A N/A N/A N/A N/A N/A "$268,899.79 " "$217,386.19 " "$217,386.19 " "$217,386.19 " "$217,386.19 " "$131,004.43 " "$74,623.97 " "$67,839.98 " "$141,287.24 " N/A N/A N/A N/A "$67,839.98 " "$67,161.58 " "$476,125.67 " 330104 223 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITH AMI, HF OR SHOCK WITHOUT MCC" I N/A N/A "$46,360.10 " N/A "$79,230.30 " "$83,373.95 " "$75,942.52 " "$45,896.50 " N/A "$88,084.19 " N/A "$46,360.10 " "$157,839.58 " "$50,996.11 " "$194,786.93 " "$161,205.64 " N/A N/A N/A "$324,524.86 " "$225,072.09 " "$305,231.33 " N/A "$47,750.90 " "$57,486.52 " N/A N/A N/A N/A N/A "$64,904.14 " N/A "$46,360.10 " "$46,360.10 " "$50,532.51 " N/A N/A N/A N/A N/A N/A N/A "$183,280.74 " "$148,169.33 " "$148,169.33 " "$148,169.33 " "$148,169.33 " "$89,291.96 " "$50,996.11 " "$46,360.10 " "$96,300.67 " N/A N/A N/A N/A "$46,360.10 " "$45,896.50 " "$324,524.86 " 330104 224 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITH MCC" I N/A N/A "$62,840.72 " N/A "$107,628.23 " "$113,257.06 " "$103,162.04 " "$62,212.31 " N/A "$119,397.37 " N/A "$62,840.72 " "$214,412.85 " "$69,124.79 " "$264,602.97 " "$218,985.39 " N/A N/A N/A "$440,841.90 " "$305,743.02 " "$414,633.13 " N/A "$64,725.94 " "$77,922.50 " N/A N/A N/A N/A N/A "$87,977.01 " N/A "$62,840.72 " "$62,840.72 " "$68,496.39 " N/A N/A N/A N/A N/A N/A N/A "$248,972.70 " "$201,276.57 " "$201,276.57 " "$201,276.57 " "$201,276.57 " "$121,296.21 " "$69,124.79 " "$62,840.72 " "$130,817.01 " N/A N/A N/A N/A "$62,840.72 " "$62,212.31 " "$440,841.90 " 330104 225 "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION WITHOUT AMI, HF OR SHOCK WITHOUT MCC" I N/A N/A "$44,941.56 " N/A "$76,786.00 " "$80,801.82 " "$73,599.65 " "$44,492.14 " N/A "$85,388.96 " N/A "$44,941.56 " "$152,970.14 " "$49,435.72 " "$188,777.64 " "$156,232.35 " N/A N/A N/A "$314,513.07 " "$218,128.49 " "$295,814.76 " N/A "$46,289.81 " "$55,727.53 " N/A N/A N/A N/A N/A "$62,918.18 " N/A "$44,941.56 " "$44,941.56 " "$48,986.30 " N/A N/A N/A N/A N/A N/A N/A "$177,626.42 " "$143,598.22 " "$143,598.22 " "$143,598.22 " "$143,598.22 " "$86,537.25 " "$49,435.72 " "$44,941.56 " "$93,329.74 " N/A N/A N/A N/A "$44,941.56 " "$44,492.14 " "$314,513.07 " 330104 226 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC I N/A N/A "$56,776.24 " N/A "$97,178.46 " "$102,260.78 " "$93,145.90 " "$56,208.48 " N/A "$107,874.86 " N/A "$56,776.24 " "$193,595.22 " "$62,453.86 " "$238,912.31 " "$197,723.80 " N/A N/A N/A "$398,039.97 " "$276,058.02 " "$374,375.84 " N/A "$58,479.53 " "$70,402.54 " N/A N/A N/A N/A N/A "$79,486.74 " N/A "$56,776.24 " "$56,776.24 " "$61,886.10 " N/A N/A N/A N/A N/A N/A N/A "$224,799.61 " "$181,734.35 " "$181,734.35 " "$181,734.35 " "$181,734.35 " "$109,519.40 " "$62,453.86 " "$56,776.24 " "$118,115.81 " N/A N/A N/A N/A "$56,776.24 " "$56,208.48 " "$398,039.97 " 330104 227 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC I N/A N/A "$44,615.56 " N/A "$76,224.27 " "$80,210.70 " "$73,061.23 " "$44,169.40 " N/A "$84,769.56 " N/A "$44,615.56 " "$151,851.07 " "$49,077.12 " "$187,396.62 " "$155,089.42 " N/A N/A N/A "$312,212.23 " "$216,532.75 " "$293,650.70 " N/A "$45,954.03 " "$55,323.29 " N/A N/A N/A N/A N/A "$62,461.78 " N/A "$44,615.56 " "$44,615.56 " "$48,630.96 " N/A N/A N/A N/A N/A N/A N/A "$176,326.98 " "$142,547.71 " "$142,547.71 " "$142,547.71 " "$142,547.71 " "$85,904.18 " "$49,077.12 " "$44,615.56 " "$92,646.98 " N/A N/A N/A N/A "$44,615.56 " "$44,169.40 " "$312,212.23 " 330104 228 OTHER CARDIOTHORACIC PROCEDURES WITH MCC I N/A N/A "$43,801.44 " N/A "$74,821.45 " "$78,734.52 " "$71,716.62 " "$43,363.43 " N/A "$83,222.74 " N/A "$43,801.44 " "$149,056.43 " "$48,181.58 " "$183,947.81 " "$152,235.19 " N/A N/A N/A "$306,466.34 " "$212,547.72 " "$288,246.41 " N/A "$45,115.48 " "$54,313.79 " N/A N/A N/A N/A N/A "$61,322.02 " N/A "$43,801.44 " "$43,801.44 " "$47,743.57 " N/A N/A N/A N/A N/A N/A N/A "$173,081.90 " "$139,924.29 " "$139,924.29 " "$139,924.29 " "$139,924.29 " "$84,323.21 " "$48,181.58 " "$43,801.44 " "$90,941.92 " N/A N/A N/A N/A "$43,801.44 " "$43,363.43 " "$306,466.34 " 330104 229 OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC I N/A N/A "$29,462.73 " N/A "$50,114.26 " "$52,735.18 " "$48,034.70 " "$29,168.10 " N/A "$55,979.18 " N/A "$29,462.73 " "$99,835.72 " "$32,409.00 " "$123,205.43 " "$101,964.80 " N/A N/A N/A "$205,266.47 " "$142,361.22 " "$193,063.04 " N/A "$30,346.61 " "$36,533.78 " N/A N/A N/A N/A N/A "$41,247.82 " N/A "$29,462.73 " "$29,462.73 " "$32,114.37 " N/A N/A N/A N/A N/A N/A N/A "$115,927.61 " "$93,719.15 " "$93,719.15 " "$93,719.15 " "$93,719.15 " "$56,478.40 " "$32,409.00 " "$29,462.73 " "$60,911.51 " N/A N/A N/A N/A "$29,462.73 " "$29,168.10 " "$205,266.47 " 330104 231 CORONARY BYPASS WITH PTCA WITH MCC I N/A N/A "$74,330.02 " N/A "$127,425.56 " "$134,089.76 " "$122,137.85 " "$73,586.72 " N/A "$141,227.04 " N/A "$74,330.02 " "$253,852.33 " "$81,763.02 " "$313,274.51 " "$259,265.95 " N/A N/A N/A "$521,931.14 " "$361,981.93 " "$490,901.48 " N/A "$76,559.92 " "$92,169.22 " N/A N/A N/A N/A N/A "$104,062.03 " N/A "$74,330.02 " "$74,330.02 " "$81,019.72 " N/A N/A N/A N/A N/A N/A N/A "$294,769.18 " "$238,299.73 " "$238,299.73 " "$238,299.73 " "$238,299.73 " "$143,607.65 " "$81,763.02 " "$74,330.02 " "$154,879.72 " N/A N/A N/A N/A "$74,330.02 " "$73,586.72 " "$521,931.14 " 330104 232 CORONARY BYPASS WITH PTCA WITHOUT MCC I N/A N/A "$51,991.09 " N/A "$88,933.12 " "$93,584.21 " "$85,242.71 " "$51,471.18 " N/A "$98,783.07 " N/A "$51,991.09 " "$177,169.16 " "$57,190.20 " "$218,641.21 " "$180,947.44 " N/A N/A N/A "$364,267.29 " "$252,635.20 " "$342,611.01 " N/A "$53,550.82 " "$64,468.95 " N/A N/A N/A N/A N/A "$72,787.52 " N/A "$51,991.09 " "$51,991.09 " "$56,670.29 " N/A N/A N/A N/A N/A N/A N/A "$205,725.94 " "$166,314.66 " "$166,314.66 " "$166,314.66 " "$166,314.66 " "$100,226.96 " "$57,190.20 " "$51,991.09 " "$108,093.98 " N/A N/A N/A N/A "$51,991.09 " "$51,471.18 " "$364,267.29 " 330104 233 CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC I N/A N/A "$68,617.97 " N/A "$117,583.07 " "$123,732.52 " "$112,703.78 " "$67,931.79 " N/A "$130,374.14 " N/A "$68,617.97 " "$234,244.50 " "$75,479.77 " "$289,076.84 " "$239,239.96 " N/A N/A N/A "$481,616.61 " "$334,022.05 " "$452,983.71 " N/A "$70,676.51 " "$85,086.28 " N/A N/A N/A N/A N/A "$96,065.16 " N/A "$68,617.97 " "$68,617.97 " "$74,793.59 " N/A N/A N/A N/A N/A N/A N/A "$272,000.89 " "$219,893.20 " "$219,893.20 " "$219,893.20 " "$219,893.20 " "$132,515.24 " "$75,479.77 " "$68,617.97 " "$142,916.64 " N/A N/A N/A N/A "$68,617.97 " "$67,931.79 " "$481,616.61 " 330104 234 CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC I N/A N/A "$46,074.63 " N/A "$78,738.41 " "$82,856.33 " "$75,471.04 " "$45,613.88 " N/A "$87,541.80 " N/A "$46,074.63 " "$156,859.64 " "$50,682.09 " "$193,577.61 " "$160,204.81 " N/A N/A N/A "$322,510.07 " "$223,674.75 " "$303,336.31 " N/A "$47,456.87 " "$57,132.54 " N/A N/A N/A N/A N/A "$64,504.48 " N/A "$46,074.63 " "$46,074.63 " "$50,221.35 " N/A N/A N/A N/A N/A N/A N/A "$182,142.86 " "$147,249.43 " "$147,249.43 " "$147,249.43 " "$147,249.43 " "$88,737.59 " "$50,682.09 " "$46,074.63 " "$95,702.79 " N/A N/A N/A N/A "$46,074.63 " "$45,613.88 " "$322,510.07 " 330104 235 CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC I N/A N/A "$53,155.88 " N/A "$90,940.18 " "$95,696.24 " "$87,166.48 " "$52,624.32 " N/A "$100,996.17 " N/A "$53,155.88 " "$181,167.55 " "$58,471.47 " "$223,575.55 " "$185,031.10 " N/A N/A N/A "$372,488.15 " "$258,336.72 " "$350,343.12 " N/A "$54,750.55 " "$65,913.29 " N/A N/A N/A N/A N/A "$74,418.23 " N/A "$53,155.88 " "$53,155.88 " "$57,939.91 " N/A N/A N/A N/A N/A N/A N/A "$210,368.80 " "$170,068.08 " "$170,068.08 " "$170,068.08 " "$170,068.08 " "$102,488.90 " "$58,471.47 " "$53,155.88 " "$110,533.47 " N/A N/A N/A N/A "$53,155.88 " "$52,624.32 " "$372,488.15 " 330104 236 CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC I N/A N/A "$36,313.13 " N/A "$61,918.27 " "$65,156.52 " "$59,348.88 " "$35,950.00 " N/A "$68,994.95 " N/A "$36,313.13 " "$123,351.21 " "$39,944.45 " "$152,225.46 " "$125,981.78 " N/A N/A N/A "$253,615.30 " "$175,893.24 " "$238,537.46 " N/A "$37,402.53 " "$45,028.28 " N/A N/A N/A N/A N/A "$50,838.38 " N/A "$36,313.13 " "$36,313.13 " "$39,581.31 " N/A N/A N/A N/A N/A N/A N/A "$143,233.41 " "$115,793.93 " "$115,793.93 " "$115,793.93 " "$115,793.93 " "$69,781.42 " "$39,944.45 " "$36,313.13 " "$75,258.72 " N/A N/A N/A N/A "$36,313.13 " "$35,950.00 " "$253,615.30 " 330104 239 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC I N/A N/A "$41,350.27 " N/A "$70,597.82 " "$74,290.00 " "$67,668.26 " "$40,936.77 " N/A "$78,565.52 " N/A "$41,350.27 " "$140,642.27 " "$45,485.30 " "$173,564.05 " "$143,641.59 " N/A N/A N/A "$289,166.47 " "$200,549.51 " "$271,975.05 " N/A "$42,590.78 " "$51,274.34 " N/A N/A N/A N/A N/A "$57,890.38 " N/A "$41,350.27 " "$41,350.27 " "$45,071.80 " N/A N/A N/A N/A N/A N/A N/A "$163,311.51 " "$132,025.64 " "$132,025.64 " "$132,025.64 " "$132,025.64 " "$79,563.21 " "$45,485.30 " "$41,350.27 " "$85,808.30 " N/A N/A N/A N/A "$41,350.27 " "$40,936.77 " "$289,166.47 " 330104 240 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC I N/A N/A "$24,293.42 " N/A "$41,206.98 " "$43,362.06 " "$39,497.04 " "$24,050.49 " N/A "$46,157.50 " N/A "$24,293.42 " "$82,090.98 " "$26,722.77 " "$101,306.97 " "$83,841.64 " N/A N/A N/A "$168,782.53 " "$117,058.02 " "$158,748.13 " N/A "$25,022.23 " "$30,123.85 " N/A N/A N/A N/A N/A "$34,010.79 " N/A "$24,293.42 " "$24,293.42 " "$26,479.83 " N/A N/A N/A N/A N/A N/A N/A "$95,322.70 " "$77,061.57 " "$77,061.57 " "$77,061.57 " "$77,061.57 " "$46,439.96 " "$26,722.77 " "$24,293.42 " "$50,085.13 " N/A N/A N/A N/A "$24,293.42 " "$24,050.49 " "$168,782.53 " 330104 241 AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC I N/A N/A "$14,026.19 " N/A "$23,515.40 " "$24,745.23 " "$22,539.59 " "$13,885.92 " N/A "$26,649.75 " N/A "$14,026.19 " "$46,846.48 " "$15,428.80 " "$57,812.38 " "$47,845.52 " N/A N/A N/A "$96,318.35 " "$66,800.96 " "$90,592.06 " N/A "$14,446.97 " "$17,392.47 " N/A N/A N/A N/A N/A "$19,636.66 " N/A "$14,026.19 " "$14,026.19 " "$15,288.54 " N/A N/A N/A N/A N/A N/A N/A "$54,397.37 " "$43,976.37 " "$43,976.37 " "$43,976.37 " "$43,976.37 " "$26,501.68 " "$15,428.80 " "$14,026.19 " "$28,581.85 " N/A N/A N/A N/A "$14,026.19 " "$13,885.92 " "$96,318.35 " 330104 242 PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC I N/A N/A "$30,983.47 " N/A "$52,734.68 " "$55,492.64 " "$50,546.37 " "$30,673.64 " N/A "$58,868.60 " N/A "$30,983.47 " "$105,056.01 " "$34,081.82 " "$129,647.69 " "$107,296.42 " N/A N/A N/A "$215,999.60 " "$149,805.11 " "$203,158.07 " N/A "$31,912.98 " "$38,419.51 " N/A N/A N/A N/A N/A "$43,376.86 " N/A "$30,983.47 " "$30,983.47 " "$33,771.98 " N/A N/A N/A N/A N/A N/A N/A "$121,989.32 " "$98,619.61 " "$98,619.61 " "$98,619.61 " "$98,619.61 " "$59,431.58 " "$34,081.82 " "$30,983.47 " "$64,096.50 " N/A N/A N/A N/A "$30,983.47 " "$30,673.64 " "$215,999.60 " 330104 243 PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC I N/A N/A "$21,031.66 " N/A "$35,586.61 " "$37,447.74 " "$34,109.89 " "$20,821.34 " N/A "$39,960.16 " N/A "$21,031.66 " "$70,894.28 " "$23,134.83 " "$87,489.33 " "$72,406.16 " N/A N/A N/A "$145,761.64 " "$101,092.03 " "$137,095.87 " N/A "$21,662.61 " "$26,079.26 " N/A N/A N/A N/A N/A "$29,444.33 " N/A "$21,031.66 " "$21,031.66 " "$22,924.51 " N/A N/A N/A N/A N/A N/A N/A "$82,321.28 " "$66,550.85 " "$66,550.85 " "$66,550.85 " "$66,550.85 " "$40,105.84 " "$23,134.83 " "$21,031.66 " "$43,253.83 " N/A N/A N/A N/A "$21,031.66 " "$20,821.34 " "$145,761.64 " 330104 244 PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC I N/A N/A "$17,129.35 " N/A "$28,862.50 " "$30,371.97 " "$27,664.81 " "$16,958.06 " N/A "$32,545.77 " N/A "$17,129.35 " "$57,498.77 " "$18,842.29 " "$70,958.18 " "$58,724.98 " N/A N/A N/A "$118,219.90 " "$81,990.64 " "$111,191.54 " N/A "$17,643.23 " "$21,240.40 " N/A N/A N/A N/A N/A "$23,981.09 " N/A "$17,129.35 " "$17,129.35 " "$18,670.99 " N/A N/A N/A N/A N/A N/A N/A "$66,766.63 " "$53,976.03 " "$53,976.03 " "$53,976.03 " "$53,976.03 " "$32,527.82 " "$18,842.29 " "$17,129.35 " "$35,081.00 " N/A N/A N/A N/A "$17,129.35 " "$16,958.06 " "$118,219.90 " 330104 245 AICD GENERATOR PROCEDURES I N/A N/A "$43,340.63 " N/A "$74,027.43 " "$77,898.98 " "$70,955.55 " "$42,907.23 " N/A "$82,347.21 " N/A "$43,340.63 " "$147,474.62 " "$47,674.70 " "$181,995.72 " "$150,619.64 " N/A N/A N/A "$303,214.06 " "$210,292.13 " "$285,187.49 " N/A "$44,640.85 " "$53,742.39 " N/A N/A N/A N/A N/A "$60,676.89 " N/A "$43,340.63 " "$43,340.63 " "$47,241.29 " N/A N/A N/A N/A N/A N/A N/A "$171,245.12 " "$138,439.39 " "$138,439.39 " "$138,439.39 " "$138,439.39 " "$83,428.36 " "$47,674.70 " "$43,340.63 " "$89,976.83 " N/A N/A N/A N/A "$43,340.63 " "$42,907.23 " "$303,214.06 " 330104 246 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS I N/A N/A "$26,771.02 " N/A "$45,476.16 " "$47,854.51 " "$43,589.06 " "$26,503.31 " N/A "$50,864.94 " N/A "$26,771.02 " "$90,595.87 " "$29,448.13 " "$111,802.71 " "$92,527.91 " N/A N/A N/A "$186,268.95 " "$129,185.61 " "$175,194.96 " N/A "$27,574.15 " "$33,196.07 " N/A N/A N/A N/A N/A "$37,479.43 " N/A "$26,771.02 " "$26,771.02 " "$29,180.42 " N/A N/A N/A N/A N/A N/A N/A "$105,198.45 " "$85,045.40 " "$85,045.40 " "$85,045.40 " "$85,045.40 " "$51,251.29 " "$29,448.13 " "$26,771.02 " "$55,274.12 " N/A N/A N/A N/A "$26,771.02 " "$26,503.31 " "$186,268.95 " 330104 247 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC I N/A N/A "$17,203.36 " N/A "$28,990.03 " "$30,506.17 " "$27,787.04 " "$17,031.33 " N/A "$32,686.39 " N/A "$17,203.36 " "$57,752.83 " "$18,923.70 " "$71,271.71 " "$58,984.46 " N/A N/A N/A "$118,742.26 " "$82,352.92 " "$111,682.84 " N/A "$17,719.46 " "$21,332.17 " N/A N/A N/A N/A N/A "$24,084.71 " N/A "$17,203.36 " "$17,203.36 " "$18,751.67 " N/A N/A N/A N/A N/A N/A N/A "$67,061.64 " "$54,214.52 " "$54,214.52 " "$54,214.52 " "$54,214.52 " "$32,671.54 " "$18,923.70 " "$17,203.36 " "$35,236.00 " N/A N/A N/A N/A "$17,203.36 " "$17,031.33 " "$118,742.26 " 330104 248 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS I N/A N/A "$26,897.90 " N/A "$45,694.78 " "$48,084.56 " "$43,798.61 " "$26,628.92 " N/A "$51,106.01 " N/A "$26,897.90 " "$91,031.40 " "$29,587.69 " "$112,340.18 " "$92,972.72 " N/A N/A N/A "$187,164.41 " "$129,806.65 " "$176,037.18 " N/A "$27,704.84 " "$33,353.39 " N/A N/A N/A N/A N/A "$37,657.06 " N/A "$26,897.90 " "$26,897.90 " "$29,318.71 " N/A N/A N/A N/A N/A N/A N/A "$105,704.18 " "$85,454.24 " "$85,454.24 " "$85,454.24 " "$85,454.24 " "$51,497.68 " "$29,587.69 " "$26,897.90 " "$55,539.84 " N/A N/A N/A N/A "$26,897.90 " "$26,628.92 " "$187,164.41 " 330104 249 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH NON-DRUG-ELUTING STENT WITHOUT MCC I N/A N/A "$16,385.72 " N/A "$27,581.14 " "$29,023.60 " "$26,436.62 " "$16,221.86 " N/A "$31,132.87 " N/A "$16,385.72 " "$54,946.09 " "$18,024.29 " "$67,807.96 " "$56,117.86 " N/A N/A N/A "$112,971.49 " "$78,350.64 " "$106,255.15 " N/A "$16,877.29 " "$20,318.29 " N/A N/A N/A N/A N/A "$22,940.01 " N/A "$16,385.72 " "$16,385.72 " "$17,860.44 " N/A N/A N/A N/A N/A N/A N/A "$63,802.50 " "$51,579.75 " "$51,579.75 " "$51,579.75 " "$51,579.75 " "$31,083.74 " "$18,024.29 " "$16,385.72 " "$33,523.57 " N/A N/A N/A N/A "$16,385.72 " "$16,221.86 " "$112,971.49 " 330104 250 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITH MCC I N/A N/A "$21,698.64 " N/A "$36,735.89 " "$38,657.13 " "$35,211.47 " "$21,481.65 " N/A "$41,227.42 " N/A "$21,698.64 " "$73,183.83 " "$23,868.50 " "$90,314.82 " "$74,744.53 " N/A N/A N/A "$150,469.04 " "$104,356.82 " "$141,523.41 " N/A "$22,349.60 " "$26,906.31 " N/A N/A N/A N/A N/A "$30,378.10 " N/A "$21,698.64 " "$21,698.64 " "$23,651.52 " N/A N/A N/A N/A N/A N/A N/A "$84,979.86 " "$68,700.12 " "$68,700.12 " "$68,700.12 " "$68,700.12 " "$41,401.07 " "$23,868.50 " "$21,698.64 " "$44,650.72 " N/A N/A N/A N/A "$21,698.64 " "$21,481.65 " "$150,469.04 " 330104 251 PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT CORONARY ARTERY STENT WITHOUT MCC I N/A N/A "$14,699.33 " N/A "$24,675.30 " "$25,965.79 " "$23,651.37 " "$14,552.34 " N/A "$27,928.73 " N/A "$14,699.33 " "$49,157.20 " "$16,169.26 " "$60,664.00 " "$50,205.52 " N/A N/A N/A "$101,069.28 " "$70,095.94 " "$95,060.55 " N/A "$15,140.31 " "$18,227.17 " N/A N/A N/A N/A N/A "$20,579.06 " N/A "$14,699.33 " "$14,699.33 " "$16,022.27 " N/A N/A N/A N/A N/A N/A N/A "$57,080.54 " "$46,145.52 " "$46,145.52 " "$46,145.52 " "$46,145.52 " "$27,808.88 " "$16,169.26 " "$14,699.33 " "$29,991.66 " N/A N/A N/A N/A "$14,699.33 " "$14,552.34 " "$101,069.28 " 330104 252 OTHER VASCULAR PROCEDURES WITH MCC I N/A N/A "$29,836.30 " N/A "$50,757.98 " "$53,412.56 " "$48,651.70 " "$29,537.94 " N/A "$56,688.98 " N/A "$29,836.30 " "$101,118.11 " "$32,819.94 " "$124,788.00 " "$103,274.54 " N/A N/A N/A "$207,903.11 " "$144,189.84 " "$195,542.93 " N/A "$30,731.39 " "$36,997.02 " N/A N/A N/A N/A N/A "$41,770.83 " N/A "$29,836.30 " "$29,836.30 " "$32,521.57 " N/A N/A N/A N/A N/A N/A N/A "$117,416.70 " "$94,922.97 " "$94,922.97 " "$94,922.97 " "$94,922.97 " "$57,203.86 " "$32,819.94 " "$29,836.30 " "$61,693.91 " N/A N/A N/A N/A "$29,836.30 " "$29,537.94 " "$207,903.11 " 330104 253 OTHER VASCULAR PROCEDURES WITH CC I N/A N/A "$23,939.23 " N/A "$40,596.67 " "$42,719.82 " "$38,912.05 " "$23,699.84 " N/A "$45,484.53 " N/A "$23,939.23 " "$80,875.13 " "$26,333.15 " "$99,806.52 " "$82,599.86 " N/A N/A N/A "$166,282.69 " "$115,324.27 " "$156,396.91 " N/A "$24,657.41 " "$29,684.64 " N/A N/A N/A N/A N/A "$33,514.92 " N/A "$23,939.23 " "$23,939.23 " "$26,093.76 " N/A N/A N/A N/A N/A N/A N/A "$93,910.88 " "$75,920.21 " "$75,920.21 " "$75,920.21 " "$75,920.21 " "$45,752.14 " "$26,333.15 " "$23,939.23 " "$49,343.32 " N/A N/A N/A N/A "$23,939.23 " "$23,699.84 " "$166,282.69 " 330104 254 OTHER VASCULAR PROCEDURES WITHOUT CC/MCC I N/A N/A "$16,489.69 " N/A "$27,760.29 " "$29,212.12 " "$26,608.33 " "$16,324.79 " N/A "$31,330.41 " N/A "$16,489.69 " "$55,302.98 " "$18,138.66 " "$68,248.40 " "$56,482.36 " N/A N/A N/A "$113,705.27 " "$78,859.55 " "$106,945.31 " N/A "$16,984.38 " "$20,447.21 " N/A N/A N/A N/A N/A "$23,085.56 " N/A "$16,489.69 " "$16,489.69 " "$17,973.76 " N/A N/A N/A N/A N/A N/A N/A "$64,216.92 " "$51,914.77 " "$51,914.77 " "$51,914.77 " "$51,914.77 " "$31,285.64 " "$18,138.66 " "$16,489.69 " "$33,741.31 " N/A N/A N/A N/A "$16,489.69 " "$16,324.79 " "$113,705.27 " 330104 255 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC I N/A N/A "$22,984.14 " N/A "$38,950.94 " "$40,988.03 " "$37,334.61 " "$22,754.30 " N/A "$43,669.86 " N/A "$22,984.14 " "$77,596.57 " "$25,282.55 " "$95,760.51 " "$79,251.38 " N/A N/A N/A "$159,541.84 " "$110,649.20 " "$150,056.81 " N/A "$23,673.66 " "$28,500.33 " N/A N/A N/A N/A N/A "$32,177.79 " N/A "$22,984.14 " "$22,984.14 " "$25,052.71 " N/A N/A N/A N/A N/A N/A N/A "$90,103.87 " "$72,842.52 " "$72,842.52 " "$72,842.52 " "$72,842.52 " "$43,897.42 " "$25,282.55 " "$22,984.14 " "$47,343.02 " N/A N/A N/A N/A "$22,984.14 " "$22,754.30 " "$159,541.84 " 330104 256 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC I N/A N/A "$14,760.13 " N/A "$24,780.06 " "$26,076.03 " "$23,751.77 " "$14,612.52 " N/A "$28,044.24 " N/A "$14,760.13 " "$49,365.89 " "$16,236.14 " "$60,921.54 " "$50,418.66 " N/A N/A N/A "$101,498.36 " "$70,393.52 " "$95,464.11 " N/A "$15,202.93 " "$18,302.56 " N/A N/A N/A N/A N/A "$20,664.18 " N/A "$14,760.13 " "$14,760.13 " "$16,088.54 " N/A N/A N/A N/A N/A N/A N/A "$57,322.86 " "$46,341.42 " "$46,341.42 " "$46,341.42 " "$46,341.42 " "$27,926.94 " "$16,236.14 " "$14,760.13 " "$30,118.99 " N/A N/A N/A N/A "$14,760.13 " "$14,612.52 " "$101,498.36 " 330104 257 UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC I N/A N/A "$9,619.02 " N/A "$15,921.36 " "$16,754.03 " "$15,260.68 " "$9,522.83 " N/A "$18,276.13 " N/A "$9,619.02 " "$31,717.93 " "$10,580.92 " "$39,142.52 " "$32,394.34 " N/A N/A N/A "$65,213.41 " "$45,228.33 " "$61,336.37 " N/A "$9,907.59 " "$11,927.58 " N/A N/A N/A N/A N/A "$13,466.62 " N/A "$9,619.02 " "$9,619.02 " "$10,484.73 " N/A N/A N/A N/A N/A N/A N/A "$36,830.34 " "$29,774.69 " "$29,774.69 " "$29,774.69 " "$29,774.69 " "$17,943.26 " "$10,580.92 " "$9,619.02 " "$19,351.66 " N/A N/A N/A N/A "$9,619.02 " "$9,522.83 " "$65,213.41 " 330104 258 CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC I N/A N/A "$25,501.39 " N/A "$43,288.44 " "$45,552.37 " "$41,492.12 " "$25,246.37 " N/A "$48,452.63 " N/A "$25,501.39 " "$86,237.57 " "$28,051.52 " "$106,424.20 " "$88,076.66 " N/A N/A N/A "$177,308.09 " "$122,970.87 " "$166,766.83 " N/A "$26,266.43 " "$31,621.72 " N/A N/A N/A N/A N/A "$35,701.94 " N/A "$25,501.39 " "$25,501.39 " "$27,796.51 " N/A N/A N/A N/A N/A N/A N/A "$100,137.66 " "$80,954.11 " "$80,954.11 " "$80,954.11 " "$80,954.11 " "$48,785.74 " "$28,051.52 " "$25,501.39 " "$52,615.04 " N/A N/A N/A N/A "$25,501.39 " "$25,246.37 " "$177,308.09 " 330104 259 CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC I N/A N/A "$17,948.76 " N/A "$30,274.43 " "$31,857.74 " "$29,018.14 " "$17,769.27 " N/A "$34,102.64 " N/A "$17,948.76 " "$60,311.55 " "$19,743.63 " "$74,429.38 " "$61,597.75 " N/A N/A N/A "$124,003.11 " "$86,001.54 " "$116,630.92 " N/A "$18,487.22 " "$22,256.46 " N/A N/A N/A N/A N/A "$25,128.26 " N/A "$17,948.76 " "$17,948.76 " "$19,564.15 " N/A N/A N/A N/A N/A N/A N/A "$70,032.79 " "$56,616.49 " "$56,616.49 " "$56,616.49 " "$56,616.49 " "$34,119.05 " "$19,743.63 " "$17,948.76 " "$36,797.13 " N/A N/A N/A N/A "$17,948.76 " "$17,769.27 " "$124,003.11 " 330104 260 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC I N/A N/A "$31,204.62 " N/A "$53,115.75 " "$55,893.63 " "$50,911.63 " "$30,892.58 " N/A "$59,288.78 " N/A "$31,204.62 " "$105,815.16 " "$34,325.09 " "$130,584.55 " "$108,071.75 " N/A N/A N/A "$217,560.44 " "$150,887.62 " "$204,626.12 " N/A "$32,140.76 " "$38,693.73 " N/A N/A N/A N/A N/A "$43,686.47 " N/A "$31,204.62 " "$31,204.62 " "$34,013.04 " N/A N/A N/A N/A N/A N/A N/A "$122,870.83 " "$99,332.25 " "$99,332.25 " "$99,332.25 " "$99,332.25 " "$59,861.05 " "$34,325.09 " "$31,204.62 " "$64,559.67 " N/A N/A N/A N/A "$31,204.62 " "$30,892.58 " "$217,560.44 " 330104 261 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC I N/A N/A "$17,214.82 " N/A "$29,009.77 " "$30,526.94 " "$27,805.96 " "$17,042.67 " N/A "$32,708.15 " N/A "$17,214.82 " "$57,792.15 " "$18,936.30 " "$71,320.23 " "$59,024.61 " N/A N/A N/A "$118,823.10 " "$82,408.98 " "$111,758.87 " N/A "$17,731.26 " "$21,346.37 " N/A N/A N/A N/A N/A "$24,100.74 " N/A "$17,214.82 " "$17,214.82 " "$18,764.15 " N/A N/A N/A N/A N/A N/A N/A "$67,107.30 " "$54,251.43 " "$54,251.43 " "$54,251.43 " "$54,251.43 " "$32,693.79 " "$18,936.30 " "$17,214.82 " "$35,259.99 " N/A N/A N/A N/A "$17,214.82 " "$17,042.67 " "$118,823.10 " 330104 262 CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CC/MCC I N/A N/A "$15,153.09 " N/A "$25,457.18 " "$26,788.56 " "$24,400.79 " "$15,001.56 " N/A "$28,790.87 " N/A "$15,153.09 " "$50,714.82 " "$16,668.40 " "$62,586.22 " "$51,796.35 " N/A N/A N/A "$104,271.81 " "$72,317.03 " "$98,072.68 " N/A "$15,607.68 " "$18,789.83 " N/A N/A N/A N/A N/A "$21,214.32 " N/A "$15,153.09 " "$15,153.09 " "$16,516.87 " N/A N/A N/A N/A N/A N/A N/A "$58,889.22 " "$47,607.71 " "$47,607.71 " "$47,607.71 " "$47,607.71 " "$28,690.05 " "$16,668.40 " "$15,153.09 " "$30,941.99 " N/A N/A N/A N/A "$15,153.09 " "$15,001.56 " "$104,271.81 " 330104 263 VEIN LIGATION AND STRIPPING I N/A N/A "$24,926.04 " N/A "$42,297.05 " "$44,509.14 " "$40,541.87 " "$24,676.78 " N/A "$47,359.48 " N/A "$24,926.04 " "$84,262.57 " "$27,418.64 " "$103,986.89 " "$86,059.54 " N/A N/A N/A "$173,247.41 " "$120,154.61 " "$162,947.57 " N/A "$25,673.82 " "$30,908.29 " N/A N/A N/A N/A N/A "$34,896.46 " N/A "$24,926.04 " "$24,926.04 " "$27,169.38 " N/A N/A N/A N/A N/A N/A N/A "$97,844.32 " "$79,100.11 " "$79,100.11 " "$79,100.11 " "$79,100.11 " "$47,668.46 " "$27,418.64 " "$24,926.04 " "$51,410.06 " N/A N/A N/A N/A "$24,926.04 " "$24,676.78 " "$173,247.41 " 330104 264 OTHER CIRCULATORY SYSTEM O.R. PROCEDURES I N/A N/A "$29,540.26 " N/A "$50,247.87 " "$52,875.77 " "$48,162.75 " "$29,244.86 " N/A "$56,126.50 " N/A "$29,540.26 " "$100,101.88 " "$32,494.29 " "$123,533.89 " "$102,236.63 " N/A N/A N/A "$205,813.69 " "$142,740.74 " "$193,577.73 " N/A "$30,426.47 " "$36,629.92 " N/A N/A N/A N/A N/A "$41,356.37 " N/A "$29,540.26 " "$29,540.26 " "$32,198.88 " N/A N/A N/A N/A N/A N/A N/A "$116,236.66 " "$93,969.00 " "$93,969.00 " "$93,969.00 " "$93,969.00 " "$56,628.97 " "$32,494.29 " "$29,540.26 " "$61,073.89 " N/A N/A N/A N/A "$29,540.26 " "$29,244.86 " "$205,813.69 " 330104 265 AICD LEAD PROCEDURES I N/A N/A "$30,178.16 " N/A "$51,347.04 " "$54,032.43 " "$49,216.32 " "$29,876.38 " N/A "$57,338.51 " N/A "$30,178.16 " "$102,291.61 " "$33,195.98 " "$126,236.21 " "$104,473.07 " N/A N/A N/A "$210,315.89 " "$145,863.21 " "$197,812.26 " N/A "$31,083.51 " "$37,420.92 " N/A N/A N/A N/A N/A "$42,249.43 " N/A "$30,178.16 " "$30,178.16 " "$32,894.20 " N/A N/A N/A N/A N/A N/A N/A "$118,779.35 " "$96,024.58 " "$96,024.58 " "$96,024.58 " "$96,024.58 " "$57,867.73 " "$33,195.98 " "$30,178.16 " "$62,409.89 " N/A N/A N/A N/A "$30,178.16 " "$29,876.38 " "$210,315.89 " 330104 266 ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC I N/A N/A "$58,536.64 " N/A "$100,211.83 " "$105,452.78 " "$96,053.39 " "$57,951.27 " N/A "$111,219.62 " N/A "$58,536.64 " "$199,638.17 " "$64,390.30 " "$246,369.81 " "$203,895.62 " N/A N/A N/A "$410,464.53 " "$284,674.99 " "$386,061.74 " N/A "$60,292.74 " "$72,585.43 " N/A N/A N/A N/A N/A "$81,951.30 " N/A "$58,536.64 " "$58,536.64 " "$63,804.94 " N/A N/A N/A N/A N/A N/A N/A "$231,816.58 " "$187,407.07 " "$187,407.07 " "$187,407.07 " "$187,407.07 " "$112,937.98 " "$64,390.30 " "$58,536.64 " "$121,802.72 " N/A N/A N/A N/A "$58,536.64 " "$57,951.27 " "$410,464.53 " 330104 267 ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC I N/A N/A "$45,848.19 " N/A "$78,348.23 " "$82,445.75 " "$75,097.05 " "$45,389.71 " N/A "$87,111.56 " N/A "$45,848.19 " "$156,082.35 " "$50,433.01 " "$192,618.36 " "$159,410.93 " N/A N/A N/A "$320,911.91 " "$222,566.36 " "$301,833.17 " N/A "$47,223.64 " "$56,851.76 " N/A N/A N/A N/A N/A "$64,187.47 " N/A "$45,848.19 " "$45,848.19 " "$49,974.53 " N/A N/A N/A N/A N/A N/A N/A "$181,240.27 " "$146,519.76 " "$146,519.76 " "$146,519.76 " "$146,519.76 " "$88,297.87 " "$50,433.01 " "$45,848.19 " "$95,228.55 " N/A N/A N/A N/A "$45,848.19 " "$45,389.71 " "$320,911.91 " 330104 268 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC I N/A N/A "$61,356.98 " N/A "$105,071.59 " "$110,566.70 " "$100,711.48 " "$60,743.41 " N/A "$116,578.26 " N/A "$61,356.98 " "$209,319.60 " "$67,492.68 " "$258,317.48 " "$213,783.51 " N/A N/A N/A "$430,369.95 " "$298,480.26 " "$404,783.75 " N/A "$63,197.69 " "$76,082.66 " N/A N/A N/A N/A N/A "$85,899.77 " N/A "$61,356.98 " "$61,356.98 " "$66,879.11 " N/A N/A N/A N/A N/A N/A N/A "$243,058.50 " "$196,495.35 " "$196,495.35 " "$196,495.35 " "$196,495.35 " "$118,414.89 " "$67,492.68 " "$61,356.98 " "$127,709.52 " N/A N/A N/A N/A "$61,356.98 " "$60,743.41 " "$430,369.95 " 330104 269 AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC I N/A N/A "$38,056.79 " N/A "$64,922.79 " "$68,318.17 " "$62,228.72 " "$37,676.22 " N/A "$72,307.90 " N/A "$38,056.79 " "$129,336.69 " "$41,862.47 " "$159,612.04 " "$132,094.91 " N/A N/A N/A "$265,921.72 " "$184,428.27 " "$250,112.23 " N/A "$39,198.50 " "$47,190.42 " N/A N/A N/A N/A N/A "$53,279.51 " N/A "$38,056.79 " "$38,056.79 " "$41,481.90 " N/A N/A N/A N/A N/A N/A N/A "$150,183.66 " "$121,412.71 " "$121,412.71 " "$121,412.71 " "$121,412.71 " "$73,167.49 " "$41,862.47 " "$38,056.79 " "$78,910.56 " N/A N/A N/A N/A "$38,056.79 " "$37,676.22 " "$265,921.72 " 330104 270 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC I N/A N/A "$45,425.27 " N/A "$77,619.49 " "$81,678.90 " "$74,398.56 " "$44,971.02 " N/A "$86,308.02 " N/A "$45,425.27 " "$154,630.59 " "$49,967.80 " "$190,826.77 " "$157,928.21 " N/A N/A N/A "$317,927.03 " "$220,496.21 " "$299,025.75 " N/A "$46,788.03 " "$56,327.34 " N/A N/A N/A N/A N/A "$63,595.38 " N/A "$45,425.27 " "$45,425.27 " "$49,513.55 " N/A N/A N/A N/A N/A N/A N/A "$179,554.51 " "$145,156.94 " "$145,156.94 " "$145,156.94 " "$145,156.94 " "$87,476.59 " "$49,967.80 " "$45,425.27 " "$94,342.81 " N/A N/A N/A N/A "$45,425.27 " "$44,971.02 " "$317,927.03 " 330104 271 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC I N/A N/A "$31,074.22 " N/A "$52,891.05 " "$55,657.19 " "$50,696.26 " "$30,763.48 " N/A "$59,041.02 " N/A "$31,074.22 " "$105,367.53 " "$34,181.65 " "$130,032.14 " "$107,614.58 " N/A N/A N/A "$216,640.10 " "$150,249.33 " "$203,760.49 " N/A "$32,006.45 " "$38,532.04 " N/A N/A N/A N/A N/A "$43,503.91 " N/A "$31,074.22 " "$31,074.22 " "$33,870.90 " N/A N/A N/A N/A N/A N/A N/A "$122,351.06 " "$98,912.05 " "$98,912.05 " "$98,912.05 " "$98,912.05 " "$59,607.82 " "$34,181.65 " "$31,074.22 " "$64,286.56 " N/A N/A N/A N/A "$31,074.22 " "$30,763.48 " "$216,640.10 " 330104 272 OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC I N/A N/A "$23,255.51 " N/A "$39,418.54 " "$41,480.09 " "$37,782.81 " "$23,022.95 " N/A "$44,185.47 " N/A "$23,255.51 " "$78,528.12 " "$25,581.06 " "$96,910.11 " "$80,202.80 " N/A N/A N/A "$161,457.13 " "$111,977.54 " "$151,858.24 " N/A "$23,953.18 " "$28,836.83 " N/A N/A N/A N/A N/A "$32,557.71 " N/A "$23,255.51 " "$23,255.51 " "$25,348.51 " N/A N/A N/A N/A N/A N/A N/A "$91,185.57 " "$73,716.99 " "$73,716.99 " "$73,716.99 " "$73,716.99 " "$44,424.40 " "$25,581.06 " "$23,255.51 " "$47,911.37 " N/A N/A N/A N/A "$23,255.51 " "$23,022.95 " "$161,457.13 " 330104 273 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC I N/A N/A "$35,736.90 " N/A "$60,925.37 " "$64,111.69 " "$58,397.18 " "$35,379.54 " N/A "$67,900.12 " N/A "$35,736.90 " "$121,373.18 " "$39,310.60 " "$149,784.42 " "$123,961.57 " N/A N/A N/A "$249,548.40 " "$173,072.66 " "$234,712.34 " N/A "$36,809.01 " "$44,313.76 " N/A N/A N/A N/A N/A "$50,031.67 " N/A "$35,736.90 " "$35,736.90 " "$38,953.23 " N/A N/A N/A N/A N/A N/A N/A "$140,936.56 " "$113,937.10 " "$113,937.10 " "$113,937.10 " "$113,937.10 " "$68,662.43 " "$39,310.60 " "$35,736.90 " "$74,051.89 " N/A N/A N/A N/A "$35,736.90 " "$35,379.54 " "$249,548.40 " 330104 274 PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC I N/A N/A "$29,979.04 " N/A "$51,003.93 " "$53,671.37 " "$48,887.44 " "$29,679.25 " N/A "$56,960.18 " N/A "$29,979.04 " "$101,608.08 " "$32,976.94 " "$125,392.67 " "$103,774.96 " N/A N/A N/A "$208,910.51 " "$144,888.52 " "$196,490.44 " N/A "$30,878.41 " "$37,174.01 " N/A N/A N/A N/A N/A "$41,970.66 " N/A "$29,979.04 " "$29,979.04 " "$32,677.15 " N/A N/A N/A N/A N/A N/A N/A "$117,985.64 " "$95,382.92 " "$95,382.92 " "$95,382.92 " "$95,382.92 " "$57,481.05 " "$32,976.94 " "$29,979.04 " "$61,992.85 " N/A N/A N/A N/A "$29,979.04 " "$29,679.25 " "$208,910.51 " 330104 280 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC" I N/A N/A "$14,532.81 " N/A "$24,388.36 " "$25,663.85 " "$23,376.33 " "$14,387.48 " N/A "$27,612.33 " N/A "$14,532.81 " "$48,585.57 " "$15,986.09 " "$59,958.56 " "$49,621.70 " N/A N/A N/A "$99,893.98 " "$69,280.82 " "$93,955.12 " N/A "$14,968.79 " "$18,020.68 " N/A N/A N/A N/A N/A "$20,345.93 " N/A "$14,532.81 " "$14,532.81 " "$15,840.76 " N/A N/A N/A N/A N/A N/A N/A "$56,416.77 " "$45,608.91 " "$45,608.91 " "$45,608.91 " "$45,608.91 " "$27,485.50 " "$15,986.09 " "$14,532.81 " "$29,642.90 " N/A N/A N/A N/A "$14,532.81 " "$14,387.48 " "$99,893.98 " 330104 281 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC" I N/A N/A "$8,472.73 " N/A "$13,946.19 " "$14,675.55 " "$13,367.47 " "$8,388.00 " N/A "$16,098.19 " N/A "$8,472.73 " "$27,783.06 " "$9,320.00 " "$34,286.56 " "$28,375.55 " N/A N/A N/A "$57,123.14 " "$39,617.38 " "$53,727.08 " N/A "$8,726.91 " "$10,506.19 " N/A N/A N/A N/A N/A "$11,861.82 " N/A "$8,472.73 " "$8,472.73 " "$9,235.28 " N/A N/A N/A N/A N/A N/A N/A "$32,261.23 " "$26,080.89 " "$26,080.89 " "$26,080.89 " "$26,080.89 " "$15,717.25 " "$9,320.00 " "$8,472.73 " "$16,950.93 " N/A N/A N/A N/A "$8,472.73 " "$8,388.00 " "$57,123.14 " 330104 282 "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC" I N/A N/A "$6,693.83 " N/A "$10,880.94 " "$11,450.00 " "$10,429.42 " "$6,626.89 " N/A "$12,718.27 " N/A "$6,693.83 " "$21,676.59 " "$7,363.21 " "$26,750.68 " "$22,138.86 " N/A N/A N/A "$44,567.99 " "$30,909.84 " "$41,918.35 " N/A "$6,894.64 " "$8,300.35 " N/A N/A N/A N/A N/A "$9,371.36 " N/A "$6,693.83 " "$6,693.83 " "$7,296.27 " N/A N/A N/A N/A N/A N/A N/A "$25,170.50 " "$20,348.55 " "$20,348.55 " "$20,348.55 " "$20,348.55 " "$12,262.74 " "$7,363.21 " "$6,693.83 " "$13,225.27 " N/A N/A N/A N/A "$6,693.83 " "$6,626.89 " "$44,567.99 " 330104 283 "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC" I N/A N/A "$17,283.54 " N/A "$29,128.19 " "$30,651.55 " "$27,919.47 " "$17,110.71 " N/A "$32,838.73 " N/A "$17,283.54 " "$58,028.06 " "$19,011.90 " "$71,611.36 " "$59,265.55 " N/A N/A N/A "$119,308.14 " "$82,745.38 " "$112,215.08 " N/A "$17,802.05 " "$21,431.59 " N/A N/A N/A N/A N/A "$24,196.96 " N/A "$17,283.54 " "$17,283.54 " "$18,839.06 " N/A N/A N/A N/A N/A N/A N/A "$67,381.23 " "$54,472.89 " "$54,472.89 " "$54,472.89 " "$54,472.89 " "$32,827.25 " "$19,011.90 " "$17,283.54 " "$35,403.93 " N/A N/A N/A N/A "$17,283.54 " "$17,110.71 " "$119,308.14 " 330104 284 "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC" I N/A N/A "$6,858.59 " N/A "$11,164.84 " "$11,748.75 " "$10,701.54 " "$6,790.00 " N/A "$13,031.32 " N/A "$6,858.59 " "$22,242.17 " "$7,544.45 " "$27,448.66 " "$22,716.51 " N/A N/A N/A "$45,730.85 " "$31,716.33 " "$43,012.08 " N/A "$7,064.35 " "$8,504.65 " N/A N/A N/A N/A N/A "$9,602.03 " N/A "$6,858.59 " "$6,858.59 " "$7,475.86 " N/A N/A N/A N/A N/A N/A N/A "$25,827.25 " "$20,879.48 " "$20,879.48 " "$20,879.48 " "$20,879.48 " "$12,582.69 " "$7,544.45 " "$6,858.59 " "$13,570.34 " N/A N/A N/A N/A "$6,858.59 " "$6,790.00 " "$45,730.85 " 330104 285 "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CC/MCC" I N/A N/A "$5,152.82 " N/A "$8,225.61 " "$8,655.80 " "$7,884.27 " "$5,101.29 " N/A "$9,790.35 " N/A "$5,152.82 " "$16,386.74 " "$5,668.10 " "$20,222.58 " "$16,736.20 " N/A N/A N/A "$33,691.83 " "$23,366.75 " "$31,688.80 " N/A "$5,307.40 " "$6,389.49 " N/A N/A N/A N/A N/A "$7,213.94 " N/A "$5,152.82 " "$5,152.82 " "$5,616.57 " N/A N/A N/A N/A N/A N/A N/A "$19,028.02 " "$15,382.79 " "$15,382.79 " "$15,382.79 " "$15,382.79 " "$9,270.20 " "$5,668.10 " "$5,152.82 " "$9,997.84 " N/A N/A N/A N/A "$5,152.82 " "$5,101.29 " "$33,691.83 " 330104 286 "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC" I N/A N/A "$19,066.85 " N/A "$32,201.02 " "$33,885.10 " "$30,864.79 " "$18,876.18 " N/A "$36,227.02 " N/A "$19,066.85 " "$64,149.64 " "$20,973.54 " "$79,165.90 " "$65,517.69 " N/A N/A N/A "$131,894.39 " "$91,474.49 " "$124,053.05 " N/A "$19,638.86 " "$23,642.89 " N/A N/A N/A N/A N/A "$26,693.59 " N/A "$19,066.85 " "$19,066.85 " "$20,782.87 " N/A N/A N/A N/A N/A N/A N/A "$74,489.52 " "$60,219.43 " "$60,219.43 " "$60,219.43 " "$60,219.43 " "$36,290.31 " "$20,973.54 " "$19,066.85 " "$39,138.81 " N/A N/A N/A N/A "$19,066.85 " "$18,876.18 " "$131,894.39 " 330104 287 "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC" I N/A N/A "$10,072.77 " N/A "$16,703.24 " "$17,576.80 " "$16,010.11 " "$9,972.05 " N/A "$19,138.27 " N/A "$10,072.77 " "$33,275.55 " "$11,080.05 " "$41,064.74 " "$33,985.18 " N/A N/A N/A "$68,415.94 " "$47,449.43 " "$64,348.50 " N/A "$10,374.96 " "$12,490.24 " N/A N/A N/A N/A N/A "$14,101.88 " N/A "$10,072.77 " "$10,072.77 " "$10,979.32 " N/A N/A N/A N/A N/A N/A N/A "$38,639.02 " "$31,236.88 " "$31,236.88 " "$31,236.88 " "$31,236.88 " "$18,824.42 " "$11,080.05 " "$10,072.77 " "$20,301.99 " N/A N/A N/A N/A "$10,072.77 " "$9,972.05 " "$68,415.94 " 330104 288 ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC I N/A N/A "$24,137.47 " N/A "$40,938.26 " "$43,079.28 " "$39,239.47 " "$23,896.10 " N/A "$45,861.20 " N/A "$24,137.47 " "$81,555.64 " "$26,551.22 " "$100,646.32 " "$83,294.88 " N/A N/A N/A "$167,681.85 " "$116,294.65 " "$157,712.89 " N/A "$24,861.60 " "$29,930.47 " N/A N/A N/A N/A N/A "$33,792.46 " N/A "$24,137.47 " "$24,137.47 " "$26,309.84 " N/A N/A N/A N/A N/A N/A N/A "$94,701.08 " "$76,559.03 " "$76,559.03 " "$76,559.03 " "$76,559.03 " "$46,137.11 " "$26,551.22 " "$24,137.47 " "$49,758.51 " N/A N/A N/A N/A "$24,137.47 " "$23,896.10 " "$167,681.85 " 330104 289 ACUTE AND SUBACUTE ENDOCARDITIS WITH CC I N/A N/A "$14,538.97 " N/A "$24,398.99 " "$25,675.03 " "$23,386.52 " "$14,393.58 " N/A "$27,624.05 " N/A "$14,538.97 " "$48,606.74 " "$15,992.87 " "$59,984.69 " "$49,643.32 " N/A N/A N/A "$99,937.51 " "$69,311.01 " "$93,996.06 " N/A "$14,975.14 " "$18,028.33 " N/A N/A N/A N/A N/A "$20,354.56 " N/A "$14,538.97 " "$14,538.97 " "$15,847.48 " N/A N/A N/A N/A N/A N/A N/A "$56,441.35 " "$45,628.78 " "$45,628.78 " "$45,628.78 " "$45,628.78 " "$27,497.48 " "$15,992.87 " "$14,538.97 " "$29,655.82 " N/A N/A N/A N/A "$14,538.97 " "$14,393.58 " "$99,937.51 " 330104 290 ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC I N/A N/A "$11,002.31 " N/A "$18,304.94 " "$19,262.26 " "$17,545.35 " "$10,892.29 " N/A "$20,904.40 " N/A "$11,002.31 " "$36,466.40 " "$12,102.55 " "$45,002.51 " "$37,244.07 " N/A N/A N/A "$74,976.45 " "$51,999.43 " "$70,518.98 " N/A "$11,332.38 " "$13,642.87 " N/A N/A N/A N/A N/A "$15,403.24 " N/A "$11,002.31 " "$11,002.31 " "$11,992.52 " N/A N/A N/A N/A N/A N/A N/A "$42,344.18 " "$34,232.23 " "$34,232.23 " "$34,232.23 " "$34,232.23 " "$20,629.53 " "$12,102.55 " "$11,002.31 " "$22,248.78 " N/A N/A N/A N/A "$11,002.31 " "$10,892.29 " "$74,976.45 " 330104 291 HEART FAILURE AND SHOCK WITH MCC I N/A N/A "$11,655.20 " N/A "$19,429.92 " "$20,446.08 " "$18,623.65 " "$11,538.64 " N/A "$22,144.87 " N/A "$11,655.20 " "$38,707.55 " "$12,820.72 " "$47,768.28 " "$39,533.02 " N/A N/A N/A "$79,584.36 " "$55,195.21 " "$74,852.94 " N/A "$12,004.85 " "$14,452.44 " N/A N/A N/A N/A N/A "$16,317.27 " N/A "$11,655.20 " "$11,655.20 " "$12,704.16 " N/A N/A N/A N/A N/A N/A N/A "$44,946.58 " "$36,336.08 " "$36,336.08 " "$36,336.08 " "$36,336.08 " "$21,897.38 " "$12,820.72 " "$11,655.20 " "$23,616.15 " N/A N/A N/A N/A "$11,655.20 " "$11,538.64 " "$79,584.36 " 330104 292 HEART FAILURE AND SHOCK WITH CC I N/A N/A "$7,981.09 " N/A "$13,099.03 " "$13,784.09 " "$12,555.47 " "$7,901.28 " N/A "$15,164.07 " N/A "$7,981.09 " "$26,095.39 " "$8,779.20 " "$32,203.84 " "$26,651.89 " N/A N/A N/A "$53,653.22 " "$37,210.84 " "$50,463.45 " N/A "$8,220.52 " "$9,896.55 " N/A N/A N/A N/A N/A "$11,173.52 " N/A "$7,981.09 " "$7,981.09 " "$8,699.39 " N/A N/A N/A N/A N/A N/A N/A "$30,301.54 " "$24,496.62 " "$24,496.62 " "$24,496.62 " "$24,496.62 " "$14,762.51 " "$8,779.20 " "$7,981.09 " "$15,921.25 " N/A N/A N/A N/A "$7,981.09 " "$7,901.28 " "$53,653.22 " 330104 293 HEART FAILURE AND SHOCK WITHOUT CC/MCC I N/A N/A "$5,315.82 " N/A "$8,506.47 " "$8,951.35 " "$8,153.49 " "$5,262.66 " N/A "$10,100.05 " N/A "$5,315.82 " "$16,946.27 " "$5,847.40 " "$20,913.09 " "$17,307.67 " N/A N/A N/A "$34,842.26 " "$24,164.62 " "$32,770.83 " N/A "$5,475.29 " "$6,591.61 " N/A N/A N/A N/A N/A "$7,442.14 " N/A "$5,315.82 " "$5,315.82 " "$5,794.24 " N/A N/A N/A N/A N/A N/A N/A "$19,677.74 " "$15,908.04 " "$15,908.04 " "$15,908.04 " "$15,908.04 " "$9,586.73 " "$5,847.40 " "$5,315.82 " "$10,339.22 " N/A N/A N/A N/A "$5,315.82 " "$5,262.66 " "$34,842.26 " 330104 294 DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC I N/A N/A "$10,551.20 " N/A "$17,527.62 " "$18,444.29 " "$16,800.28 " "$10,445.69 " N/A "$20,047.28 " N/A "$10,551.20 " "$34,917.85 " "$11,606.32 " "$43,091.48 " "$35,662.51 " N/A N/A N/A "$71,792.58 " "$49,791.28 " "$67,524.40 " N/A "$10,867.74 " "$13,083.49 " N/A N/A N/A N/A N/A "$14,771.68 " N/A "$10,551.20 " "$10,551.20 " "$11,500.81 " N/A N/A N/A N/A N/A N/A N/A "$40,546.04 " "$32,778.56 " "$32,778.56 " "$32,778.56 " "$32,778.56 " "$19,753.50 " "$11,606.32 " "$10,551.20 " "$21,303.99 " N/A N/A N/A N/A "$10,551.20 " "$10,445.69 " "$71,792.58 " 330104 295 DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC I N/A N/A "$8,182.86 " N/A "$13,446.70 " "$14,149.94 " "$12,888.71 " "$8,101.03 " N/A "$15,547.43 " N/A "$8,182.86 " "$26,788.00 " "$9,001.14 " "$33,058.58 " "$27,359.27 " N/A N/A N/A "$55,077.25 " "$38,198.47 " "$51,802.82 " N/A "$8,428.34 " "$10,146.74 " N/A N/A N/A N/A N/A "$11,456.00 " N/A "$8,182.86 " "$8,182.86 " "$8,919.31 " N/A N/A N/A N/A N/A N/A N/A "$31,105.78 " "$25,146.79 " "$25,146.79 " "$25,146.79 " "$25,146.79 " "$15,154.33 " "$9,001.14 " "$8,182.86 " "$16,343.82 " N/A N/A N/A N/A "$8,182.86 " "$8,101.03 " "$55,077.25 " 330104 296 "CARDIAC ARREST, UNEXPLAINED WITH MCC" I N/A N/A "$14,813.87 " N/A "$24,872.67 " "$26,173.48 " "$23,840.54 " "$14,665.73 " N/A "$28,146.36 " N/A "$14,813.87 " "$49,550.38 " "$16,295.26 " "$61,149.22 " "$50,607.09 " N/A N/A N/A "$101,877.69 " "$70,656.60 " "$95,820.89 " N/A "$15,258.29 " "$18,369.20 " N/A N/A N/A N/A N/A "$20,739.42 " N/A "$14,813.87 " "$14,813.87 " "$16,147.12 " N/A N/A N/A N/A N/A N/A N/A "$57,537.10 " "$46,514.61 " "$46,514.61 " "$46,514.61 " "$46,514.61 " "$28,031.31 " "$16,295.26 " "$14,813.87 " "$30,231.55 " N/A N/A N/A N/A "$14,813.87 " "$14,665.73 " "$101,877.69 " 330104 297 "CARDIAC ARREST, UNEXPLAINED WITH CC" I N/A N/A "$5,985.44 " N/A "$9,660.31 " "$10,165.53 " "$9,259.44 " "$5,925.58 " N/A "$11,372.33 " N/A "$5,985.44 " "$19,244.89 " "$6,583.98 " "$23,749.77 " "$19,655.31 " N/A N/A N/A "$39,568.32 " "$27,442.35 " "$37,215.91 " N/A "$6,165.00 " "$7,421.94 " N/A N/A N/A N/A N/A "$8,379.61 " N/A "$5,985.44 " "$5,985.44 " "$6,524.13 " N/A N/A N/A N/A N/A N/A N/A "$22,346.86 " "$18,065.83 " "$18,065.83 " "$18,065.83 " "$18,065.83 " "$10,887.09 " "$6,583.98 " "$5,985.44 " "$11,741.64 " N/A N/A N/A N/A "$5,985.44 " "$5,925.58 " "$39,568.32 " 330104 298 "CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC" I N/A N/A "$4,683.20 " N/A "$7,416.41 " "$7,804.28 " "$7,108.65 " "$4,636.37 " N/A "$8,898.08 " N/A "$4,683.20 " "$14,774.68 " "$5,151.52 " "$18,233.16 " "$15,089.76 " N/A N/A N/A "$30,377.37 " "$21,068.03 " "$28,571.39 " N/A "$4,823.70 " "$5,807.17 " N/A N/A N/A N/A N/A "$6,556.48 " N/A "$4,683.20 " "$4,683.20 " "$5,104.69 " N/A N/A N/A N/A N/A N/A N/A "$17,156.12 " "$13,869.49 " "$13,869.49 " "$13,869.49 " "$13,869.49 " "$8,358.24 " "$5,151.52 " "$4,683.20 " "$9,014.29 " N/A N/A N/A N/A "$4,683.20 " "$4,636.37 " "$30,377.37 " 330104 299 PERIPHERAL VASCULAR DISORDERS WITH MCC I N/A N/A "$13,930.15 " N/A "$23,349.92 " "$24,571.09 " "$22,380.98 " "$13,790.85 " N/A "$26,467.28 " N/A "$13,930.15 " "$46,516.81 " "$15,323.16 " "$57,405.54 " "$47,508.82 " N/A N/A N/A "$95,640.53 " "$66,330.86 " "$89,954.54 " N/A "$14,348.05 " "$17,273.38 " N/A N/A N/A N/A N/A "$19,502.21 " N/A "$13,930.15 " "$13,930.15 " "$15,183.86 " N/A N/A N/A N/A N/A N/A N/A "$54,014.56 " "$43,666.90 " "$43,666.90 " "$43,666.90 " "$43,666.90 " "$26,315.18 " "$15,323.16 " "$13,930.15 " "$28,380.71 " N/A N/A N/A N/A "$13,930.15 " "$13,790.85 " "$95,640.53 " 330104 300 PERIPHERAL VASCULAR DISORDERS WITH CC I N/A N/A "$9,463.95 " N/A "$15,654.16 " "$16,472.85 " "$15,004.57 " "$9,369.31 " N/A "$17,981.50 " N/A "$9,463.95 " "$31,185.62 " "$10,410.34 " "$38,485.60 " "$31,850.68 " N/A N/A N/A "$64,118.95 " "$44,469.28 " "$60,306.98 " N/A "$9,747.87 " "$11,735.29 " N/A N/A N/A N/A N/A "$13,249.53 " N/A "$9,463.95 " "$9,463.95 " "$10,315.70 " N/A N/A N/A N/A N/A N/A N/A "$36,212.23 " "$29,274.99 " "$29,274.99 " "$29,274.99 " "$29,274.99 " "$17,642.12 " "$10,410.34 " "$9,463.95 " "$19,026.89 " N/A N/A N/A N/A "$9,463.95 " "$9,369.31 " "$64,118.95 " 330104 301 PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC I N/A N/A "$6,689.42 " N/A "$10,873.35 " "$11,442.01 " "$10,422.14 " "$6,622.53 " N/A "$12,709.90 " N/A "$6,689.42 " "$21,661.47 " "$7,358.37 " "$26,732.02 " "$22,123.42 " N/A N/A N/A "$44,536.90 " "$30,888.27 " "$41,889.11 " N/A "$6,890.11 " "$8,294.88 " N/A N/A N/A N/A N/A "$9,365.19 " N/A "$6,689.42 " "$6,689.42 " "$7,291.47 " N/A N/A N/A N/A N/A N/A N/A "$25,152.94 " "$20,334.35 " "$20,334.35 " "$20,334.35 " "$20,334.35 " "$12,254.18 " "$7,358.37 " "$6,689.42 " "$13,216.04 " N/A N/A N/A N/A "$6,689.42 " "$6,622.53 " "$44,536.90 " 330104 302 ATHEROSCLEROSIS WITH MCC I N/A N/A "$11,003.20 " N/A "$18,306.46 " "$19,263.86 " "$17,546.80 " "$10,893.16 " N/A "$20,906.07 " N/A "$11,003.20 " "$36,469.42 " "$12,103.52 " "$45,006.24 " "$37,247.16 " N/A N/A N/A "$74,982.67 " "$52,003.74 " "$70,524.83 " N/A "$11,333.29 " "$13,643.96 " N/A N/A N/A N/A N/A "$15,404.47 " N/A "$11,003.20 " "$11,003.20 " "$11,993.48 " N/A N/A N/A N/A N/A N/A N/A "$42,347.70 " "$34,235.07 " "$34,235.07 " "$34,235.07 " "$34,235.07 " "$20,631.24 " "$12,103.52 " "$11,003.20 " "$22,250.63 " N/A N/A N/A N/A "$11,003.20 " "$10,893.16 " "$74,982.67 " 330104 303 ATHEROSCLEROSIS WITHOUT MCC I N/A N/A "$6,336.11 " N/A "$10,264.55 " "$10,801.37 " "$9,838.61 " "$6,272.75 " N/A "$12,038.61 " N/A "$6,336.11 " "$20,448.64 " "$6,969.72 " "$25,235.30 " "$20,884.73 " N/A N/A N/A "$42,043.28 " "$29,158.84 " "$39,543.74 " N/A "$6,526.19 " "$7,856.78 " N/A N/A N/A N/A N/A "$8,870.55 " N/A "$6,336.11 " "$6,336.11 " "$6,906.36 " N/A N/A N/A N/A N/A N/A N/A "$23,744.63 " "$19,195.83 " "$19,195.83 " "$19,195.83 " "$19,195.83 " "$11,568.07 " "$6,969.72 " "$6,336.11 " "$12,476.07 " N/A N/A N/A N/A "$6,336.11 " "$6,272.75 " "$42,043.28 " 330104 304 HYPERTENSION WITH MCC I N/A N/A "$10,058.68 " N/A "$16,678.95 " "$17,551.23 " "$15,986.83 " "$9,958.09 " N/A "$19,111.49 " N/A "$10,058.68 " "$33,227.16 " "$11,064.54 " "$41,005.03 " "$33,935.75 " N/A N/A N/A "$68,316.44 " "$47,380.42 " "$64,254.92 " N/A "$10,360.44 " "$12,472.76 " N/A N/A N/A N/A N/A "$14,082.15 " N/A "$10,058.68 " "$10,058.68 " "$10,963.96 " N/A N/A N/A N/A N/A N/A N/A "$38,582.83 " "$31,191.45 " "$31,191.45 " "$31,191.45 " "$31,191.45 " "$18,797.05 " "$11,064.54 " "$10,058.68 " "$20,272.47 " N/A N/A N/A N/A "$10,058.68 " "$9,958.09 " "$68,316.44 " 330104 305 HYPERTENSION WITHOUT MCC I N/A N/A "$6,948.46 " N/A "$11,319.70 " "$11,911.71 " "$10,849.97 " "$6,878.98 " N/A "$13,202.08 " N/A "$6,948.46 " "$22,550.67 " "$7,643.31 " "$27,829.37 " "$23,031.58 " N/A N/A N/A "$46,365.14 " "$32,156.24 " "$43,608.65 " N/A "$7,156.91 " "$8,616.09 " N/A N/A N/A N/A N/A "$9,727.85 " N/A "$6,948.46 " "$6,948.46 " "$7,573.82 " N/A N/A N/A N/A N/A N/A N/A "$26,185.47 " "$21,169.08 " "$21,169.08 " "$21,169.08 " "$21,169.08 " "$12,757.22 " "$7,643.31 " "$6,948.46 " "$13,758.56 " N/A N/A N/A N/A "$6,948.46 " "$6,878.98 " "$46,365.14 " 330104 306 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC I N/A N/A "$13,382.11 " N/A "$22,405.60 " "$23,577.38 " "$21,475.84 " "$13,248.29 " N/A "$25,426.02 " N/A "$13,382.11 " "$44,635.57 " "$14,720.33 " "$55,083.94 " "$45,587.46 " N/A N/A N/A "$91,772.62 " "$63,648.30 " "$86,316.59 " N/A "$13,783.58 " "$16,593.82 " N/A N/A N/A N/A N/A "$18,734.96 " N/A "$13,382.11 " "$13,382.11 " "$14,586.51 " N/A N/A N/A N/A N/A N/A N/A "$51,830.10 " "$41,900.91 " "$41,900.91 " "$41,900.91 " "$41,900.91 " "$25,250.94 " "$14,720.33 " "$13,382.11 " "$27,232.94 " N/A N/A N/A N/A "$13,382.11 " "$13,248.29 " "$91,772.62 " 330104 307 CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC I N/A N/A "$8,409.29 " N/A "$13,836.87 " "$14,560.53 " "$13,262.69 " "$8,325.20 " N/A "$15,977.66 " N/A "$8,409.29 " "$27,565.29 " "$9,250.22 " "$34,017.82 " "$28,153.15 " N/A N/A N/A "$56,675.41 " "$39,306.86 " "$53,305.96 " N/A "$8,661.57 " "$10,427.52 " N/A N/A N/A N/A N/A "$11,773.01 " N/A "$8,409.29 " "$8,409.29 " "$9,166.13 " N/A N/A N/A N/A N/A N/A N/A "$32,008.37 " "$25,876.47 " "$25,876.47 " "$25,876.47 " "$25,876.47 " "$15,594.05 " "$9,250.22 " "$8,409.29 " "$16,818.06 " N/A N/A N/A N/A "$8,409.29 " "$8,325.20 " "$56,675.41 " 330104 308 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC I N/A N/A "$10,710.68 " N/A "$17,802.41 " "$18,733.46 " "$17,063.68 " "$10,603.57 " N/A "$20,350.29 " N/A "$10,710.68 " "$35,465.29 " "$11,781.74 " "$43,767.06 " "$36,221.61 " N/A N/A N/A "$72,918.13 " "$50,571.89 " "$68,583.03 " N/A "$11,032.00 " "$13,281.24 " N/A N/A N/A N/A N/A "$14,994.95 " N/A "$10,710.68 " "$10,710.68 " "$11,674.64 " N/A N/A N/A N/A N/A N/A N/A "$41,181.71 " "$33,292.46 " "$33,292.46 " "$33,292.46 " "$33,292.46 " "$20,063.19 " "$11,781.74 " "$10,710.68 " "$21,637.99 " N/A N/A N/A N/A "$10,710.68 " "$10,603.57 " "$72,918.13 " 330104 309 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC I N/A N/A "$6,877.97 " N/A "$11,198.24 " "$11,783.90 " "$10,733.56 " "$6,809.19 " N/A "$13,068.15 " N/A "$6,877.97 " "$22,308.71 " "$7,565.77 " "$27,530.77 " "$22,784.46 " N/A N/A N/A "$45,867.66 " "$31,811.21 " "$43,140.75 " N/A "$7,084.31 " "$8,528.69 " N/A N/A N/A N/A N/A "$9,629.16 " N/A "$6,877.97 " "$6,877.97 " "$7,496.99 " N/A N/A N/A N/A N/A N/A N/A "$25,904.51 " "$20,941.94 " "$20,941.94 " "$20,941.94 " "$20,941.94 " "$12,620.34 " "$7,565.77 " "$6,877.97 " "$13,610.93 " N/A N/A N/A N/A "$6,877.97 " "$6,809.19 " "$45,867.66 " 330104 310 CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC I N/A N/A "$5,235.64 " N/A "$8,368.32 " "$8,805.97 " "$8,021.06 " "$5,183.28 " N/A "$9,947.71 " N/A "$5,235.64 " "$16,671.04 " "$5,759.20 " "$20,573.43 " "$17,026.57 " N/A N/A N/A "$34,276.37 " "$23,772.15 " "$32,238.59 " N/A "$5,392.71 " "$6,492.19 " N/A N/A N/A N/A N/A "$7,329.89 " N/A "$5,235.64 " "$5,235.64 " "$5,706.85 " N/A N/A N/A N/A N/A N/A N/A "$19,358.14 " "$15,649.67 " "$15,649.67 " "$15,649.67 " "$15,649.67 " "$9,431.03 " "$5,759.20 " "$5,235.64 " "$10,171.29 " N/A N/A N/A N/A "$5,235.64 " "$5,183.28 " "$34,276.37 " 330104 311 ANGINA PECTORIS I N/A N/A "$6,265.62 " N/A "$10,143.09 " "$10,673.57 " "$9,722.19 " "$6,202.97 " N/A "$11,904.68 " N/A "$6,265.62 " "$20,206.68 " "$6,892.19 " "$24,936.70 " "$20,637.61 " N/A N/A N/A "$41,545.80 " "$28,813.82 " "$39,075.83 " N/A "$6,453.59 " "$7,769.37 " N/A N/A N/A N/A N/A "$8,771.87 " N/A "$6,265.62 " "$6,265.62 " "$6,829.53 " N/A N/A N/A N/A N/A N/A N/A "$23,463.67 " "$18,968.70 " "$18,968.70 " "$18,968.70 " "$18,968.70 " "$11,431.19 " "$6,892.19 " "$6,265.62 " "$12,328.45 " N/A N/A N/A N/A "$6,265.62 " "$6,202.97 " "$41,545.80 " 330104 312 SYNCOPE AND COLLAPSE I N/A N/A "$7,892.10 " N/A "$12,945.69 " "$13,622.74 " "$12,408.49 " "$7,813.18 " N/A "$14,994.99 " N/A "$7,892.10 " "$25,789.91 " "$8,681.31 " "$31,826.86 " "$26,339.90 " N/A N/A N/A "$53,025.15 " "$36,775.25 " "$49,872.72 " N/A "$8,128.86 " "$9,786.20 " N/A N/A N/A N/A N/A "$11,048.94 " N/A "$7,892.10 " "$7,892.10 " "$8,602.39 " N/A N/A N/A N/A N/A N/A N/A "$29,946.82 " "$24,209.86 " "$24,209.86 " "$24,209.86 " "$24,209.86 " "$14,589.70 " "$8,681.31 " "$7,892.10 " "$15,734.87 " N/A N/A N/A N/A "$7,892.10 " "$7,813.18 " "$53,025.15 " 330104 313 CHEST PAIN I N/A N/A "$6,752.86 " N/A "$10,982.66 " "$11,557.04 " "$10,526.92 " "$6,685.33 " N/A "$12,830.44 " N/A "$6,752.86 " "$21,879.23 " "$7,428.15 " "$27,000.76 " "$22,345.83 " N/A N/A N/A "$44,984.63 " "$31,198.80 " "$42,310.22 " N/A "$6,955.45 " "$8,373.55 " N/A N/A N/A N/A N/A "$9,454.01 " N/A "$6,752.86 " "$6,752.86 " "$7,360.62 " N/A N/A N/A N/A N/A N/A N/A "$25,405.81 " "$20,538.77 " "$20,538.77 " "$20,538.77 " "$20,538.77 " "$12,377.37 " "$7,428.15 " "$6,752.86 " "$13,348.90 " N/A N/A N/A N/A "$6,752.86 " "$6,685.33 " "$44,984.63 " 330104 314 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC I N/A N/A "$18,728.52 " N/A "$31,618.03 " "$33,271.62 " "$30,306.00 " "$18,541.23 " N/A "$35,584.18 " N/A "$18,728.52 " "$62,988.24 " "$20,601.37 " "$77,732.63 " "$64,331.51 " N/A N/A N/A "$129,506.48 " "$89,818.37 " "$121,807.11 " N/A "$19,290.37 " "$23,223.36 " N/A N/A N/A N/A N/A "$26,219.92 " N/A "$18,728.52 " "$18,728.52 " "$20,414.08 " N/A N/A N/A N/A N/A N/A N/A "$73,140.91 " "$59,129.18 " "$59,129.18 " "$59,129.18 " "$59,129.18 " "$35,633.29 " "$20,601.37 " "$18,728.52 " "$38,430.22 " N/A N/A N/A N/A "$18,728.52 " "$18,541.23 " "$129,506.48 " 330104 315 OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC I N/A N/A "$8,912.39 " N/A "$14,703.77 " "$15,472.76 " "$14,093.61 " "$8,823.27 " N/A "$16,933.54 " N/A "$8,912.39 " "$29,292.28 " "$9,803.63 " "$36,149.07 " "$29,916.97 " N/A N/A N/A "$60,226.17 " "$41,769.47 " "$56,645.63 " N/A "$9,179.76 " "$11,051.36 " N/A N/A N/A N/A N/A "$12,477.35 " N/A "$8,912.39 " "$8,912.39 " "$9,714.51 " N/A N/A N/A N/A N/A N/A N/A "$34,013.72 " "$27,497.65 " "$27,497.65 " "$27,497.65 " "$27,497.65 " "$16,571.03 " "$9,803.63 " "$8,912.39 " "$17,871.73 " N/A N/A N/A N/A "$8,912.39 " "$8,823.27 " "$60,226.17 " 330104 316 OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC I N/A N/A "$6,388.09 " N/A "$10,354.12 " "$10,895.63 " "$9,924.46 " "$6,324.21 " N/A "$12,137.38 " N/A "$6,388.09 " "$20,627.09 " "$7,026.90 " "$25,455.51 " "$21,066.98 " N/A N/A N/A "$42,410.17 " "$29,413.30 " "$39,888.82 " N/A "$6,579.74 " "$7,921.24 " N/A N/A N/A N/A N/A "$8,943.33 " N/A "$6,388.09 " "$6,388.09 " "$6,963.02 " N/A N/A N/A N/A N/A N/A N/A "$23,951.84 " "$19,363.34 " "$19,363.34 " "$19,363.34 " "$19,363.34 " "$11,669.02 " "$7,026.90 " "$6,388.09 " "$12,584.95 " N/A N/A N/A N/A "$6,388.09 " "$6,324.21 " "$42,410.17 " 330104 319 OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC I N/A N/A "$38,323.76 " N/A "$65,382.80 " "$68,802.24 " "$62,669.64 " "$37,940.52 " N/A "$72,815.14 " N/A "$38,323.76 " "$130,253.12 " "$42,156.13 " "$160,742.98 " "$133,030.87 " N/A N/A N/A "$267,805.92 " "$185,735.04 " "$251,884.42 " N/A "$39,473.47 " "$47,521.46 " N/A N/A N/A N/A N/A "$53,653.26 " N/A "$38,323.76 " "$38,323.76 " "$41,772.90 " N/A N/A N/A N/A N/A N/A N/A "$151,247.79 " "$122,272.99 " "$122,272.99 " "$122,272.99 " "$122,272.99 " "$73,685.93 " "$42,156.13 " "$38,323.76 " "$79,469.69 " N/A N/A N/A N/A "$38,323.76 " "$37,940.52 " "$267,805.92 " 330104 320 OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC I N/A N/A "$22,154.16 " N/A "$37,520.79 " "$39,483.09 " "$35,963.81 " "$21,932.62 " N/A "$42,092.90 " N/A "$22,154.16 " "$74,747.49 " "$24,369.57 " "$92,244.51 " "$76,341.55 " N/A N/A N/A "$153,684.01 " "$106,586.54 " "$144,547.24 " N/A "$22,818.78 " "$27,471.16 " N/A N/A N/A N/A N/A "$31,015.82 " N/A "$22,154.16 " "$22,154.16 " "$24,148.03 " N/A N/A N/A N/A N/A N/A N/A "$86,795.57 " "$70,167.99 " "$70,167.99 " "$70,167.99 " "$70,167.99 " "$42,285.65 " "$24,369.57 " "$22,154.16 " "$45,604.74 " N/A N/A N/A N/A "$22,154.16 " "$21,932.62 " "$153,684.01 " 330104 326 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC" I N/A N/A "$45,479.90 " N/A "$77,713.62 " "$81,777.95 " "$74,488.78 " "$45,025.10 " N/A "$86,411.81 " N/A "$45,479.90 " "$154,818.11 " "$50,027.89 " "$191,058.19 " "$158,119.73 " N/A N/A N/A "$318,312.58 " "$220,763.61 " "$299,388.37 " N/A "$46,844.30 " "$56,395.08 " N/A N/A N/A N/A N/A "$63,671.86 " N/A "$45,479.90 " "$45,479.90 " "$49,573.09 " N/A N/A N/A N/A N/A N/A N/A "$179,772.26 " "$145,332.97 " "$145,332.97 " "$145,332.97 " "$145,332.97 " "$87,582.67 " "$50,027.89 " "$45,479.90 " "$94,457.22 " N/A N/A N/A N/A "$45,479.90 " "$45,025.10 " "$318,312.58 " 330104 327 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC" I N/A N/A "$22,946.25 " N/A "$38,885.66 " "$40,919.33 " "$37,272.04 " "$22,716.79 " N/A "$43,597.88 " N/A "$22,946.25 " "$77,466.52 " "$25,240.88 " "$95,600.01 " "$79,118.56 " N/A N/A N/A "$159,274.44 " "$110,463.75 " "$149,805.31 " N/A "$23,634.64 " "$28,453.35 " N/A N/A N/A N/A N/A "$32,124.75 " N/A "$22,946.25 " "$22,946.25 " "$25,011.41 " N/A N/A N/A N/A N/A N/A N/A "$89,952.86 " "$72,720.43 " "$72,720.43 " "$72,720.43 " "$72,720.43 " "$43,823.84 " "$25,240.88 " "$22,946.25 " "$47,263.67 " N/A N/A N/A N/A "$22,946.25 " "$22,716.79 " "$159,274.44 " 330104 328 "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC" I N/A N/A "$14,984.80 " N/A "$25,167.20 " "$26,483.42 " "$24,122.85 " "$14,834.95 " N/A "$28,471.12 " N/A "$14,984.80 " "$50,137.14 " "$16,483.28 " "$61,873.32 " "$51,206.35 " N/A N/A N/A "$103,084.07 " "$71,493.29 " "$96,955.56 " N/A "$15,434.35 " "$18,581.15 " N/A N/A N/A N/A N/A "$20,978.72 " N/A "$14,984.80 " "$14,984.80 " "$16,333.43 " N/A N/A N/A N/A N/A N/A N/A "$58,218.42 " "$47,065.42 " "$47,065.42 " "$47,065.42 " "$47,065.42 " "$28,363.25 " "$16,483.28 " "$14,984.80 " "$30,589.54 " N/A N/A N/A N/A "$14,984.80 " "$14,834.95 " "$103,084.07 " 330104 329 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC I N/A N/A "$41,114.14 " N/A "$70,190.94 " "$73,861.84 " "$67,278.26 " "$40,703.00 " N/A "$78,116.87 " N/A "$41,114.14 " "$139,831.71 " "$45,225.56 " "$172,563.75 " "$142,813.74 " N/A N/A N/A "$287,499.91 " "$199,393.68 " "$270,407.57 " N/A "$42,347.57 " "$50,981.54 " N/A N/A N/A N/A N/A "$57,559.80 " N/A "$41,114.14 " "$41,114.14 " "$44,814.42 " N/A N/A N/A N/A N/A N/A N/A "$162,370.30 " "$131,264.73 " "$131,264.73 " "$131,264.73 " "$131,264.73 " "$79,104.66 " "$45,225.56 " "$41,114.14 " "$85,313.75 " N/A N/A N/A N/A "$41,114.14 " "$40,703.00 " "$287,499.91 " 330104 330 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC I N/A N/A "$22,013.19 " N/A "$37,277.88 " "$39,227.47 " "$35,730.98 " "$21,793.05 " N/A "$41,825.05 " N/A "$22,013.19 " "$74,263.57 " "$24,214.50 " "$91,647.31 " "$75,847.31 " N/A N/A N/A "$152,689.05 " "$105,896.49 " "$143,611.44 " N/A "$22,673.58 " "$27,296.35 " N/A N/A N/A N/A N/A "$30,818.46 " N/A "$22,013.19 " "$22,013.19 " "$23,994.37 " N/A N/A N/A N/A N/A N/A N/A "$86,233.65 " "$69,713.72 " "$69,713.72 " "$69,713.72 " "$69,713.72 " "$42,011.89 " "$24,214.50 " "$22,013.19 " "$45,309.50 " N/A N/A N/A N/A "$22,013.19 " "$21,793.05 " "$152,689.05 " 330104 331 MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC I N/A N/A "$15,435.03 " N/A "$25,943.00 " "$27,299.79 " "$24,866.46 " "$15,280.68 " N/A "$29,326.56 " N/A "$15,435.03 " "$51,682.66 " "$16,978.54 " "$63,780.62 " "$52,784.83 " N/A N/A N/A "$106,261.73 " "$73,697.13 " "$99,944.29 " N/A "$15,898.08 " "$19,139.44 " N/A N/A N/A N/A N/A "$21,609.05 " N/A "$15,435.03 " "$15,435.03 " "$16,824.19 " N/A N/A N/A N/A N/A N/A N/A "$60,013.06 " "$48,516.25 " "$48,516.25 " "$48,516.25 " "$48,516.25 " "$29,237.57 " "$16,978.54 " "$15,435.03 " "$31,532.49 " N/A N/A N/A N/A "$15,435.03 " "$15,280.68 " "$106,261.73 " 330104 332 RECTAL RESECTION WITH MCC I N/A N/A "$36,153.66 " N/A "$61,643.47 " "$64,867.35 " "$59,085.49 " "$35,792.12 " N/A "$68,691.95 " N/A "$36,153.66 " "$122,803.77 " "$39,769.02 " "$151,549.89 " "$125,422.67 " N/A N/A N/A "$252,489.76 " "$175,112.62 " "$237,478.83 " N/A "$37,238.27 " "$44,830.53 " N/A N/A N/A N/A N/A "$50,615.12 " N/A "$36,153.66 " "$36,153.66 " "$39,407.49 " N/A N/A N/A N/A N/A N/A N/A "$142,597.74 " "$115,280.04 " "$115,280.04 " "$115,280.04 " "$115,280.04 " "$69,471.73 " "$39,769.02 " "$36,153.66 " "$74,924.72 " N/A N/A N/A N/A "$36,153.66 " "$35,792.12 " "$252,489.76 " 330104 333 RECTAL RESECTION WITH CC I N/A N/A "$20,054.54 " N/A "$33,902.92 " "$35,676.01 " "$32,496.07 " "$19,854.00 " N/A "$38,103.63 " N/A "$20,054.54 " "$67,540.11 " "$22,060.00 " "$83,350.01 " "$68,980.46 " N/A N/A N/A "$138,865.32 " "$96,309.14 " "$130,609.55 " N/A "$20,656.18 " "$24,867.63 " N/A N/A N/A N/A N/A "$28,076.36 " N/A "$20,054.54 " "$20,054.54 " "$21,859.45 " N/A N/A N/A N/A N/A N/A N/A "$78,426.47 " "$63,402.18 " "$63,402.18 " "$63,402.18 " "$63,402.18 " "$38,208.34 " "$22,060.00 " "$20,054.54 " "$41,207.39 " N/A N/A N/A N/A "$20,054.54 " "$19,854.00 " "$138,865.32 " 330104 334 RECTAL RESECTION WITHOUT CC/MCC I N/A N/A "$15,485.26 " N/A "$26,029.54 " "$27,390.85 " "$24,949.40 " "$15,330.40 " N/A "$29,421.99 " N/A "$15,485.26 " "$51,855.05 " "$17,033.78 " "$63,993.37 " "$52,960.90 " N/A N/A N/A "$106,616.18 " "$73,942.96 " "$100,277.68 " N/A "$15,949.81 " "$19,201.72 " N/A N/A N/A N/A N/A "$21,679.36 " N/A "$15,485.26 " "$15,485.26 " "$16,878.93 " N/A N/A N/A N/A N/A N/A N/A "$60,213.24 " "$48,678.08 " "$48,678.08 " "$48,678.08 " "$48,678.08 " "$29,335.09 " "$17,033.78 " "$15,485.26 " "$31,637.67 " N/A N/A N/A N/A "$15,485.26 " "$15,330.40 " "$106,616.18 " 330104 335 PERITONEAL ADHESIOLYSIS WITH MCC I N/A N/A "$32,836.39 " N/A "$55,927.45 " "$58,852.39 " "$53,606.66 " "$32,508.02 " N/A "$62,389.13 " N/A "$32,836.39 " "$111,416.53 " "$36,120.02 " "$137,497.10 " "$113,792.58 " N/A N/A N/A "$229,077.10 " "$158,874.93 " "$215,458.09 " N/A "$33,821.48 " "$40,717.12 " N/A N/A N/A N/A N/A "$45,970.94 " N/A "$32,836.39 " "$32,836.39 " "$35,791.66 " N/A N/A N/A N/A N/A N/A N/A "$129,375.06 " "$104,590.45 " "$104,590.45 " "$104,590.45 " "$104,590.45 " "$63,029.82 " "$36,120.02 " "$32,836.39 " "$67,977.16 " N/A N/A N/A N/A "$32,836.39 " "$32,508.02 " "$229,077.10 " 330104 336 PERITONEAL ADHESIOLYSIS WITH CC I N/A N/A "$19,119.72 " N/A "$32,292.11 " "$33,980.95 " "$30,952.10 " "$18,928.52 " N/A "$36,327.46 " N/A "$19,119.72 " "$64,331.11 " "$21,031.69 " "$79,389.85 " "$65,703.03 " N/A N/A N/A "$132,267.49 " "$91,733.26 " "$124,403.98 " N/A "$19,693.31 " "$23,708.45 " N/A N/A N/A N/A N/A "$26,767.60 " N/A "$19,119.72 " "$19,119.72 " "$20,840.49 " N/A N/A N/A N/A N/A N/A N/A "$74,700.24 " "$60,389.78 " "$60,389.78 " "$60,389.78 " "$60,389.78 " "$36,392.97 " "$21,031.69 " "$19,119.72 " "$39,249.53 " N/A N/A N/A N/A "$19,119.72 " "$18,928.52 " "$132,267.49 " 330104 337 PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC I N/A N/A "$14,260.55 " N/A "$23,919.24 " "$25,170.19 " "$22,926.68 " "$14,117.95 " N/A "$27,095.05 " N/A "$14,260.55 " "$47,651.00 " "$15,686.61 " "$58,805.22 " "$48,667.19 " N/A N/A N/A "$97,972.47 " "$67,948.16 " "$92,147.84 " N/A "$14,688.37 " "$17,683.09 " N/A N/A N/A N/A N/A "$19,964.77 " N/A "$14,260.55 " "$14,260.55 " "$15,544.00 " N/A N/A N/A N/A N/A N/A N/A "$55,331.56 " "$44,731.60 " "$44,731.60 " "$44,731.60 " "$44,731.60 " "$26,956.80 " "$15,686.61 " "$14,260.55 " "$29,072.70 " N/A N/A N/A N/A "$14,260.55 " "$14,117.95 " "$97,972.47 " 330104 338 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC I N/A N/A "$23,785.04 " N/A "$40,330.98 " "$42,440.24 " "$38,657.39 " "$23,547.19 " N/A "$45,191.58 " N/A "$23,785.04 " "$80,345.84 " "$26,163.54 " "$99,153.33 " "$82,059.28 " N/A N/A N/A "$165,194.45 " "$114,569.53 " "$155,373.37 " N/A "$24,498.59 " "$29,493.45 " N/A N/A N/A N/A N/A "$33,299.06 " N/A "$23,785.04 " "$23,785.04 " "$25,925.69 " N/A N/A N/A N/A N/A N/A N/A "$93,296.28 " "$75,423.35 " "$75,423.35 " "$75,423.35 " "$75,423.35 " "$45,452.71 " "$26,163.54 " "$23,785.04 " "$49,020.39 " N/A N/A N/A N/A "$23,785.04 " "$23,547.19 " "$165,194.45 " 330104 339 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC I N/A N/A "$14,726.64 " N/A "$24,722.37 " "$26,015.32 " "$23,696.48 " "$14,579.38 " N/A "$27,980.63 " N/A "$14,726.64 " "$49,250.96 " "$16,199.31 " "$60,779.70 " "$50,301.28 " N/A N/A N/A "$101,262.05 " "$70,229.64 " "$95,241.86 " N/A "$15,168.44 " "$18,261.04 " N/A N/A N/A N/A N/A "$20,617.30 " N/A "$14,726.64 " "$14,726.64 " "$16,052.04 " N/A N/A N/A N/A N/A N/A N/A "$57,189.41 " "$46,233.53 " "$46,233.53 " "$46,233.53 " "$46,233.53 " "$27,861.92 " "$16,199.31 " "$14,726.64 " "$30,048.87 " N/A N/A N/A N/A "$14,726.64 " "$14,579.38 " "$101,262.05 " 330104 340 APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC I N/A N/A "$10,951.21 " N/A "$18,216.88 " "$19,169.60 " "$17,460.94 " "$10,841.70 " N/A "$20,807.30 " N/A "$10,951.21 " "$36,290.98 " "$12,046.33 " "$44,786.03 " "$37,064.91 " N/A N/A N/A "$74,615.78 " "$51,749.29 " "$70,179.75 " N/A "$11,279.75 " "$13,579.50 " N/A N/A N/A N/A N/A "$15,331.70 " N/A "$10,951.21 " "$10,951.21 " "$11,936.82 " N/A N/A N/A N/A N/A N/A N/A "$42,140.49 " "$34,067.56 " "$34,067.56 " "$34,067.56 " "$34,067.56 " "$20,530.29 " "$12,046.33 " "$10,951.21 " "$22,141.75 " N/A N/A N/A N/A "$10,951.21 " "$10,841.70 " "$74,615.78 " 330104 341 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH MCC I N/A N/A "$20,282.74 " N/A "$34,296.14 " "$36,089.78 " "$32,872.97 " "$20,079.91 " N/A "$38,537.21 " N/A "$20,282.74 " "$68,323.46 " "$22,311.02 " "$84,316.72 " "$69,780.51 " N/A N/A N/A "$140,475.91 " "$97,426.15 " "$132,124.39 " N/A "$20,891.22 " "$25,150.60 " N/A N/A N/A N/A N/A "$28,395.84 " N/A "$20,282.74 " "$20,282.74 " "$22,108.19 " N/A N/A N/A N/A N/A N/A N/A "$79,336.08 " "$64,137.53 " "$64,137.53 " "$64,137.53 " "$64,137.53 " "$38,651.49 " "$22,311.02 " "$20,282.74 " "$41,685.33 " N/A N/A N/A N/A "$20,282.74 " "$20,079.91 " "$140,475.91 " 330104 342 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC I N/A N/A "$13,182.99 " N/A "$22,062.48 " "$23,216.32 " "$21,146.97 " "$13,051.16 " N/A "$25,047.68 " N/A "$13,182.99 " "$43,952.03 " "$14,501.29 " "$54,240.40 " "$44,889.35 " N/A N/A N/A "$90,367.24 " "$62,673.61 " "$84,994.76 " N/A "$13,578.48 " "$16,346.91 " N/A N/A N/A N/A N/A "$18,456.19 " N/A "$13,182.99 " "$13,182.99 " "$14,369.46 " N/A N/A N/A N/A N/A N/A N/A "$51,036.38 " "$41,259.25 " "$41,259.25 " "$41,259.25 " "$41,259.25 " "$24,864.25 " "$14,501.29 " "$13,182.99 " "$26,815.90 " N/A N/A N/A N/A "$13,182.99 " "$13,051.16 " "$90,367.24 " 330104 343 APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC I N/A N/A "$10,006.69 " N/A "$16,589.37 " "$17,456.98 " "$15,900.97 " "$9,906.63 " N/A "$19,012.72 " N/A "$10,006.69 " "$33,048.71 " "$11,007.36 " "$40,784.81 " "$33,753.50 " N/A N/A N/A "$67,949.55 " "$47,125.97 " "$63,909.84 " N/A "$10,306.89 " "$12,408.30 " N/A N/A N/A N/A N/A "$14,009.37 " N/A "$10,006.69 " "$10,006.69 " "$10,907.30 " N/A N/A N/A N/A N/A N/A N/A "$38,375.62 " "$31,023.94 " "$31,023.94 " "$31,023.94 " "$31,023.94 " "$18,696.10 " "$11,007.36 " "$10,006.69 " "$20,163.59 " N/A N/A N/A N/A "$10,006.69 " "$9,906.63 " "$67,949.55 " 330104 344 MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC I N/A N/A "$23,573.58 " N/A "$39,966.61 " "$42,056.82 " "$38,308.14 " "$23,337.84 " N/A "$44,789.80 " N/A "$23,573.58 " "$79,619.96 " "$25,930.94 " "$98,257.54 " "$81,317.92 " N/A N/A N/A "$163,702.01 " "$113,534.46 " "$153,969.66 " N/A "$24,280.79 " "$29,231.24 " N/A N/A N/A N/A N/A "$33,003.01 " N/A "$23,573.58 " "$23,573.58 " "$25,695.20 " N/A N/A N/A N/A N/A N/A N/A "$92,453.40 " "$74,741.94 " "$74,741.94 " "$74,741.94 " "$74,741.94 " "$45,042.07 " "$25,930.94 " "$23,573.58 " "$48,577.52 " N/A N/A N/A N/A "$23,573.58 " "$23,337.84 " "$163,702.01 " 330104 345 MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC I N/A N/A "$14,049.09 " N/A "$23,554.87 " "$24,786.76 " "$22,577.43 " "$13,908.60 " N/A "$26,693.28 " N/A "$14,049.09 " "$46,925.12 " "$15,454.00 " "$57,909.43 " "$47,925.84 " N/A N/A N/A "$96,480.03 " "$66,913.09 " "$90,744.13 " N/A "$14,470.57 " "$17,420.88 " N/A N/A N/A N/A N/A "$19,668.73 " N/A "$14,049.09 " "$14,049.09 " "$15,313.51 " N/A N/A N/A N/A N/A N/A N/A "$54,488.68 " "$44,050.19 " "$44,050.19 " "$44,050.19 " "$44,050.19 " "$26,546.17 " "$15,454.00 " "$14,049.09 " "$28,629.83 " N/A N/A N/A N/A "$14,049.09 " "$13,908.60 " "$96,480.03 " 330104 346 MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC I N/A N/A "$11,398.80 " N/A "$18,988.13 " "$19,981.18 " "$18,200.19 " "$11,284.81 " N/A "$21,657.72 " N/A "$11,398.80 " "$37,827.42 " "$12,538.68 " "$46,682.13 " "$38,634.12 " N/A N/A N/A "$77,774.78 " "$53,940.19 " "$73,150.94 " N/A "$11,740.77 " "$14,134.51 " N/A N/A N/A N/A N/A "$15,958.32 " N/A "$11,398.80 " "$11,398.80 " "$12,424.69 " N/A N/A N/A N/A N/A N/A N/A "$43,924.58 " "$35,509.87 " "$35,509.87 " "$35,509.87 " "$35,509.87 " "$21,399.48 " "$12,538.68 " "$11,398.80 " "$23,079.17 " N/A N/A N/A N/A "$11,398.80 " "$11,284.81 " "$77,774.78 " 330104 347 ANAL AND STOMAL PROCEDURES WITH MCC I N/A N/A "$22,742.72 " N/A "$38,534.95 " "$40,550.28 " "$36,935.89 " "$22,515.29 " N/A "$43,211.17 " N/A "$22,742.72 " "$76,767.86 " "$25,016.99 " "$94,737.81 " "$78,405.00 " N/A N/A N/A "$157,837.97 " "$109,467.49 " "$148,454.24 " N/A "$23,425.00 " "$28,200.97 " N/A N/A N/A N/A N/A "$31,839.81 " N/A "$22,742.72 " "$22,742.72 " "$24,789.57 " N/A N/A N/A N/A N/A N/A N/A "$89,141.58 " "$72,064.57 " "$72,064.57 " "$72,064.57 " "$72,064.57 " "$43,428.60 " "$25,016.99 " "$22,742.72 " "$46,837.40 " N/A N/A N/A N/A "$22,742.72 " "$22,515.29 " "$157,837.97 " 330104 348 ANAL AND STOMAL PROCEDURES WITH CC I N/A N/A "$12,546.85 " N/A "$20,966.34 " "$22,062.86 " "$20,096.31 " "$12,421.38 " N/A "$23,839.02 " N/A "$12,546.85 " "$41,768.35 " "$13,801.54 " "$51,545.55 " "$42,659.09 " N/A N/A N/A "$85,877.49 " "$59,559.77 " "$80,771.93 " N/A "$12,923.26 " "$15,558.09 " N/A N/A N/A N/A N/A "$17,565.59 " N/A "$12,546.85 " "$12,546.85 " "$13,676.07 " N/A N/A N/A N/A N/A N/A N/A "$48,500.72 " "$39,209.35 " "$39,209.35 " "$39,209.35 " "$39,209.35 " "$23,628.91 " "$13,801.54 " "$12,546.85 " "$25,483.59 " N/A N/A N/A N/A "$12,546.85 " "$12,421.38 " "$85,877.49 " 330104 349 ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC I N/A N/A "$9,165.26 " N/A "$15,139.49 " "$15,931.27 " "$14,511.25 " "$9,073.61 " N/A "$17,414.00 " N/A "$9,165.26 " "$30,160.31 " "$10,081.79 " "$37,220.29 " "$30,803.51 " N/A N/A N/A "$62,010.88 " "$43,007.24 " "$58,324.23 " N/A "$9,440.22 " "$11,364.92 " N/A N/A N/A N/A N/A "$12,831.37 " N/A "$9,165.26 " "$9,165.26 " "$9,990.13 " N/A N/A N/A N/A N/A N/A N/A "$35,021.66 " "$28,312.50 " "$28,312.50 " "$28,312.50 " "$28,312.50 " "$17,062.09 " "$10,081.79 " "$9,165.26 " "$18,401.33 " N/A N/A N/A N/A "$9,165.26 " "$9,073.61 " "$62,010.88 " 330104 350 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC I N/A N/A "$21,146.20 " N/A "$35,783.97 " "$37,655.43 " "$34,299.06 " "$20,934.74 " N/A "$40,177.78 " N/A "$21,146.20 " "$71,287.46 " "$23,260.82 " "$87,974.55 " "$72,807.73 " N/A N/A N/A "$146,570.04 " "$101,652.70 " "$137,856.22 " N/A "$21,780.59 " "$26,221.29 " N/A N/A N/A N/A N/A "$29,604.68 " N/A "$21,146.20 " "$21,146.20 " "$23,049.36 " N/A N/A N/A N/A N/A N/A N/A "$82,777.84 " "$66,919.94 " "$66,919.94 " "$66,919.94 " "$66,919.94 " "$40,328.27 " "$23,260.82 " "$21,146.20 " "$43,493.72 " N/A N/A N/A N/A "$21,146.20 " "$20,934.74 " "$146,570.04 " 330104 351 INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC I N/A N/A "$13,332.77 " N/A "$22,320.58 " "$23,487.92 " "$21,394.35 " "$13,199.45 " N/A "$25,332.27 " N/A "$13,332.77 " "$44,466.20 " "$14,666.05 " "$54,874.92 " "$45,414.48 " N/A N/A N/A "$91,424.39 " "$63,406.79 " "$85,989.06 " N/A "$13,732.76 " "$16,532.64 " N/A N/A N/A N/A N/A "$18,665.88 " N/A "$13,332.77 " "$13,332.77 " "$14,532.72 " N/A N/A N/A N/A N/A N/A N/A "$51,633.42 " "$41,741.92 " "$41,741.92 " "$41,741.92 " "$41,741.92 " "$25,155.12 " "$14,666.05 " "$13,332.77 " "$27,129.60 " N/A N/A N/A N/A "$13,332.77 " "$13,199.45 " "$91,424.39 " 330104 352 INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC I N/A N/A "$10,089.51 " N/A "$16,732.08 " "$17,607.15 " "$16,037.76 " "$9,988.62 " N/A "$19,170.08 " N/A "$10,089.51 " "$33,333.01 " "$11,098.47 " "$41,135.66 " "$34,043.87 " N/A N/A N/A "$68,534.09 " "$47,531.37 " "$64,459.62 " N/A "$10,392.20 " "$12,511.00 " N/A N/A N/A N/A N/A "$14,125.32 " N/A "$10,089.51 " "$10,089.51 " "$10,997.57 " N/A N/A N/A N/A N/A N/A N/A "$38,705.75 " "$31,290.82 " "$31,290.82 " "$31,290.82 " "$31,290.82 " "$18,856.93 " "$11,098.47 " "$10,089.51 " "$20,337.05 " N/A N/A N/A N/A "$10,089.51 " "$9,988.62 " "$68,534.09 " 330104 353 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC I N/A N/A "$25,646.76 " N/A "$43,538.94 " "$45,815.97 " "$41,732.23 " "$25,390.30 " N/A "$48,728.85 " N/A "$25,646.76 " "$86,736.61 " "$28,211.44 " "$107,040.06 " "$88,586.34 " N/A N/A N/A "$178,334.14 " "$123,682.48 " "$167,731.89 " N/A "$26,416.17 " "$31,801.99 " N/A N/A N/A N/A N/A "$35,905.47 " N/A "$25,646.76 " "$25,646.76 " "$27,954.97 " N/A N/A N/A N/A N/A N/A N/A "$100,717.14 " "$81,422.58 " "$81,422.58 " "$81,422.58 " "$81,422.58 " "$49,068.06 " "$28,211.44 " "$25,646.76 " "$52,919.51 " N/A N/A N/A N/A "$25,646.76 " "$25,390.30 " "$178,334.14 " 330104 354 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC I N/A N/A "$15,815.66 " N/A "$26,598.86 " "$27,989.95 " "$25,495.10 " "$15,657.50 " N/A "$30,049.76 " N/A "$15,815.66 " "$52,989.24 " "$17,397.23 " "$65,393.05 " "$54,119.28 " N/A N/A N/A "$108,948.12 " "$75,560.26 " "$102,470.98 " N/A "$16,290.13 " "$19,611.42 " N/A N/A N/A N/A N/A "$22,141.93 " N/A "$15,815.66 " "$15,815.66 " "$17,239.07 " N/A N/A N/A N/A N/A N/A N/A "$61,530.24 " "$49,742.78 " "$49,742.78 " "$49,742.78 " "$49,742.78 " "$29,976.72 " "$17,397.23 " "$15,815.66 " "$32,329.66 " N/A N/A N/A N/A "$15,815.66 " "$15,657.50 " "$108,948.12 " 330104 355 HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC I N/A N/A "$12,470.20 " N/A "$20,834.26 " "$21,923.86 " "$19,969.71 " "$12,345.49 " N/A "$23,693.37 " N/A "$12,470.20 " "$41,505.21 " "$13,717.22 " "$51,220.82 " "$42,390.35 " N/A N/A N/A "$85,336.48 " "$59,184.55 " "$80,263.08 " N/A "$12,844.30 " "$15,463.04 " N/A N/A N/A N/A N/A "$17,458.27 " N/A "$12,470.20 " "$12,470.20 " "$13,592.51 " N/A N/A N/A N/A N/A N/A N/A "$48,195.18 " "$38,962.34 " "$38,962.34 " "$38,962.34 " "$38,962.34 " "$23,480.05 " "$13,717.22 " "$12,470.20 " "$25,323.05 " N/A N/A N/A N/A "$12,470.20 " "$12,345.49 " "$85,336.48 " 330104 356 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC I N/A N/A "$37,582.77 " N/A "$64,106.00 " "$67,458.66 " "$61,445.82 " "$37,206.94 " N/A "$71,407.26 " N/A "$37,582.77 " "$127,709.51 " "$41,341.05 " "$157,603.97 " "$130,433.03 " N/A N/A N/A "$262,576.16 " "$182,107.98 " "$246,965.58 " N/A "$38,710.25 " "$46,602.63 " N/A N/A N/A N/A N/A "$52,615.88 " N/A "$37,582.77 " "$37,582.77 " "$40,965.22 " N/A N/A N/A N/A N/A N/A N/A "$148,294.20 " "$119,885.22 " "$119,885.22 " "$119,885.22 " "$119,885.22 " "$72,246.98 " "$41,341.05 " "$37,582.77 " "$77,917.79 " N/A N/A N/A N/A "$37,582.77 " "$37,206.94 " "$262,576.16 " 330104 357 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC I N/A N/A "$20,169.96 " N/A "$34,101.81 " "$35,885.29 " "$32,686.70 " "$19,968.26 " N/A "$38,322.93 " N/A "$20,169.96 " "$67,936.32 " "$22,186.96 " "$83,838.97 " "$69,385.12 " N/A N/A N/A "$139,679.95 " "$96,874.11 " "$131,375.75 " N/A "$20,775.06 " "$25,010.76 " N/A N/A N/A N/A N/A "$28,237.95 " N/A "$20,169.96 " "$20,169.96 " "$21,985.26 " N/A N/A N/A N/A N/A N/A N/A "$78,886.54 " "$63,774.11 " "$63,774.11 " "$63,774.11 " "$63,774.11 " "$38,432.48 " "$22,186.96 " "$20,169.96 " "$41,449.13 " N/A N/A N/A N/A "$20,169.96 " "$19,968.26 " "$139,679.95 " 330104 358 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$12,601.48 " N/A "$21,060.47 " "$22,161.91 " "$20,186.53 " "$12,475.46 " N/A "$23,942.81 " N/A "$12,601.48 " "$41,955.86 " "$13,861.62 " "$51,776.96 " "$42,850.61 " N/A N/A N/A "$86,263.03 " "$59,827.16 " "$81,134.55 " N/A "$12,979.52 " "$15,625.83 " N/A N/A N/A N/A N/A "$17,642.07 " N/A "$12,601.48 " "$12,601.48 " "$13,735.61 " N/A N/A N/A N/A N/A N/A N/A "$48,718.46 " "$39,385.38 " "$39,385.38 " "$39,385.38 " "$39,385.38 " "$23,734.99 " "$13,861.62 " "$12,601.48 " "$25,598.00 " N/A N/A N/A N/A "$12,601.48 " "$12,475.46 " "$86,263.03 " 330104 368 MAJOR ESOPHAGEAL DISORDERS WITH MCC I N/A N/A "$15,835.04 " N/A "$26,632.26 " "$28,025.10 " "$25,527.12 " "$15,676.69 " N/A "$30,086.59 " N/A "$15,835.04 " "$53,055.78 " "$17,418.55 " "$65,475.16 " "$54,187.24 " N/A N/A N/A "$109,084.93 " "$75,655.14 " "$102,599.65 " N/A "$16,310.10 " "$19,635.46 " N/A N/A N/A N/A N/A "$22,169.06 " N/A "$15,835.04 " "$15,835.04 " "$17,260.20 " N/A N/A N/A N/A N/A N/A N/A "$61,607.50 " "$49,805.25 " "$49,805.25 " "$49,805.25 " "$49,805.25 " "$30,014.36 " "$17,418.55 " "$15,835.04 " "$32,370.25 " N/A N/A N/A N/A "$15,835.04 " "$15,676.69 " "$109,084.93 " 330104 369 MAJOR ESOPHAGEAL DISORDERS WITH CC I N/A N/A "$9,384.65 " N/A "$15,517.52 " "$16,329.07 " "$14,873.60 " "$9,290.80 " N/A "$17,830.83 " N/A "$9,384.65 " "$30,913.41 " "$10,323.11 " "$38,149.68 " "$31,572.67 " N/A N/A N/A "$63,559.29 " "$44,081.13 " "$59,780.58 " N/A "$9,666.19 " "$11,636.97 " N/A N/A N/A N/A N/A "$13,138.51 " N/A "$9,384.65 " "$9,384.65 " "$10,229.27 " N/A N/A N/A N/A N/A N/A N/A "$35,896.15 " "$29,019.46 " "$29,019.46 " "$29,019.46 " "$29,019.46 " "$17,488.13 " "$10,323.11 " "$9,384.65 " "$18,860.81 " N/A N/A N/A N/A "$9,384.65 " "$9,290.80 " "$63,559.29 " 330104 370 MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC I N/A N/A "$6,975.77 " N/A "$11,366.76 " "$11,961.23 " "$10,895.08 " "$6,906.02 " N/A "$13,253.97 " N/A "$6,975.77 " "$22,644.43 " "$7,673.35 " "$27,945.08 " "$23,127.34 " N/A N/A N/A "$46,557.91 " "$32,289.93 " "$43,789.97 " N/A "$7,185.05 " "$8,649.96 " N/A N/A N/A N/A N/A "$9,766.08 " N/A "$6,975.77 " "$6,975.77 " "$7,603.59 " N/A N/A N/A N/A N/A N/A N/A "$26,294.34 " "$21,257.09 " "$21,257.09 " "$21,257.09 " "$21,257.09 " "$12,810.26 " "$7,673.35 " "$6,975.77 " "$13,815.76 " N/A N/A N/A N/A "$6,975.77 " "$6,906.02 " "$46,557.91 " 330104 371 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC I N/A N/A "$15,285.25 " N/A "$25,684.91 " "$27,028.20 " "$24,619.07 " "$15,132.40 " N/A "$29,041.98 " N/A "$15,285.25 " "$51,168.49 " "$16,813.78 " "$63,146.10 " "$52,259.70 " N/A N/A N/A "$105,204.58 " "$72,963.95 " "$98,950.00 " N/A "$15,743.81 " "$18,953.71 " N/A N/A N/A N/A N/A "$21,399.35 " N/A "$15,285.25 " "$15,285.25 " "$16,660.92 " N/A N/A N/A N/A N/A N/A N/A "$59,416.02 " "$48,033.59 " "$48,033.59 " "$48,033.59 " "$48,033.59 " "$28,946.70 " "$16,813.78 " "$15,285.25 " "$31,218.79 " N/A N/A N/A N/A "$15,285.25 " "$15,132.40 " "$105,204.58 " 330104 372 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC I N/A N/A "$9,348.53 " N/A "$15,455.28 " "$16,263.57 " "$14,813.94 " "$9,255.04 " N/A "$17,762.20 " N/A "$9,348.53 " "$30,789.41 " "$10,283.38 " "$37,996.65 " "$31,446.02 " N/A N/A N/A "$63,304.33 " "$43,904.30 " "$59,540.78 " N/A "$9,628.98 " "$11,592.17 " N/A N/A N/A N/A N/A "$13,087.94 " N/A "$9,348.53 " "$9,348.53 " "$10,189.89 " N/A N/A N/A N/A N/A N/A N/A "$35,752.16 " "$28,903.06 " "$28,903.06 " "$28,903.06 " "$28,903.06 " "$17,417.98 " "$10,283.38 " "$9,348.53 " "$18,785.15 " N/A N/A N/A N/A "$9,348.53 " "$9,255.04 " "$63,304.33 " 330104 373 MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC I N/A N/A "$6,775.77 " N/A "$11,022.13 " "$11,598.58 " "$10,564.75 " "$6,708.01 " N/A "$12,873.96 " N/A "$6,775.77 " "$21,957.87 " "$7,453.35 " "$27,097.80 " "$22,426.14 " N/A N/A N/A "$45,146.31 " "$31,310.93 " "$42,462.29 " N/A "$6,979.04 " "$8,401.95 " N/A N/A N/A N/A N/A "$9,486.08 " N/A "$6,775.77 " "$6,775.77 " "$7,385.59 " N/A N/A N/A N/A N/A N/A N/A "$25,497.12 " "$20,612.59 " "$20,612.59 " "$20,612.59 " "$20,612.59 " "$12,421.86 " "$7,453.35 " "$6,775.77 " "$13,396.88 " N/A N/A N/A N/A "$6,775.77 " "$6,708.01 " "$45,146.31 " 330104 374 DIGESTIVE MALIGNANCY WITH MCC I N/A N/A "$17,941.71 " N/A "$30,262.28 " "$31,844.96 " "$29,006.50 " "$17,762.29 " N/A "$34,089.25 " N/A "$17,941.71 " "$60,287.36 " "$19,735.88 " "$74,399.52 " "$61,573.04 " N/A N/A N/A "$123,953.36 " "$85,967.04 " "$116,584.13 " N/A "$18,479.96 " "$22,247.72 " N/A N/A N/A N/A N/A "$25,118.39 " N/A "$17,941.71 " "$17,941.71 " "$19,556.46 " N/A N/A N/A N/A N/A N/A N/A "$70,004.70 " "$56,593.77 " "$56,593.77 " "$56,593.77 " "$56,593.77 " "$34,105.36 " "$19,735.88 " "$17,941.71 " "$36,782.36 " N/A N/A N/A N/A "$17,941.71 " "$17,762.29 " "$123,953.36 " 330104 375 DIGESTIVE MALIGNANCY WITH CC I N/A N/A "$10,992.62 " N/A "$18,288.24 " "$19,244.69 " "$17,529.34 " "$10,882.70 " N/A "$20,885.98 " N/A "$10,992.62 " "$36,433.13 " "$12,091.89 " "$44,961.45 " "$37,210.09 " N/A N/A N/A "$74,908.05 " "$51,951.99 " "$70,454.64 " N/A "$11,322.40 " "$13,630.85 " N/A N/A N/A N/A N/A "$15,389.67 " N/A "$10,992.62 " "$10,992.62 " "$11,981.96 " N/A N/A N/A N/A N/A N/A N/A "$42,305.55 " "$34,201.00 " "$34,201.00 " "$34,201.00 " "$34,201.00 " "$20,610.71 " "$12,091.89 " "$10,992.62 " "$22,228.48 " N/A N/A N/A N/A "$10,992.62 " "$10,882.70 " "$74,908.05 " 330104 376 DIGESTIVE MALIGNANCY WITHOUT CC/MCC I N/A N/A "$8,113.25 " N/A "$13,326.76 " "$14,023.73 " "$12,773.75 " "$8,032.12 " N/A "$15,415.17 " N/A "$8,113.25 " "$26,549.06 " "$8,924.57 " "$32,763.71 " "$27,115.24 " N/A N/A N/A "$54,585.99 " "$37,857.76 " "$51,340.77 " N/A "$8,356.65 " "$10,060.43 " N/A N/A N/A N/A N/A "$11,358.55 " N/A "$8,113.25 " "$8,113.25 " "$8,843.44 " N/A N/A N/A N/A N/A N/A N/A "$30,828.34 " "$24,922.50 " "$24,922.50 " "$24,922.50 " "$24,922.50 " "$15,019.16 " "$8,924.57 " "$8,113.25 " "$16,198.04 " N/A N/A N/A N/A "$8,113.25 " "$8,032.12 " "$54,585.99 " 330104 377 GASTROINTESTINAL HEMORRHAGE WITH MCC I N/A N/A "$16,044.74 " N/A "$26,993.60 " "$28,405.33 " "$25,873.46 " "$15,884.29 " N/A "$30,485.01 " N/A "$16,044.74 " "$53,775.61 " "$17,649.22 " "$66,363.49 " "$54,922.42 " N/A N/A N/A "$110,564.93 " "$76,681.58 " "$103,991.66 " N/A "$16,526.08 " "$19,895.48 " N/A N/A N/A N/A N/A "$22,462.64 " N/A "$16,044.74 " "$16,044.74 " "$17,488.77 " N/A N/A N/A N/A N/A N/A N/A "$62,443.36 " "$50,480.98 " "$50,480.98 " "$50,480.98 " "$50,480.98 " "$30,421.58 " "$17,649.22 " "$16,044.74 " "$32,809.43 " N/A N/A N/A N/A "$16,044.74 " "$15,884.29 " "$110,564.93 " 330104 378 GASTROINTESTINAL HEMORRHAGE WITH CC I N/A N/A "$9,057.77 " N/A "$14,954.27 " "$15,736.36 " "$14,333.72 " "$8,967.19 " N/A "$17,209.76 " N/A "$9,057.77 " "$29,791.33 " "$9,963.55 " "$36,764.93 " "$30,426.65 " N/A N/A N/A "$61,252.22 " "$42,481.08 " "$57,610.68 " N/A "$9,329.50 " "$11,231.63 " N/A N/A N/A N/A N/A "$12,680.88 " N/A "$9,057.77 " "$9,057.77 " "$9,872.97 " N/A N/A N/A N/A N/A N/A N/A "$34,593.20 " "$27,966.12 " "$27,966.12 " "$27,966.12 " "$27,966.12 " "$16,853.35 " "$9,963.55 " "$9,057.77 " "$18,176.20 " N/A N/A N/A N/A "$9,057.77 " "$8,967.19 " "$61,252.22 " 330104 379 GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC I N/A N/A "$5,963.41 " N/A "$9,622.35 " "$10,125.59 " "$9,223.06 " "$5,903.78 " N/A "$11,330.48 " N/A "$5,963.41 " "$19,169.28 " "$6,559.75 " "$23,656.46 " "$19,578.08 " N/A N/A N/A "$39,412.85 " "$27,334.53 " "$37,069.69 " N/A "$6,142.31 " "$7,394.63 " N/A N/A N/A N/A N/A "$8,348.78 " N/A "$5,963.41 " "$5,963.41 " "$6,500.12 " N/A N/A N/A N/A N/A N/A N/A "$22,259.06 " "$17,994.85 " "$17,994.85 " "$17,994.85 " "$17,994.85 " "$10,844.32 " "$6,559.75 " "$5,963.41 " "$11,695.51 " N/A N/A N/A N/A "$5,963.41 " "$5,903.78 " "$39,412.85 " 330104 380 COMPLICATED PEPTIC ULCER WITH MCC I N/A N/A "$17,155.79 " N/A "$28,908.05 " "$30,419.90 " "$27,708.46 " "$16,984.23 " N/A "$32,595.99 " N/A "$17,155.79 " "$57,589.50 " "$18,871.36 " "$71,070.15 " "$58,817.65 " N/A N/A N/A "$118,406.46 " "$82,120.02 " "$111,367.00 " N/A "$17,670.46 " "$21,273.17 " N/A N/A N/A N/A N/A "$24,018.10 " N/A "$17,155.79 " "$17,155.79 " "$18,699.81 " N/A N/A N/A N/A N/A N/A N/A "$66,871.99 " "$54,061.21 " "$54,061.21 " "$54,061.21 " "$54,061.21 " "$32,579.15 " "$18,871.36 " "$17,155.79 " "$35,136.36 " N/A N/A N/A N/A "$17,155.79 " "$16,984.23 " "$118,406.46 " 330104 381 COMPLICATED PEPTIC ULCER WITH CC I N/A N/A "$9,678.93 " N/A "$16,024.60 " "$16,862.67 " "$15,359.64 " "$9,582.14 " N/A "$18,389.97 " N/A "$9,678.93 " "$31,923.60 " "$10,646.82 " "$39,396.33 " "$32,604.40 " N/A N/A N/A "$65,636.27 " "$45,521.60 " "$61,734.08 " N/A "$9,969.30 " "$12,001.87 " N/A N/A N/A N/A N/A "$13,550.50 " N/A "$9,678.93 " "$9,678.93 " "$10,550.03 " N/A N/A N/A N/A N/A N/A N/A "$37,069.16 " "$29,967.76 " "$29,967.76 " "$29,967.76 " "$29,967.76 " "$18,059.61 " "$10,646.82 " "$9,678.93 " "$19,477.14 " N/A N/A N/A N/A "$9,678.93 " "$9,582.14 " "$65,636.27 " 330104 382 COMPLICATED PEPTIC ULCER WITHOUT CC/MCC I N/A N/A "$7,161.68 " N/A "$11,687.10 " "$12,298.32 " "$11,202.13 " "$7,090.07 " N/A "$13,607.20 " N/A "$7,161.68 " "$23,282.60 " "$7,877.85 " "$28,732.63 " "$23,779.12 " N/A N/A N/A "$47,870.01 " "$33,199.93 " "$45,024.06 " N/A "$7,376.53 " "$8,880.49 " N/A N/A N/A N/A N/A "$10,026.36 " N/A "$7,161.68 " "$7,161.68 " "$7,806.23 " N/A N/A N/A N/A N/A N/A N/A "$27,035.38 " "$21,856.16 " "$21,856.16 " "$21,856.16 " "$21,856.16 " "$13,171.28 " "$7,877.85 " "$7,161.68 " "$14,205.12 " N/A N/A N/A N/A "$7,161.68 " "$7,090.07 " "$47,870.01 " 330104 383 UNCOMPLICATED PEPTIC ULCER WITH MCC I N/A N/A "$12,361.82 " N/A "$20,647.52 " "$21,727.36 " "$19,790.72 " "$12,238.20 " N/A "$23,487.46 " N/A "$12,361.82 " "$41,133.20 " "$13,598.01 " "$50,761.73 " "$42,010.40 " N/A N/A N/A "$84,571.60 " "$58,654.08 " "$79,543.68 " N/A "$12,732.68 " "$15,328.66 " N/A N/A N/A N/A N/A "$17,306.55 " N/A "$12,361.82 " "$12,361.82 " "$13,474.39 " N/A N/A N/A N/A N/A N/A N/A "$47,763.20 " "$38,613.12 " "$38,613.12 " "$38,613.12 " "$38,613.12 " "$23,269.60 " "$13,598.01 " "$12,361.82 " "$25,096.08 " N/A N/A N/A N/A "$12,361.82 " "$12,238.20 " "$84,571.60 " 330104 384 UNCOMPLICATED PEPTIC ULCER WITHOUT MCC I N/A N/A "$8,322.95 " N/A "$13,688.09 " "$14,403.96 " "$13,120.08 " "$8,239.72 " N/A "$15,813.60 " N/A "$8,322.95 " "$27,268.89 " "$9,155.24 " "$33,652.04 " "$27,850.42 " N/A N/A N/A "$56,066.00 " "$38,884.20 " "$52,732.78 " N/A "$8,572.64 " "$10,320.45 " N/A N/A N/A N/A N/A "$11,652.13 " N/A "$8,322.95 " "$8,322.95 " "$9,072.01 " N/A N/A N/A N/A N/A N/A N/A "$31,664.19 " "$25,598.23 " "$25,598.23 " "$25,598.23 " "$25,598.23 " "$15,426.38 " "$9,155.24 " "$8,322.95 " "$16,637.22 " N/A N/A N/A N/A "$8,322.95 " "$8,239.72 " "$56,066.00 " 330104 385 INFLAMMATORY BOWEL DISEASE WITH MCC I N/A N/A "$14,729.29 " N/A "$24,726.92 " "$26,020.11 " "$23,700.84 " "$14,582.00 " N/A "$27,985.65 " N/A "$14,729.29 " "$49,260.03 " "$16,202.22 " "$60,790.90 " "$50,310.54 " N/A N/A N/A "$101,280.71 " "$70,242.57 " "$95,259.41 " N/A "$15,171.17 " "$18,264.32 " N/A N/A N/A N/A N/A "$20,621.00 " N/A "$14,729.29 " "$14,729.29 " "$16,054.92 " N/A N/A N/A N/A N/A N/A N/A "$57,199.94 " "$46,242.05 " "$46,242.05 " "$46,242.05 " "$46,242.05 " "$27,867.06 " "$16,202.22 " "$14,729.29 " "$30,054.40 " N/A N/A N/A N/A "$14,729.29 " "$14,582.00 " "$101,280.71 " 330104 386 INFLAMMATORY BOWEL DISEASE WITH CC I N/A N/A "$9,100.06 " N/A "$15,027.14 " "$15,813.04 " "$14,403.57 " "$9,009.06 " N/A "$17,290.12 " N/A "$9,100.06 " "$29,936.50 " "$10,010.07 " "$36,944.09 " "$30,574.92 " N/A N/A N/A "$61,550.71 " "$42,688.09 " "$57,891.42 " N/A "$9,373.06 " "$11,284.08 " N/A N/A N/A N/A N/A "$12,740.09 " N/A "$9,100.06 " "$9,100.06 " "$9,919.07 " N/A N/A N/A N/A N/A N/A N/A "$34,761.78 " "$28,102.40 " "$28,102.40 " "$28,102.40 " "$28,102.40 " "$16,935.48 " "$10,010.07 " "$9,100.06 " "$18,264.78 " N/A N/A N/A N/A "$9,100.06 " "$9,009.06 " "$61,550.71 " 330104 387 INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC I N/A N/A "$6,472.68 " N/A "$10,499.87 " "$11,049.00 " "$10,064.16 " "$6,407.95 " N/A "$12,298.09 " N/A "$6,472.68 " "$20,917.44 " "$7,119.94 " "$25,813.83 " "$21,363.52 " N/A N/A N/A "$43,007.15 " "$29,827.32 " "$40,450.30 " N/A "$6,666.86 " "$8,026.12 " N/A N/A N/A N/A N/A "$9,061.75 " N/A "$6,472.68 " "$6,472.68 " "$7,055.22 " N/A N/A N/A N/A N/A N/A N/A "$24,288.99 " "$19,635.91 " "$19,635.91 " "$19,635.91 " "$19,635.91 " "$11,833.28 " "$7,119.94 " "$6,472.68 " "$12,762.09 " N/A N/A N/A N/A "$6,472.68 " "$6,407.95 " "$43,007.15 " 330104 388 GASTROINTESTINAL OBSTRUCTION WITH MCC I N/A N/A "$13,308.10 " N/A "$22,278.07 " "$23,443.18 " "$21,353.60 " "$13,175.02 " N/A "$25,285.40 " N/A "$13,308.10 " "$44,381.51 " "$14,638.91 " "$54,770.41 " "$45,327.99 " N/A N/A N/A "$91,250.27 " "$63,286.03 " "$85,825.29 " N/A "$13,707.35 " "$16,502.05 " N/A N/A N/A N/A N/A "$18,631.35 " N/A "$13,308.10 " "$13,308.10 " "$14,505.83 " N/A N/A N/A N/A N/A N/A N/A "$51,535.09 " "$41,662.42 " "$41,662.42 " "$41,662.42 " "$41,662.42 " "$25,107.21 " "$14,638.91 " "$13,308.10 " "$27,077.93 " N/A N/A N/A N/A "$13,308.10 " "$13,175.02 " "$91,250.27 " 330104 389 GASTROINTESTINAL OBSTRUCTION WITH CC I N/A N/A "$7,490.33 " N/A "$12,253.39 " "$12,894.23 " "$11,744.92 " "$7,415.42 " N/A "$14,231.62 " N/A "$7,490.33 " "$24,410.74 " "$8,239.36 " "$30,124.85 " "$24,931.32 " N/A N/A N/A "$50,189.51 " "$34,808.61 " "$47,205.66 " N/A "$7,715.04 " "$9,288.00 " N/A N/A N/A N/A N/A "$10,486.46 " N/A "$7,490.33 " "$7,490.33 " "$8,164.45 " N/A N/A N/A N/A N/A N/A N/A "$28,345.35 " "$22,915.18 " "$22,915.18 " "$22,915.18 " "$22,915.18 " "$13,809.48 " "$8,239.36 " "$7,490.33 " "$14,893.42 " N/A N/A N/A N/A "$7,490.33 " "$7,415.42 " "$50,189.51 " 330104 390 GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC I N/A N/A "$5,361.63 " N/A "$8,585.42 " "$9,034.43 " "$8,229.16 " "$5,308.02 " N/A "$10,187.10 " N/A "$5,361.63 " "$17,103.55 " "$5,897.80 " "$21,107.17 " "$17,468.30 " N/A N/A N/A "$35,165.62 " "$24,388.88 " "$33,074.96 " N/A "$5,522.48 " "$6,648.43 " N/A N/A N/A N/A N/A "$7,506.29 " N/A "$5,361.63 " "$5,361.63 " "$5,844.18 " N/A N/A N/A N/A N/A N/A N/A "$19,860.36 " "$16,055.68 " "$16,055.68 " "$16,055.68 " "$16,055.68 " "$9,675.70 " "$5,897.80 " "$5,361.63 " "$10,435.17 " N/A N/A N/A N/A "$5,361.63 " "$5,308.02 " "$35,165.62 " 330104 391 "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC" I N/A N/A "$11,692.20 " N/A "$19,493.69 " "$20,513.18 " "$18,684.77 " "$11,575.28 " N/A "$22,215.18 " N/A "$11,692.20 " "$38,834.58 " "$12,861.42 " "$47,925.04 " "$39,662.76 " N/A N/A N/A "$79,845.54 " "$55,376.35 " "$75,098.59 " N/A "$12,042.97 " "$14,498.33 " N/A N/A N/A N/A N/A "$16,369.08 " N/A "$11,692.20 " "$11,692.20 " "$12,744.50 " N/A N/A N/A N/A N/A N/A N/A "$45,094.08 " "$36,455.33 " "$36,455.33 " "$36,455.33 " "$36,455.33 " "$21,969.24 " "$12,861.42 " "$11,692.20 " "$23,693.65 " N/A N/A N/A N/A "$11,692.20 " "$11,575.28 " "$79,845.54 " 330104 392 "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC" I N/A N/A "$7,318.51 " N/A "$11,957.34 " "$12,582.70 " "$11,461.16 " "$7,245.33 " N/A "$13,905.18 " N/A "$7,318.51 " "$23,820.96 " "$8,050.37 " "$29,397.01 " "$24,328.96 " N/A N/A N/A "$48,976.91 " "$33,967.61 " "$46,065.15 " N/A "$7,538.07 " "$9,074.96 " N/A N/A N/A N/A N/A "$10,245.92 " N/A "$7,318.51 " "$7,318.51 " "$7,977.18 " N/A N/A N/A N/A N/A N/A N/A "$27,660.51 " "$22,361.54 " "$22,361.54 " "$22,361.54 " "$22,361.54 " "$13,475.84 " "$8,050.37 " "$7,318.51 " "$14,533.58 " N/A N/A N/A N/A "$7,318.51 " "$7,245.33 " "$48,976.91 " 330104 393 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC I N/A N/A "$14,575.98 " N/A "$24,462.76 " "$25,742.13 " "$23,447.64 " "$14,430.22 " N/A "$27,694.36 " N/A "$14,575.98 " "$48,733.77 " "$16,033.58 " "$60,141.45 " "$49,773.06 " N/A N/A N/A "$100,198.69 " "$69,492.15 " "$94,241.71 " N/A "$15,013.26 " "$18,074.22 " N/A N/A N/A N/A N/A "$20,406.37 " N/A "$14,575.98 " "$14,575.98 " "$15,887.82 " N/A N/A N/A N/A N/A N/A N/A "$56,588.86 " "$45,748.03 " "$45,748.03 " "$45,748.03 " "$45,748.03 " "$27,569.34 " "$16,033.58 " "$14,575.98 " "$29,733.32 " N/A N/A N/A N/A "$14,575.98 " "$14,430.22 " "$100,198.69 " 330104 394 OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC I N/A N/A "$8,687.71 " N/A "$14,316.63 " "$15,065.37 " "$13,722.54 " "$8,600.84 " N/A "$16,506.66 " N/A "$8,687.71 " "$28,521.03 " "$9,556.49 " "$35,197.29 " "$29,129.27 " N/A N/A N/A "$58,640.45 " "$40,669.70 " "$55,154.18 " N/A "$8,948.35 " "$10,772.77 " N/A N/A N/A N/A N/A "$12,162.80 " N/A "$8,687.71 " "$8,687.71 " "$9,469.61 " N/A N/A N/A N/A N/A N/A N/A "$33,118.16 " "$26,773.66 " "$26,773.66 " "$26,773.66 " "$26,773.66 " "$16,134.73 " "$9,556.49 " "$8,687.71 " "$17,401.18 " N/A N/A N/A N/A "$8,687.71 " "$8,600.84 " "$58,640.45 " 330104 395 OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC I N/A N/A "$6,061.21 " N/A "$9,790.87 " "$10,302.92 " "$9,384.58 " "$6,000.60 " N/A "$11,516.30 " N/A "$6,061.21 " "$19,505.00 " "$6,667.33 " "$24,070.76 " "$19,920.96 " N/A N/A N/A "$40,103.11 " "$27,813.25 " "$37,718.91 " N/A "$6,243.05 " "$7,515.90 " N/A N/A N/A N/A N/A "$8,485.70 " N/A "$6,061.21 " "$6,061.21 " "$6,606.72 " N/A N/A N/A N/A N/A N/A N/A "$22,648.89 " "$18,310.00 " "$18,310.00 " "$18,310.00 " "$18,310.00 " "$11,034.24 " "$6,667.33 " "$6,061.21 " "$11,900.34 " N/A N/A N/A N/A "$6,061.21 " "$6,000.60 " "$40,103.11 " 330104 405 "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC" I N/A N/A "$49,207.75 " N/A "$84,137.13 " "$88,537.39 " "$80,645.73 " "$48,715.68 " N/A "$93,494.73 " N/A "$49,207.75 " "$167,614.77 " "$54,128.53 " "$206,850.31 " "$171,189.29 " N/A N/A N/A "$344,623.05 " "$239,011.06 " "$324,134.65 " N/A "$50,683.99 " "$61,017.61 " N/A N/A N/A N/A N/A "$68,890.86 " N/A "$49,207.75 " "$49,207.75 " "$53,636.45 " N/A N/A N/A N/A N/A N/A N/A "$194,631.53 " "$157,345.62 " "$157,345.62 " "$157,345.62 " "$157,345.62 " "$94,821.91 " "$54,128.53 " "$49,207.75 " "$102,264.68 " N/A N/A N/A N/A "$49,207.75 " "$48,715.68 " "$344,623.05 " 330104 406 "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC" I N/A N/A "$26,192.15 " N/A "$44,478.71 " "$46,804.89 " "$42,632.99 " "$25,930.23 " N/A "$49,765.09 " N/A "$26,192.15 " "$88,608.78 " "$28,811.37 " "$109,350.47 " "$90,498.43 " N/A N/A N/A "$182,183.39 " "$126,352.10 " "$171,352.29 " N/A "$26,977.92 " "$32,478.27 " N/A N/A N/A N/A N/A "$36,669.01 " N/A "$26,192.15 " "$26,192.15 " "$28,549.45 " N/A N/A N/A N/A N/A N/A N/A "$102,891.06 " "$83,180.04 " "$83,180.04 " "$83,180.04 " "$83,180.04 " "$50,127.17 " "$28,811.37 " "$26,192.15 " "$54,061.75 " N/A N/A N/A N/A "$26,192.15 " "$25,930.23 " "$182,183.39 " 330104 407 "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC" I N/A N/A "$19,989.34 " N/A "$33,790.58 " "$35,557.78 " "$32,388.39 " "$19,789.45 " N/A "$37,979.75 " N/A "$19,989.34 " "$67,316.30 " "$21,988.28 " "$83,073.81 " "$68,751.87 " N/A N/A N/A "$138,405.15 " "$95,989.99 " "$130,176.74 " N/A "$20,589.02 " "$24,786.78 " N/A N/A N/A N/A N/A "$27,985.08 " N/A "$19,989.34 " "$19,989.34 " "$21,788.38 " N/A N/A N/A N/A N/A N/A N/A "$78,166.58 " "$63,192.07 " "$63,192.07 " "$63,192.07 " "$63,192.07 " "$38,081.73 " "$21,988.28 " "$19,989.34 " "$41,070.84 " N/A N/A N/A N/A "$19,989.34 " "$19,789.45 " "$138,405.15 " 330104 408 BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC I N/A N/A "$32,710.39 " N/A "$55,710.35 " "$58,623.93 " "$53,398.56 " "$32,383.29 " N/A "$62,149.74 " N/A "$32,710.39 " "$110,984.03 " "$35,981.43 " "$136,963.35 " "$113,350.86 " N/A N/A N/A "$228,187.86 " "$158,258.20 " "$214,621.72 " N/A "$33,691.70 " "$40,560.89 " N/A N/A N/A N/A N/A "$45,794.55 " N/A "$32,710.39 " "$32,710.39 " "$35,654.33 " N/A N/A N/A N/A N/A N/A N/A "$128,872.84 " "$104,184.44 " "$104,184.44 " "$104,184.44 " "$104,184.44 " "$62,785.15 " "$35,981.43 " "$32,710.39 " "$67,713.28 " N/A N/A N/A N/A "$32,710.39 " "$32,383.29 " "$228,187.86 " 330104 409 BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC I N/A N/A "$19,158.48 " N/A "$32,358.91 " "$34,051.25 " "$31,016.13 " "$18,966.90 " N/A "$36,401.12 " N/A "$19,158.48 " "$64,464.19 " "$21,074.33 " "$79,554.08 " "$65,838.95 " N/A N/A N/A "$132,541.11 " "$91,923.02 " "$124,661.32 " N/A "$19,733.24 " "$23,756.52 " N/A N/A N/A N/A N/A "$26,821.88 " N/A "$19,158.48 " "$19,158.48 " "$20,882.75 " N/A N/A N/A N/A N/A N/A N/A "$74,854.77 " "$60,514.71 " "$60,514.71 " "$60,514.71 " "$60,514.71 " "$36,468.25 " "$21,074.33 " "$19,158.48 " "$39,330.72 " N/A N/A N/A N/A "$19,158.48 " "$18,966.90 " "$132,541.11 " 330104 410 BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC I N/A N/A "$15,337.23 " N/A "$25,774.48 " "$27,122.46 " "$24,704.93 " "$15,183.86 " N/A "$29,140.74 " N/A "$15,337.23 " "$51,346.94 " "$16,870.96 " "$63,366.31 " "$52,441.95 " N/A N/A N/A "$105,571.47 " "$73,218.41 " "$99,295.08 " N/A "$15,797.35 " "$19,018.17 " N/A N/A N/A N/A N/A "$21,472.13 " N/A "$15,337.23 " "$15,337.23 " "$16,717.59 " N/A N/A N/A N/A N/A N/A N/A "$59,623.22 " "$48,201.10 " "$48,201.10 " "$48,201.10 " "$48,201.10 " "$29,047.65 " "$16,870.96 " "$15,337.23 " "$31,327.66 " N/A N/A N/A N/A "$15,337.23 " "$15,183.86 " "$105,571.47 " 330104 411 CHOLECYSTECTOMY WITH C.D.E. WITH MCC I N/A N/A "$30,143.80 " N/A "$51,287.83 " "$53,970.12 " "$49,159.57 " "$29,842.36 " N/A "$57,273.22 " N/A "$30,143.80 " "$102,173.66 " "$33,158.18 " "$126,090.64 " "$104,352.60 " N/A N/A N/A "$210,073.37 " "$145,695.01 " "$197,584.16 " N/A "$31,048.12 " "$37,378.31 " N/A N/A N/A N/A N/A "$42,201.32 " N/A "$30,143.80 " "$30,143.80 " "$32,856.74 " N/A N/A N/A N/A N/A N/A N/A "$118,642.38 " "$95,913.85 " "$95,913.85 " "$95,913.85 " "$95,913.85 " "$57,801.00 " "$33,158.18 " "$30,143.80 " "$62,337.92 " N/A N/A N/A N/A "$30,143.80 " "$29,842.36 " "$210,073.37 " 330104 412 CHOLECYSTECTOMY WITH C.D.E. WITH CC I N/A N/A "$20,606.10 " N/A "$34,853.32 " "$36,676.10 " "$33,407.03 " "$20,400.04 " N/A "$39,151.59 " N/A "$20,606.10 " "$69,433.45 " "$22,666.71 " "$85,686.54 " "$70,914.17 " N/A N/A N/A "$142,758.10 " "$99,008.95 " "$134,270.90 " N/A "$21,224.28 " "$25,551.56 " N/A N/A N/A N/A N/A "$28,848.54 " N/A "$20,606.10 " "$20,606.10 " "$22,460.65 " N/A N/A N/A N/A N/A N/A N/A "$80,624.98 " "$65,179.51 " "$65,179.51 " "$65,179.51 " "$65,179.51 " "$39,279.43 " "$22,666.71 " "$20,606.10 " "$42,362.55 " N/A N/A N/A N/A "$20,606.10 " "$20,400.04 " "$142,758.10 " 330104 413 CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC I N/A N/A "$14,656.16 " N/A "$24,600.91 " "$25,887.51 " "$23,580.06 " "$14,509.60 " N/A "$27,846.70 " N/A "$14,656.16 " "$49,009.00 " "$16,121.77 " "$60,481.11 " "$50,054.16 " N/A N/A N/A "$100,764.57 " "$69,884.61 " "$94,773.96 " N/A "$15,095.84 " "$18,173.64 " N/A N/A N/A N/A N/A "$20,518.62 " N/A "$14,656.16 " "$14,656.16 " "$15,975.21 " N/A N/A N/A N/A N/A N/A N/A "$56,908.45 " "$46,006.40 " "$46,006.40 " "$46,006.40 " "$46,006.40 " "$27,725.04 " "$16,121.77 " "$14,656.16 " "$29,901.24 " N/A N/A N/A N/A "$14,656.16 " "$14,509.60 " "$100,764.57 " 330104 414 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC I N/A N/A "$31,522.69 " N/A "$53,663.82 " "$56,470.37 " "$51,436.95 " "$31,207.47 " N/A "$59,893.12 " N/A "$31,522.69 " "$106,907.00 " "$34,674.96 " "$131,931.97 " "$109,186.88 " N/A N/A N/A "$219,805.32 " "$152,444.54 " "$206,737.53 " N/A "$32,468.37 " "$39,088.14 " N/A N/A N/A N/A N/A "$44,131.77 " N/A "$31,522.69 " "$31,522.69 " "$34,359.74 " N/A N/A N/A N/A N/A N/A N/A "$124,138.66 " "$100,357.20 " "$100,357.20 " "$100,357.20 " "$100,357.20 " "$60,478.72 " "$34,674.96 " "$31,522.69 " "$65,225.82 " N/A N/A N/A N/A "$31,522.69 " "$31,207.47 " "$219,805.32 " 330104 415 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC I N/A N/A "$18,000.74 " N/A "$30,364.00 " "$31,952.00 " "$29,104.00 " "$17,820.73 " N/A "$34,201.41 " N/A "$18,000.74 " "$60,490.00 " "$19,800.82 " "$74,649.60 " "$61,780.00 " N/A N/A N/A "$124,370.00 " "$86,256.00 " "$116,976.00 " N/A "$18,540.76 " "$22,320.92 " N/A N/A N/A N/A N/A "$25,201.04 " N/A "$18,000.74 " "$18,000.74 " "$19,620.81 " N/A N/A N/A N/A N/A N/A N/A "$70,240.00 " "$56,784.00 " "$56,784.00 " "$56,784.00 " "$56,784.00 " "$34,220.00 " "$19,800.82 " "$18,000.74 " "$36,906.00 " N/A N/A N/A N/A "$18,000.74 " "$17,820.73 " "$124,370.00 " 330104 416 CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC I N/A N/A "$12,506.32 " N/A "$20,896.50 " "$21,989.37 " "$20,029.37 " "$12,381.26 " N/A "$23,762.01 " N/A "$12,506.32 " "$41,629.22 " "$13,756.95 " "$51,373.85 " "$42,517.00 " N/A N/A N/A "$85,591.43 " "$59,361.38 " "$80,502.88 " N/A "$12,881.51 " "$15,507.84 " N/A N/A N/A N/A N/A "$17,508.85 " N/A "$12,506.32 " "$12,506.32 " "$13,631.89 " N/A N/A N/A N/A N/A N/A N/A "$48,339.17 " "$39,078.75 " "$39,078.75 " "$39,078.75 " "$39,078.75 " "$23,550.20 " "$13,756.95 " "$12,506.32 " "$25,398.71 " N/A N/A N/A N/A "$12,506.32 " "$12,381.26 " "$85,591.43 " 330104 417 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC I N/A N/A "$21,328.59 " N/A "$36,098.24 " "$37,986.14 " "$34,600.29 " "$21,115.30 " N/A "$40,524.31 " N/A "$21,328.59 " "$71,913.54 " "$23,461.44 " "$88,747.18 " "$73,447.15 " N/A N/A N/A "$147,857.27 " "$102,545.45 " "$139,066.92 " N/A "$21,968.44 " "$26,447.45 " N/A N/A N/A N/A N/A "$29,860.02 " N/A "$21,328.59 " "$21,328.59 " "$23,248.16 " N/A N/A N/A N/A N/A N/A N/A "$83,504.82 " "$67,507.66 " "$67,507.66 " "$67,507.66 " "$67,507.66 " "$40,682.45 " "$23,461.44 " "$21,328.59 " "$43,875.70 " N/A N/A N/A N/A "$21,328.59 " "$21,115.30 " "$147,857.27 " 330104 418 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC I N/A N/A "$15,013.88 " N/A "$25,217.30 " "$26,536.14 " "$24,170.87 " "$14,863.74 " N/A "$28,526.37 " N/A "$15,013.88 " "$50,236.94 " "$16,515.26 " "$61,996.49 " "$51,308.29 " N/A N/A N/A "$103,289.29 " "$71,635.61 " "$97,148.57 " N/A "$15,464.29 " "$18,617.21 " N/A N/A N/A N/A N/A "$21,019.43 " N/A "$15,013.88 " "$15,013.88 " "$16,365.13 " N/A N/A N/A N/A N/A N/A N/A "$58,334.32 " "$47,159.11 " "$47,159.11 " "$47,159.11 " "$47,159.11 " "$28,419.71 " "$16,515.26 " "$15,013.88 " "$30,650.43 " N/A N/A N/A N/A "$15,013.88 " "$14,863.74 " "$103,289.29 " 330104 419 LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC I N/A N/A "$11,877.23 " N/A "$19,812.51 " "$20,848.68 " "$18,990.36 " "$11,758.46 " N/A "$22,566.73 " N/A "$11,877.23 " "$39,469.72 " "$13,064.95 " "$48,708.86 " "$40,311.45 " N/A N/A N/A "$81,151.43 " "$56,282.04 " "$76,326.84 " N/A "$12,233.55 " "$14,727.76 " N/A N/A N/A N/A N/A "$16,628.12 " N/A "$11,877.23 " "$11,877.23 " "$12,946.18 " N/A N/A N/A N/A N/A N/A N/A "$45,831.60 " "$37,051.56 " "$37,051.56 " "$37,051.56 " "$37,051.56 " "$22,328.55 " "$13,064.95 " "$11,877.23 " "$24,081.16 " N/A N/A N/A N/A "$11,877.23 " "$11,758.46 " "$81,151.43 " 330104 420 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC I N/A N/A "$29,112.94 " N/A "$49,511.54 " "$52,100.93 " "$47,456.98 " "$28,821.81 " N/A "$55,314.58 " N/A "$29,112.94 " "$98,634.99 " "$32,024.23 " "$121,723.64 " "$100,738.47 " N/A N/A N/A "$202,797.72 " "$140,649.03 " "$190,741.07 " N/A "$29,986.33 " "$36,100.04 " N/A N/A N/A N/A N/A "$40,758.11 " N/A "$29,112.94 " "$29,112.94 " "$31,733.10 " N/A N/A N/A N/A N/A N/A N/A "$114,533.34 " "$92,591.99 " "$92,591.99 " "$92,591.99 " "$92,591.99 " "$55,799.13 " "$32,024.23 " "$29,112.94 " "$60,178.92 " N/A N/A N/A N/A "$29,112.94 " "$28,821.81 " "$202,797.72 " 330104 421 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC I N/A N/A "$16,340.79 " N/A "$27,503.71 " "$28,942.12 " "$26,362.40 " "$16,177.38 " N/A "$31,047.49 " N/A "$16,340.79 " "$54,791.84 " "$17,974.86 " "$67,617.61 " "$55,960.32 " N/A N/A N/A "$112,654.35 " "$78,130.68 " "$105,956.86 " N/A "$16,831.01 " "$20,262.57 " N/A N/A N/A N/A N/A "$22,877.10 " N/A "$16,340.79 " "$16,340.79 " "$17,811.46 " N/A N/A N/A N/A N/A N/A N/A "$63,623.39 " "$51,434.95 " "$51,434.95 " "$51,434.95 " "$51,434.95 " "$30,996.48 " "$17,974.86 " "$16,340.79 " "$33,429.45 " N/A N/A N/A N/A "$16,340.79 " "$16,177.38 " "$112,654.35 " 330104 422 HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC I N/A N/A "$12,587.38 " N/A "$21,036.18 " "$22,136.35 " "$20,163.25 " "$12,461.51 " N/A "$23,916.02 " N/A "$12,587.38 " "$41,907.47 " "$13,846.12 " "$51,717.24 " "$42,801.18 " N/A N/A N/A "$86,163.54 " "$59,758.16 " "$81,040.97 " N/A "$12,965.00 " "$15,608.35 " N/A N/A N/A N/A N/A "$17,622.33 " N/A "$12,587.38 " "$12,587.38 " "$13,720.24 " N/A N/A N/A N/A N/A N/A N/A "$48,662.27 " "$39,339.96 " "$39,339.96 " "$39,339.96 " "$39,339.96 " "$23,707.62 " "$13,846.12 " "$12,587.38 " "$25,568.48 " N/A N/A N/A N/A "$12,587.38 " "$12,461.51 " "$86,163.54 " 330104 423 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC I N/A N/A "$35,022.35 " N/A "$59,694.11 " "$62,816.03 " "$57,217.01 " "$34,672.12 " N/A "$66,542.46 " N/A "$35,022.35 " "$118,920.32 " "$38,524.58 " "$146,757.38 " "$121,456.39 " N/A N/A N/A "$244,505.20 " "$169,574.98 " "$229,968.97 " N/A "$36,073.02 " "$43,427.71 " N/A N/A N/A N/A N/A "$49,031.29 " N/A "$35,022.35 " "$35,022.35 " "$38,174.36 " N/A N/A N/A N/A N/A N/A N/A "$138,088.33 " "$111,634.50 " "$111,634.50 " "$111,634.50 " "$111,634.50 " "$67,274.81 " "$38,524.58 " "$35,022.35 " "$72,555.35 " N/A N/A N/A N/A "$35,022.35 " "$34,672.12 " "$244,505.20 " 330104 424 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC I N/A N/A "$21,248.41 " N/A "$35,960.09 " "$37,840.75 " "$34,467.87 " "$21,035.92 " N/A "$40,371.97 " N/A "$21,248.41 " "$71,638.31 " "$23,373.25 " "$88,407.52 " "$73,166.05 " N/A N/A N/A "$147,291.39 " "$102,152.98 " "$138,534.68 " N/A "$21,885.86 " "$26,348.02 " N/A N/A N/A N/A N/A "$29,747.77 " N/A "$21,248.41 " "$21,248.41 " "$23,160.76 " N/A N/A N/A N/A N/A N/A N/A "$83,185.23 " "$67,249.29 " "$67,249.29 " "$67,249.29 " "$67,249.29 " "$40,526.75 " "$23,373.25 " "$21,248.41 " "$43,707.78 " N/A N/A N/A N/A "$21,248.41 " "$21,035.92 " "$147,291.39 " 330104 425 OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$12,983.87 " N/A "$21,719.37 " "$22,855.27 " "$20,818.09 " "$12,854.03 " N/A "$24,669.35 " N/A "$12,983.87 " "$43,268.50 " "$14,282.25 " "$53,396.86 " "$44,191.23 " N/A N/A N/A "$88,961.86 " "$61,698.92 " "$83,672.93 " N/A "$13,373.38 " "$16,099.99 " N/A N/A N/A N/A N/A "$18,177.41 " N/A "$12,983.87 " "$12,983.87 " "$14,152.41 " N/A N/A N/A N/A N/A N/A N/A "$50,242.67 " "$40,617.60 " "$40,617.60 " "$40,617.60 " "$40,617.60 " "$24,477.57 " "$14,282.25 " "$12,983.87 " "$26,398.86 " N/A N/A N/A N/A "$12,983.87 " "$12,854.03 " "$88,961.86 " 330104 432 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC I N/A N/A "$17,015.69 " N/A "$28,666.65 " "$30,165.88 " "$27,477.09 " "$16,845.54 " N/A "$32,329.82 " N/A "$17,015.69 " "$57,108.61 " "$18,717.26 " "$70,476.69 " "$58,326.50 " N/A N/A N/A "$117,417.72 " "$81,434.29 " "$110,437.04 " N/A "$17,526.16 " "$21,099.46 " N/A N/A N/A N/A N/A "$23,821.97 " N/A "$17,015.69 " "$17,015.69 " "$18,547.11 " N/A N/A N/A N/A N/A N/A N/A "$66,313.58 " "$53,609.77 " "$53,609.77 " "$53,609.77 " "$53,609.77 " "$32,307.10 " "$18,717.26 " "$17,015.69 " "$34,842.95 " N/A N/A N/A N/A "$17,015.69 " "$16,845.54 " "$117,417.72 " 330104 433 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC I N/A N/A "$9,540.60 " N/A "$15,786.24 " "$16,611.84 " "$15,131.17 " "$9,445.20 " N/A "$18,127.14 " N/A "$9,540.60 " "$31,448.75 " "$10,494.66 " "$38,810.33 " "$32,119.42 " N/A N/A N/A "$64,659.96 " "$44,844.49 " "$60,815.82 " N/A "$9,826.82 " "$11,830.35 " N/A N/A N/A N/A N/A "$13,356.84 " N/A "$9,540.60 " "$9,540.60 " "$10,399.26 " N/A N/A N/A N/A N/A N/A N/A "$36,517.78 " "$29,522.00 " "$29,522.00 " "$29,522.00 " "$29,522.00 " "$17,790.98 " "$10,494.66 " "$9,540.60 " "$19,187.43 " N/A N/A N/A N/A "$9,540.60 " "$9,445.20 " "$64,659.96 " 330104 434 CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC I N/A N/A "$5,909.67 " N/A "$9,529.74 " "$10,028.14 " "$9,134.29 " "$5,850.57 " N/A "$11,228.37 " N/A "$5,909.67 " "$18,984.79 " "$6,500.63 " "$23,428.78 " "$19,389.65 " N/A N/A N/A "$39,033.52 " "$27,071.45 " "$36,712.92 " N/A "$6,086.96 " "$7,327.99 " N/A N/A N/A N/A N/A "$8,273.53 " N/A "$5,909.67 " "$5,909.67 " "$6,441.54 " N/A N/A N/A N/A N/A N/A N/A "$22,044.82 " "$17,821.66 " "$17,821.66 " "$17,821.66 " "$17,821.66 " "$10,739.95 " "$6,500.63 " "$5,909.67 " "$11,582.95 " N/A N/A N/A N/A "$5,909.67 " "$5,850.57 " "$39,033.52 " 330104 435 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC I N/A N/A "$15,782.18 " N/A "$26,541.17 " "$27,929.24 " "$25,439.81 " "$15,624.36 " N/A "$29,986.14 " N/A "$15,782.18 " "$52,874.31 " "$17,360.40 " "$65,251.22 " "$54,001.90 " N/A N/A N/A "$108,711.82 " "$75,396.37 " "$102,248.72 " N/A "$16,255.65 " "$19,569.90 " N/A N/A N/A N/A N/A "$22,095.05 " N/A "$15,782.18 " "$15,782.18 " "$17,202.58 " N/A N/A N/A N/A N/A N/A N/A "$61,396.78 " "$49,634.89 " "$49,634.89 " "$49,634.89 " "$49,634.89 " "$29,911.70 " "$17,360.40 " "$15,782.18 " "$32,259.53 " N/A N/A N/A N/A "$15,782.18 " "$15,624.36 " "$108,711.82 " 330104 436 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC I N/A N/A "$10,074.54 " N/A "$16,706.27 " "$17,579.99 " "$16,013.02 " "$9,973.79 " N/A "$19,141.62 " N/A "$10,074.54 " "$33,281.60 " "$11,081.99 " "$41,072.21 " "$33,991.36 " N/A N/A N/A "$68,428.37 " "$47,458.05 " "$64,360.20 " N/A "$10,376.77 " "$12,492.43 " N/A N/A N/A N/A N/A "$14,104.35 " N/A "$10,074.54 " "$10,074.54 " "$10,981.24 " N/A N/A N/A N/A N/A N/A N/A "$38,646.05 " "$31,242.56 " "$31,242.56 " "$31,242.56 " "$31,242.56 " "$18,827.84 " "$11,081.99 " "$10,074.54 " "$20,305.68 " N/A N/A N/A N/A "$10,074.54 " "$9,973.79 " "$68,428.37 " 330104 437 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC I N/A N/A "$7,832.19 " N/A "$12,842.45 " "$13,514.10 " "$12,309.54 " "$7,753.86 " N/A "$14,881.15 " N/A "$7,832.19 " "$25,584.25 " "$8,615.40 " "$31,573.05 " "$26,129.85 " N/A N/A N/A "$52,602.29 " "$36,481.98 " "$49,475.00 " N/A "$8,067.15 " "$9,711.91 " N/A N/A N/A N/A N/A "$10,965.06 " N/A "$7,832.19 " "$7,832.19 " "$8,537.08 " N/A N/A N/A N/A N/A N/A N/A "$29,708.01 " "$24,016.79 " "$24,016.79 " "$24,016.79 " "$24,016.79 " "$14,473.35 " "$8,615.40 " "$7,832.19 " "$15,609.39 " N/A N/A N/A N/A "$7,832.19 " "$7,753.86 " "$52,602.29 " 330104 438 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC I N/A N/A "$14,982.16 " N/A "$25,162.65 " "$26,478.62 " "$24,118.48 " "$14,832.34 " N/A "$28,466.10 " N/A "$14,982.16 " "$50,128.06 " "$16,480.37 " "$61,862.12 " "$51,197.09 " N/A N/A N/A "$103,065.42 " "$71,480.35 " "$96,938.01 " N/A "$15,431.62 " "$18,577.88 " N/A N/A N/A N/A N/A "$20,975.02 " N/A "$14,982.16 " "$14,982.16 " "$16,330.55 " N/A N/A N/A N/A N/A N/A N/A "$58,207.89 " "$47,056.90 " "$47,056.90 " "$47,056.90 " "$47,056.90 " "$28,358.11 " "$16,480.37 " "$14,982.16 " "$30,584.00 " N/A N/A N/A N/A "$14,982.16 " "$14,832.34 " "$103,065.42 " 330104 439 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC I N/A N/A "$8,042.76 " N/A "$13,205.30 " "$13,895.92 " "$12,657.33 " "$7,962.34 " N/A "$15,281.25 " N/A "$8,042.76 " "$26,307.10 " "$8,847.04 " "$32,465.11 " "$26,868.12 " N/A N/A N/A "$54,088.51 " "$37,512.73 " "$50,872.86 " N/A "$8,284.05 " "$9,973.03 " N/A N/A N/A N/A N/A "$11,259.87 " N/A "$8,042.76 " "$8,042.76 " "$8,766.61 " N/A N/A N/A N/A N/A N/A N/A "$30,547.38 " "$24,695.36 " "$24,695.36 " "$24,695.36 " "$24,695.36 " "$14,882.28 " "$8,847.04 " "$8,042.76 " "$16,050.42 " N/A N/A N/A N/A "$8,042.76 " "$7,962.34 " "$54,088.51 " 330104 440 DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC I N/A N/A "$5,722.00 " N/A "$9,206.36 " "$9,687.85 " "$8,824.33 " "$5,664.78 " N/A "$10,871.79 " N/A "$5,722.00 " "$18,340.57 " "$6,294.20 " "$22,633.76 " "$18,731.70 " N/A N/A N/A "$37,708.98 " "$26,152.82 " "$35,467.12 " N/A "$5,893.66 " "$7,095.27 " N/A N/A N/A N/A N/A "$8,010.79 " N/A "$5,722.00 " "$5,722.00 " "$6,236.98 " N/A N/A N/A N/A N/A N/A N/A "$21,296.77 " "$17,216.91 " "$17,216.91 " "$17,216.91 " "$17,216.91 " "$10,375.50 " "$6,294.20 " "$5,722.00 " "$11,189.90 " N/A N/A N/A N/A "$5,722.00 " "$5,664.78 " "$37,708.98 " 330104 441 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC" I N/A N/A "$17,073.84 " N/A "$28,766.85 " "$30,271.32 " "$27,573.13 " "$16,903.11 " N/A "$32,440.31 " N/A "$17,073.84 " "$57,308.23 " "$18,781.23 " "$70,723.03 " "$58,530.37 " N/A N/A N/A "$117,828.14 " "$81,718.93 " "$110,823.06 " N/A "$17,586.06 " "$21,171.57 " N/A N/A N/A N/A N/A "$23,903.38 " N/A "$17,073.84 " "$17,073.84 " "$18,610.49 " N/A N/A N/A N/A N/A N/A N/A "$66,545.38 " "$53,797.16 " "$53,797.16 " "$53,797.16 " "$53,797.16 " "$32,420.03 " "$18,781.23 " "$17,073.84 " "$34,964.74 " N/A N/A N/A N/A "$17,073.84 " "$16,903.11 " "$117,828.14 " 330104 442 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC" I N/A N/A "$8,714.15 " N/A "$14,362.17 " "$15,113.30 " "$13,766.19 " "$8,627.01 " N/A "$16,556.88 " N/A "$8,714.15 " "$28,611.77 " "$9,585.56 " "$35,309.26 " "$29,221.94 " N/A N/A N/A "$58,827.01 " "$40,799.09 " "$55,329.65 " N/A "$8,975.57 " "$10,805.54 " N/A N/A N/A N/A N/A "$12,199.81 " N/A "$8,714.15 " "$8,714.15 " "$9,498.42 " N/A N/A N/A N/A N/A N/A N/A "$33,223.52 " "$26,858.83 " "$26,858.83 " "$26,858.83 " "$26,858.83 " "$16,186.06 " "$9,585.56 " "$8,714.15 " "$17,456.54 " N/A N/A N/A N/A "$8,714.15 " "$8,627.01 " "$58,827.01 " 330104 443 "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC" I N/A N/A "$6,122.89 " N/A "$9,897.15 " "$10,414.75 " "$9,486.45 " "$6,061.66 " N/A "$11,633.49 " N/A "$6,122.89 " "$19,716.72 " "$6,735.18 " "$24,332.04 " "$20,137.19 " N/A N/A N/A "$40,538.40 " "$28,115.14 " "$38,128.33 " N/A "$6,306.57 " "$7,592.38 " N/A N/A N/A N/A N/A "$8,572.04 " N/A "$6,122.89 " "$6,122.89 " "$6,673.95 " N/A N/A N/A N/A N/A N/A N/A "$22,894.73 " "$18,508.74 " "$18,508.74 " "$18,508.74 " "$18,508.74 " "$11,154.01 " "$6,735.18 " "$6,122.89 " "$12,029.51 " N/A N/A N/A N/A "$6,122.89 " "$6,061.66 " "$40,538.40 " 330104 444 DISORDERS OF THE BILIARY TRACT WITH MCC I N/A N/A "$15,046.48 " N/A "$25,273.48 " "$26,595.25 " "$24,224.71 " "$14,896.01 " N/A "$28,588.31 " N/A "$15,046.48 " "$50,348.85 " "$16,551.12 " "$62,134.59 " "$51,422.58 " N/A N/A N/A "$103,519.37 " "$71,795.18 " "$97,364.97 " N/A "$15,497.87 " "$18,657.63 " N/A N/A N/A N/A N/A "$21,065.07 " N/A "$15,046.48 " "$15,046.48 " "$16,400.66 " N/A N/A N/A N/A N/A N/A N/A "$58,464.26 " "$47,264.16 " "$47,264.16 " "$47,264.16 " "$47,264.16 " "$28,483.02 " "$16,551.12 " "$15,046.48 " "$30,718.71 " N/A N/A N/A N/A "$15,046.48 " "$14,896.01 " "$103,519.37 " 330104 445 DISORDERS OF THE BILIARY TRACT WITH CC I N/A N/A "$10,067.49 " N/A "$16,694.13 " "$17,567.21 " "$16,001.38 " "$9,966.81 " N/A "$19,128.23 " N/A "$10,067.49 " "$33,257.40 " "$11,074.24 " "$41,042.35 " "$33,966.64 " N/A N/A N/A "$68,378.63 " "$47,423.55 " "$64,313.40 " N/A "$10,369.51 " "$12,483.68 " N/A N/A N/A N/A N/A "$14,094.48 " N/A "$10,067.49 " "$10,067.49 " "$10,973.56 " N/A N/A N/A N/A N/A N/A N/A "$38,617.95 " "$31,219.84 " "$31,219.84 " "$31,219.84 " "$31,219.84 " "$18,814.16 " "$11,074.24 " "$10,067.49 " "$20,290.92 " N/A N/A N/A N/A "$10,067.49 " "$9,966.81 " "$68,378.63 " 330104 446 DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC I N/A N/A "$7,530.86 " N/A "$12,323.23 " "$12,967.72 " "$11,811.86 " "$7,455.55 " N/A "$14,308.63 " N/A "$7,530.86 " "$24,549.87 " "$8,283.94 " "$30,296.54 " "$25,073.41 " N/A N/A N/A "$50,475.56 " "$35,007.00 " "$47,474.71 " N/A "$7,756.78 " "$9,338.26 " N/A N/A N/A N/A N/A "$10,543.20 " N/A "$7,530.86 " "$7,530.86 " "$8,208.63 " N/A N/A N/A N/A N/A N/A N/A "$28,506.90 " "$23,045.79 " "$23,045.79 " "$23,045.79 " "$23,045.79 " "$13,888.19 " "$8,283.94 " "$7,530.86 " "$14,978.30 " N/A N/A N/A N/A "$7,530.86 " "$7,455.55 " "$50,475.56 " 330104 453 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC I N/A N/A "$81,040.33 " N/A "$138,988.17 " "$146,257.08 " "$133,220.65 " "$80,229.93 " N/A "$153,976.63 " N/A "$81,040.33 " "$276,886.93 " "$89,144.37 " "$341,701.08 " "$282,791.77 " N/A N/A N/A "$569,291.24 " "$394,828.21 " "$535,445.94 " N/A "$83,471.54 " "$100,490.01 " N/A N/A N/A N/A N/A "$113,456.47 " N/A "$81,040.33 " "$81,040.33 " "$88,333.96 " N/A N/A N/A N/A N/A N/A N/A "$321,516.58 " "$259,923.08 " "$259,923.08 " "$259,923.08 " "$259,923.08 " "$156,638.63 " "$89,144.37 " "$81,040.33 " "$168,933.52 " N/A N/A N/A N/A "$81,040.33 " "$80,229.93 " "$569,291.24 " 330104 454 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC I N/A N/A "$54,044.89 " N/A "$92,472.04 " "$97,308.22 " "$88,634.78 " "$53,504.44 " N/A "$102,685.29 " N/A "$54,044.89 " "$184,219.27 " "$59,449.38 " "$227,341.62 " "$188,147.90 " N/A N/A N/A "$378,762.62 " "$262,688.34 " "$356,244.56 " N/A "$55,666.24 " "$67,015.66 " N/A N/A N/A N/A N/A "$75,662.84 " N/A "$54,044.89 " "$54,044.89 " "$58,908.93 " N/A N/A N/A N/A N/A N/A N/A "$213,912.41 " "$172,932.83 " "$172,932.83 " "$172,932.83 " "$172,932.83 " "$104,215.30 " "$59,449.38 " "$54,044.89 " "$112,395.38 " N/A N/A N/A N/A "$54,044.89 " "$53,504.44 " "$378,762.62 " 330104 455 COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC I N/A N/A "$42,565.28 " N/A "$72,691.42 " "$76,493.09 " "$69,674.98 " "$42,139.63 " N/A "$80,874.04 " N/A "$42,565.28 " "$144,813.06 " "$46,821.81 " "$178,711.14 " "$147,901.32 " N/A N/A N/A "$297,741.78 " "$206,496.86 " "$280,040.54 " N/A "$43,842.24 " "$52,780.95 " N/A N/A N/A N/A N/A "$59,591.40 " N/A "$42,565.28 " "$42,565.28 " "$46,396.16 " N/A N/A N/A N/A N/A N/A N/A "$168,154.56 " "$135,940.90 " "$135,940.90 " "$135,940.90 " "$135,940.90 " "$81,922.68 " "$46,821.81 " "$42,565.28 " "$88,352.96 " N/A N/A N/A N/A "$42,565.28 " "$42,139.63 " "$297,741.78 " 330104 456 "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH MCC" I N/A N/A "$74,823.42 " N/A "$128,275.75 " "$134,984.42 " "$122,952.76 " "$74,075.19 " N/A "$142,164.51 " N/A "$74,823.42 " "$255,546.05 " "$82,305.77 " "$315,364.70 " "$260,995.79 " N/A N/A N/A "$525,413.50 " "$364,397.10 " "$494,176.81 " N/A "$77,068.13 " "$92,781.05 " N/A N/A N/A N/A N/A "$104,752.79 " N/A "$74,823.42 " "$74,823.42 " "$81,557.53 " N/A N/A N/A N/A N/A N/A N/A "$296,735.90 " "$239,889.69 " "$239,889.69 " "$239,889.69 " "$239,889.69 " "$144,565.81 " "$82,305.77 " "$74,823.42 " "$155,913.09 " N/A N/A N/A N/A "$74,823.42 " "$74,075.19 " "$525,413.50 " 330104 457 "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC" I N/A N/A "$53,568.22 " N/A "$91,650.70 " "$96,443.92 " "$87,847.51 " "$53,032.54 " N/A "$101,779.63 " N/A "$53,568.22 " "$182,583.02 " "$58,925.05 " "$225,322.35 " "$186,476.75 " N/A N/A N/A "$375,398.41 " "$260,355.11 " "$353,080.36 " N/A "$55,175.27 " "$66,424.60 " N/A N/A N/A N/A N/A "$74,995.51 " N/A "$53,568.22 " "$53,568.22 " "$58,389.36 " N/A N/A N/A N/A N/A N/A N/A "$212,012.42 " "$171,396.83 " "$171,396.83 " "$171,396.83 " "$171,396.83 " "$103,289.65 " "$58,925.05 " "$53,568.22 " "$111,397.07 " N/A N/A N/A N/A "$53,568.22 " "$53,032.54 " "$375,398.41 " 330104 458 "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITHOUT CC/MCC" I N/A N/A "$42,786.43 " N/A "$73,072.48 " "$76,894.09 " "$70,040.23 " "$42,358.57 " N/A "$81,294.23 " N/A "$42,786.43 " "$145,572.21 " "$47,065.08 " "$179,647.99 " "$148,676.66 " N/A N/A N/A "$299,302.62 " "$207,579.38 " "$281,508.59 " N/A "$44,070.03 " "$53,055.18 " N/A N/A N/A N/A N/A "$59,901.01 " N/A "$42,786.43 " "$42,786.43 " "$46,637.21 " N/A N/A N/A N/A N/A N/A N/A "$169,036.07 " "$136,653.54 " "$136,653.54 " "$136,653.54 " "$136,653.54 " "$82,352.14 " "$47,065.08 " "$42,786.43 " "$88,816.13 " N/A N/A N/A N/A "$42,786.43 " "$42,358.57 " "$299,302.62 " 330104 459 SPINAL FUSION EXCEPT CERVICAL WITH MCC I N/A N/A "$58,821.23 " N/A "$100,702.21 " "$105,968.81 " "$96,523.42 " "$58,233.02 " N/A "$111,760.34 " N/A "$58,821.23 " "$200,615.08 " "$64,703.35 " "$247,575.40 " "$204,893.37 " N/A N/A N/A "$412,473.10 " "$286,068.02 " "$387,950.90 " N/A "$60,585.87 " "$72,938.32 " N/A N/A N/A N/A N/A "$82,349.72 " N/A "$58,821.23 " "$58,821.23 " "$64,115.14 " N/A N/A N/A N/A N/A N/A N/A "$232,950.96 " "$188,324.14 " "$188,324.14 " "$188,324.14 " "$188,324.14 " "$113,490.63 " "$64,703.35 " "$58,821.23 " "$122,398.75 " N/A N/A N/A N/A "$58,821.23 " "$58,233.02 " "$412,473.10 " 330104 460 SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC I N/A N/A "$33,560.63 " N/A "$57,175.41 " "$60,165.62 " "$54,802.83 " "$33,225.03 " N/A "$63,765.21 " N/A "$33,560.63 " "$113,902.67 " "$36,916.70 " "$140,565.20 " "$116,331.74 " N/A N/A N/A "$234,188.71 " "$162,420.05 " "$220,265.81 " N/A "$34,567.45 " "$41,615.19 " N/A N/A N/A N/A N/A "$46,984.89 " N/A "$33,560.63 " "$33,560.63 " "$36,581.09 " N/A N/A N/A N/A N/A N/A N/A "$132,261.92 " "$106,924.27 " "$106,924.27 " "$106,924.27 " "$106,924.27 " "$64,436.26 " "$36,916.70 " "$33,560.63 " "$69,494.00 " N/A N/A N/A N/A "$33,560.63 " "$33,225.03 " "$234,188.71 " 330104 461 BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC I N/A N/A "$56,902.24 " N/A "$97,395.57 " "$102,489.24 " "$93,353.99 " "$56,333.21 " N/A "$108,114.25 " N/A "$56,902.24 " "$194,027.72 " "$62,592.46 " "$239,446.06 " "$198,165.53 " N/A N/A N/A "$398,929.21 " "$276,674.75 " "$375,212.22 " N/A "$58,609.30 " "$70,558.77 " N/A N/A N/A N/A N/A "$79,663.13 " N/A "$56,902.24 " "$56,902.24 " "$62,023.44 " N/A N/A N/A N/A N/A N/A N/A "$225,301.82 " "$182,140.36 " "$182,140.36 " "$182,140.36 " "$182,140.36 " "$109,764.07 " "$62,592.46 " "$56,902.24 " "$118,379.69 " N/A N/A N/A N/A "$56,902.24 " "$56,333.21 " "$398,929.21 " 330104 462 BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC I N/A N/A "$26,684.68 " N/A "$45,327.38 " "$47,697.95 " "$43,446.45 " "$26,417.83 " N/A "$50,700.89 " N/A "$26,684.68 " "$90,299.47 " "$29,353.15 " "$111,436.92 " "$92,225.18 " N/A N/A N/A "$185,659.54 " "$128,762.96 " "$174,621.77 " N/A "$27,485.22 " "$33,089.00 " N/A N/A N/A N/A N/A "$37,358.55 " N/A "$26,684.68 " "$26,684.68 " "$29,086.30 " N/A N/A N/A N/A N/A N/A N/A "$104,854.27 " "$84,767.16 " "$84,767.16 " "$84,767.16 " "$84,767.16 " "$51,083.62 " "$29,353.15 " "$26,684.68 " "$55,093.28 " N/A N/A N/A N/A "$26,684.68 " "$26,417.83 " "$185,659.54 " 330104 463 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC I N/A N/A "$46,561.87 " N/A "$79,577.97 " "$83,739.80 " "$76,275.76 " "$46,096.25 " N/A "$88,467.55 " N/A "$46,561.87 " "$158,532.19 " "$51,218.05 " "$195,641.67 " "$161,913.02 " N/A N/A N/A "$325,948.90 " "$226,059.72 " "$306,570.70 " N/A "$47,958.72 " "$57,736.72 " N/A N/A N/A N/A N/A "$65,186.61 " N/A "$46,561.87 " "$46,561.87 " "$50,752.44 " N/A N/A N/A N/A N/A N/A N/A "$184,084.99 " "$148,819.51 " "$148,819.51 " "$148,819.51 " "$148,819.51 " "$89,683.78 " "$51,218.05 " "$46,561.87 " "$96,723.24 " N/A N/A N/A N/A "$46,561.87 " "$46,096.25 " "$325,948.90 " 330104 464 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC I N/A N/A "$26,698.77 " N/A "$45,351.67 " "$47,723.51 " "$43,469.73 " "$26,431.79 " N/A "$50,727.67 " N/A "$26,698.77 " "$90,347.86 " "$29,368.65 " "$111,496.64 " "$92,274.61 " N/A N/A N/A "$185,759.03 " "$128,831.96 " "$174,715.35 " N/A "$27,499.74 " "$33,106.48 " N/A N/A N/A N/A N/A "$37,378.28 " N/A "$26,698.77 " "$26,698.77 " "$29,101.66 " N/A N/A N/A N/A N/A N/A N/A "$104,910.46 " "$84,812.58 " "$84,812.58 " "$84,812.58 " "$84,812.58 " "$51,110.99 " "$29,368.65 " "$26,698.77 " "$55,122.80 " N/A N/A N/A N/A "$26,698.77 " "$26,431.79 " "$185,759.03 " 330104 465 WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC I N/A N/A "$17,936.42 " N/A "$30,253.17 " "$31,835.38 " "$28,997.77 " "$17,757.06 " N/A "$34,079.20 " N/A "$17,936.42 " "$60,269.21 " "$19,730.07 " "$74,377.13 " "$61,554.50 " N/A N/A N/A "$123,916.05 " "$85,941.17 " "$116,549.04 " N/A "$18,474.52 " "$22,241.16 " N/A N/A N/A N/A N/A "$25,110.99 " N/A "$17,936.42 " "$17,936.42 " "$19,550.70 " N/A N/A N/A N/A N/A N/A N/A "$69,983.62 " "$56,576.74 " "$56,576.74 " "$56,576.74 " "$56,576.74 " "$34,095.10 " "$19,730.07 " "$17,936.42 " "$36,771.29 " N/A N/A N/A N/A "$17,936.42 " "$17,757.06 " "$123,916.05 " 330104 466 REVISION OF HIP OR KNEE REPLACEMENT WITH MCC I N/A N/A "$46,592.71 " N/A "$79,631.11 " "$83,795.72 " "$76,326.70 " "$46,126.78 " N/A "$88,526.14 " N/A "$46,592.71 " "$158,638.05 " "$51,251.98 " "$195,772.31 " "$162,021.14 " N/A N/A N/A "$326,166.54 " "$226,210.67 " "$306,775.41 " N/A "$47,990.49 " "$57,774.95 " N/A N/A N/A N/A N/A "$65,229.79 " N/A "$46,592.71 " "$46,592.71 " "$50,786.05 " N/A N/A N/A N/A N/A N/A N/A "$184,207.91 " "$148,918.88 " "$148,918.88 " "$148,918.88 " "$148,918.88 " "$89,743.66 " "$51,251.98 " "$46,592.71 " "$96,787.83 " N/A N/A N/A N/A "$46,592.71 " "$46,126.78 " "$326,166.54 " 330104 467 REVISION OF HIP OR KNEE REPLACEMENT WITH CC I N/A N/A "$32,326.24 " N/A "$55,048.41 " "$57,927.38 " "$52,764.10 " "$32,002.98 " N/A "$61,419.86 " N/A "$32,326.24 " "$109,665.35 " "$35,558.86 " "$135,335.99 " "$112,004.05 " N/A N/A N/A "$225,476.59 " "$156,377.82 " "$212,071.64 " N/A "$33,296.03 " "$40,084.54 " N/A N/A N/A N/A N/A "$45,256.74 " N/A "$32,326.24 " "$32,326.24 " "$35,235.60 " N/A N/A N/A N/A N/A N/A N/A "$127,341.61 " "$102,946.55 " "$102,946.55 " "$102,946.55 " "$102,946.55 " "$62,039.15 " "$35,558.86 " "$32,326.24 " "$66,908.73 " N/A N/A N/A N/A "$32,326.24 " "$32,002.98 " "$225,476.59 " 330104 468 REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC I N/A N/A "$24,955.12 " N/A "$42,347.15 " "$44,561.86 " "$40,589.89 " "$24,705.56 " N/A "$47,414.72 " N/A "$24,955.12 " "$84,362.38 " "$27,450.63 " "$104,110.06 " "$86,161.48 " N/A N/A N/A "$173,452.62 " "$120,296.93 " "$163,140.58 " N/A "$25,703.77 " "$30,944.34 " N/A N/A N/A N/A N/A "$34,937.16 " N/A "$24,955.12 " "$24,955.12 " "$27,201.08 " N/A N/A N/A N/A N/A N/A N/A "$97,960.22 " "$79,193.81 " "$79,193.81 " "$79,193.81 " "$79,193.81 " "$47,724.92 " "$27,450.63 " "$24,955.12 " "$51,470.95 " N/A N/A N/A N/A "$24,955.12 " "$24,705.56 " "$173,452.62 " 330104 469 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT I N/A N/A "$28,850.37 " N/A "$49,059.11 " "$51,624.85 " "$47,023.33 " "$28,561.87 " N/A "$54,815.71 " N/A "$28,850.37 " "$97,733.69 " "$31,735.41 " "$120,611.36 " "$99,817.95 " N/A N/A N/A "$200,944.61 " "$139,363.82 " "$188,998.12 " N/A "$29,715.89 " "$35,774.46 " N/A N/A N/A N/A N/A "$40,390.52 " N/A "$28,850.37 " "$28,850.37 " "$31,446.91 " N/A N/A N/A N/A N/A N/A N/A "$113,486.77 " "$91,745.91 " "$91,745.91 " "$91,745.91 " "$91,745.91 " "$55,289.25 " "$31,735.41 " "$28,850.37 " "$59,629.02 " N/A N/A N/A N/A "$28,850.37 " "$28,561.87 " "$200,944.61 " 330104 470 MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC I N/A N/A "$17,224.51 " N/A "$29,026.47 " "$30,544.51 " "$27,821.97 " "$17,052.26 " N/A "$32,726.57 " N/A "$17,224.51 " "$57,825.42 " "$18,946.96 " "$71,361.29 " "$59,058.59 " N/A N/A N/A "$118,891.50 " "$82,456.42 " "$111,823.21 " N/A "$17,741.24 " "$21,358.39 " N/A N/A N/A N/A N/A "$24,114.31 " N/A "$17,224.51 " "$17,224.51 " "$18,774.72 " N/A N/A N/A N/A N/A N/A N/A "$67,145.93 " "$54,282.66 " "$54,282.66 " "$54,282.66 " "$54,282.66 " "$32,712.61 " "$18,946.96 " "$17,224.51 " "$35,280.29 " N/A N/A N/A N/A "$17,224.51 " "$17,052.26 " "$118,891.50 " 330104 471 CERVICAL SPINAL FUSION WITH MCC I N/A N/A "$44,759.18 " N/A "$76,471.73 " "$80,471.11 " "$73,298.42 " "$44,311.58 " N/A "$85,042.43 " N/A "$44,759.18 " "$152,344.07 " "$49,235.09 " "$188,005.02 " "$155,592.93 " N/A N/A N/A "$313,225.84 " "$217,235.74 " "$294,604.06 " N/A "$46,101.95 " "$55,501.38 " N/A N/A N/A N/A N/A "$62,662.85 " N/A "$44,759.18 " "$44,759.18 " "$48,787.50 " N/A N/A N/A N/A N/A N/A N/A "$176,899.44 " "$143,010.50 " "$143,010.50 " "$143,010.50 " "$143,010.50 " "$86,183.07 " "$49,235.09 " "$44,759.18 " "$92,947.76 " N/A N/A N/A N/A "$44,759.18 " "$44,311.58 " "$313,225.84 " 330104 472 CERVICAL SPINAL FUSION WITH CC I N/A N/A "$27,437.12 " N/A "$46,623.92 " "$49,062.30 " "$44,689.19 " "$27,162.75 " N/A "$52,130.53 " N/A "$27,437.12 " "$92,882.40 " "$30,180.83 " "$114,624.46 " "$94,863.19 " N/A N/A N/A "$190,970.14 " "$132,446.09 " "$179,616.65 " N/A "$28,260.23 " "$34,022.03 " N/A N/A N/A N/A N/A "$38,411.97 " N/A "$27,437.12 " "$27,437.12 " "$29,906.46 " N/A N/A N/A N/A N/A N/A N/A "$107,853.52 " "$87,191.83 " "$87,191.83 " "$87,191.83 " "$87,191.83 " "$52,544.81 " "$30,180.83 " "$27,437.12 " "$56,669.16 " N/A N/A N/A N/A "$27,437.12 " "$27,162.75 " "$190,970.14 " 330104 473 CERVICAL SPINAL FUSION WITHOUT CC/MCC I N/A N/A "$22,715.41 " N/A "$38,487.89 " "$40,500.76 " "$36,890.78 " "$22,488.25 " N/A "$43,159.27 " N/A "$22,715.41 " "$76,674.10 " "$24,986.95 " "$94,622.10 " "$78,309.24 " N/A N/A N/A "$157,645.19 " "$109,333.79 " "$148,272.93 " N/A "$23,396.87 " "$28,167.10 " N/A N/A N/A N/A N/A "$31,801.57 " N/A "$22,715.41 " "$22,715.41 " "$24,759.79 " N/A N/A N/A N/A N/A N/A N/A "$89,032.71 " "$71,976.56 " "$71,976.56 " "$71,976.56 " "$71,976.56 " "$43,375.56 " "$24,986.95 " "$22,715.41 " "$46,780.20 " N/A N/A N/A N/A "$22,715.41 " "$22,488.25 " "$157,645.19 " 330104 474 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC I N/A N/A "$36,476.13 " N/A "$62,199.14 " "$65,452.07 " "$59,618.09 " "$36,111.37 " N/A "$69,304.65 " N/A "$36,476.13 " "$123,910.74 " "$40,123.75 " "$152,915.97 " "$126,553.24 " N/A N/A N/A "$254,765.73 " "$176,691.10 " "$239,619.49 " N/A "$37,570.42 " "$45,230.40 " N/A N/A N/A N/A N/A "$51,066.58 " N/A "$36,476.13 " "$36,476.13 " "$39,758.98 " N/A N/A N/A N/A N/A N/A N/A "$143,883.13 " "$116,319.18 " "$116,319.18 " "$116,319.18 " "$116,319.18 " "$70,097.96 " "$40,123.75 " "$36,476.13 " "$75,600.10 " N/A N/A N/A N/A "$36,476.13 " "$36,111.37 " "$254,765.73 " 330104 475 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC I N/A N/A "$19,949.69 " N/A "$33,722.26 " "$35,485.89 " "$32,322.90 " "$19,750.20 " N/A "$37,904.42 " N/A "$19,949.69 " "$67,180.19 " "$21,944.66 " "$82,905.85 " "$68,612.87 " N/A N/A N/A "$138,125.32 " "$95,795.91 " "$129,913.55 " N/A "$20,548.18 " "$24,737.62 " N/A N/A N/A N/A N/A "$27,929.57 " N/A "$19,949.69 " "$19,949.69 " "$21,745.17 " N/A N/A N/A N/A N/A N/A N/A "$78,008.54 " "$63,064.31 " "$63,064.31 " "$63,064.31 " "$63,064.31 " "$38,004.73 " "$21,944.66 " "$19,949.69 " "$40,987.80 " N/A N/A N/A N/A "$19,949.69 " "$19,750.20 " "$138,125.32 " 330104 476 AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC I N/A N/A "$11,194.39 " N/A "$18,635.90 " "$19,610.54 " "$17,862.58 " "$11,082.45 " N/A "$21,269.34 " N/A "$11,194.39 " "$37,125.74 " "$12,313.83 " "$45,816.19 " "$37,917.47 " N/A N/A N/A "$76,332.09 " "$52,939.62 " "$71,794.02 " N/A "$11,530.22 " "$13,881.04 " N/A N/A N/A N/A N/A "$15,672.15 " N/A "$11,194.39 " "$11,194.39 " "$12,201.89 " N/A N/A N/A N/A N/A N/A N/A "$43,109.80 " "$34,851.18 " "$34,851.18 " "$34,851.18 " "$34,851.18 " "$21,002.53 " "$12,313.83 " "$11,194.39 " "$22,651.06 " N/A N/A N/A N/A "$11,194.39 " "$11,082.45 " "$76,332.09 " 330104 477 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC I N/A N/A "$30,360.55 " N/A "$51,661.31 " "$54,363.13 " "$49,517.55 " "$30,056.94 " N/A "$57,685.04 " N/A "$30,360.55 " "$102,917.69 " "$33,396.60 " "$127,008.83 " "$105,112.49 " N/A N/A N/A "$211,603.12 " "$146,755.96 " "$199,022.97 " N/A "$31,271.36 " "$37,647.08 " N/A N/A N/A N/A N/A "$42,504.77 " N/A "$30,360.55 " "$30,360.55 " "$33,093.00 " N/A N/A N/A N/A N/A N/A N/A "$119,506.34 " "$96,612.30 " "$96,612.30 " "$96,612.30 " "$96,612.30 " "$58,221.91 " "$33,396.60 " "$30,360.55 " "$62,791.87 " N/A N/A N/A N/A "$30,360.55 " "$30,056.94 " "$211,603.12 " 330104 478 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC I N/A N/A "$21,074.83 " N/A "$35,661.00 " "$37,526.03 " "$34,181.19 " "$20,864.09 " N/A "$40,042.18 " N/A "$21,074.83 " "$71,042.48 " "$23,182.32 " "$87,672.22 " "$72,557.52 " N/A N/A N/A "$146,066.35 " "$101,303.36 " "$137,382.46 " N/A "$21,707.08 " "$26,132.79 " N/A N/A N/A N/A N/A "$29,504.77 " N/A "$21,074.83 " "$21,074.83 " "$22,971.57 " N/A N/A N/A N/A N/A N/A N/A "$82,493.37 " "$66,689.97 " "$66,689.97 " "$66,689.97 " "$66,689.97 " "$40,189.68 " "$23,182.32 " "$21,074.83 " "$43,344.25 " N/A N/A N/A N/A "$21,074.83 " "$20,864.09 " "$146,066.35 " 330104 479 BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC I N/A N/A "$15,960.16 " N/A "$26,847.85 " "$28,251.96 " "$25,733.76 " "$15,800.56 " N/A "$30,324.30 " N/A "$15,960.16 " "$53,485.26 " "$17,556.17 " "$66,005.18 " "$54,625.88 " N/A N/A N/A "$109,967.95 " "$76,267.56 " "$103,430.18 " N/A "$16,438.96 " "$19,790.60 " N/A N/A N/A N/A N/A "$22,344.22 " N/A "$15,960.16 " "$15,960.16 " "$17,396.57 " N/A N/A N/A N/A N/A N/A N/A "$62,106.21 " "$50,208.41 " "$50,208.41 " "$50,208.41 " "$50,208.41 " "$30,257.32 " "$17,556.17 " "$15,960.16 " "$32,632.29 " N/A N/A N/A N/A "$15,960.16 " "$15,800.56 " "$109,967.95 " 330104 480 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC I N/A N/A "$26,511.99 " N/A "$45,029.81 " "$47,384.82 " "$43,161.23 " "$26,246.87 " N/A "$50,372.77 " N/A "$26,511.99 " "$89,706.67 " "$29,163.18 " "$110,705.36 " "$91,619.74 " N/A N/A N/A "$184,440.71 " "$127,917.65 " "$173,475.41 " N/A "$27,307.35 " "$32,874.86 " N/A N/A N/A N/A N/A "$37,116.78 " N/A "$26,511.99 " "$26,511.99 " "$28,898.06 " N/A N/A N/A N/A N/A N/A N/A "$104,165.92 " "$84,210.67 " "$84,210.67 " "$84,210.67 " "$84,210.67 " "$50,748.26 " "$29,163.18 " "$26,511.99 " "$54,731.60 " N/A N/A N/A N/A "$26,511.99 " "$26,246.87 " "$184,440.71 " 330104 481 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC I N/A N/A "$18,991.08 " N/A "$32,070.46 " "$33,747.70 " "$30,739.64 " "$18,801.17 " N/A "$36,083.05 " N/A "$18,991.08 " "$63,889.54 " "$20,890.19 " "$78,844.91 " "$65,252.04 " N/A N/A N/A "$131,359.59 " "$91,103.59 " "$123,550.05 " N/A "$19,560.81 " "$23,548.94 " N/A N/A N/A N/A N/A "$26,587.51 " N/A "$18,991.08 " "$18,991.08 " "$20,700.27 " N/A N/A N/A N/A N/A N/A N/A "$74,187.49 " "$59,975.26 " "$59,975.26 " "$59,975.26 " "$59,975.26 " "$36,143.16 " "$20,890.19 " "$18,991.08 " "$38,980.12 " N/A N/A N/A N/A "$18,991.08 " "$18,801.17 " "$131,359.59 " 330104 482 HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC I N/A N/A "$14,882.60 " N/A "$24,991.09 " "$26,298.09 " "$23,954.05 " "$14,733.77 " N/A "$28,276.93 " N/A "$14,882.60 " "$49,786.29 " "$16,370.86 " "$61,440.35 " "$50,848.03 " N/A N/A N/A "$102,362.73 " "$70,993.00 " "$96,277.10 " N/A "$15,329.07 " "$18,454.42 " N/A N/A N/A N/A N/A "$20,835.63 " N/A "$14,882.60 " "$14,882.60 " "$16,222.03 " N/A N/A N/A N/A N/A N/A N/A "$57,811.03 " "$46,736.07 " "$46,736.07 " "$46,736.07 " "$46,736.07 " "$28,164.77 " "$16,370.86 " "$14,882.60 " "$30,375.48 " N/A N/A N/A N/A "$14,882.60 " "$14,733.77 " "$102,362.73 " 330104 483 MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES I N/A N/A "$21,151.49 " N/A "$35,793.08 " "$37,665.02 " "$34,307.80 " "$20,939.97 " N/A "$40,187.83 " N/A "$21,151.49 " "$71,305.61 " "$23,266.64 " "$87,996.95 " "$72,826.26 " N/A N/A N/A "$146,607.36 " "$101,678.57 " "$137,891.31 " N/A "$21,786.03 " "$26,227.85 " N/A N/A N/A N/A N/A "$29,612.08 " N/A "$21,151.49 " "$21,151.49 " "$23,055.12 " N/A N/A N/A N/A N/A N/A N/A "$82,798.91 " "$66,936.98 " "$66,936.98 " "$66,936.98 " "$66,936.98 " "$40,338.54 " "$23,266.64 " "$21,151.49 " "$43,504.79 " N/A N/A N/A N/A "$21,151.49 " "$20,939.97 " "$146,607.36 " 330104 485 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH MCC I N/A N/A "$29,023.07 " N/A "$49,356.68 " "$51,937.98 " "$47,308.55 " "$28,732.84 " N/A "$55,143.83 " N/A "$29,023.07 " "$98,326.50 " "$31,925.37 " "$121,342.92 " "$100,423.39 " N/A N/A N/A "$202,163.44 " "$140,209.13 " "$190,144.49 " N/A "$29,893.76 " "$35,988.60 " N/A N/A N/A N/A N/A "$40,632.29 " N/A "$29,023.07 " "$29,023.07 " "$31,635.14 " N/A N/A N/A N/A N/A N/A N/A "$114,175.12 " "$92,302.39 " "$92,302.39 " "$92,302.39 " "$92,302.39 " "$55,624.61 " "$31,925.37 " "$29,023.07 " "$59,990.70 " N/A N/A N/A N/A "$29,023.07 " "$28,732.84 " "$202,163.44 " 330104 486 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITH CC I N/A N/A "$18,758.47 " N/A "$31,669.65 " "$33,325.94 " "$30,355.47 " "$18,570.89 " N/A "$35,641.10 " N/A "$18,758.47 " "$63,091.07 " "$20,634.32 " "$77,859.53 " "$64,436.54 " N/A N/A N/A "$129,717.91 " "$89,965.01 " "$122,005.97 " N/A "$19,321.23 " "$23,260.51 " N/A N/A N/A N/A N/A "$26,261.86 " N/A "$18,758.47 " "$18,758.47 " "$20,446.73 " N/A N/A N/A N/A N/A N/A N/A "$73,260.32 " "$59,225.71 " "$59,225.71 " "$59,225.71 " "$59,225.71 " "$35,691.46 " "$20,634.32 " "$18,758.47 " "$38,492.96 " N/A N/A N/A N/A "$18,758.47 " "$18,570.89 " "$129,717.91 " 330104 487 KNEE PROCEDURES WITH PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC I N/A N/A "$14,511.66 " N/A "$24,351.93 " "$25,625.50 " "$23,341.41 " "$14,366.54 " N/A "$27,572.16 " N/A "$14,511.66 " "$48,512.98 " "$15,962.83 " "$59,868.98 " "$49,547.56 " N/A N/A N/A "$99,744.74 " "$69,177.31 " "$93,814.75 " N/A "$14,947.01 " "$17,994.46 " N/A N/A N/A N/A N/A "$20,316.33 " N/A "$14,511.66 " "$14,511.66 " "$15,817.71 " N/A N/A N/A N/A N/A N/A N/A "$56,332.48 " "$45,540.77 " "$45,540.77 " "$45,540.77 " "$45,540.77 " "$27,444.44 " "$15,962.83 " "$14,511.66 " "$29,598.61 " N/A N/A N/A N/A "$14,511.66 " "$14,366.54 " "$99,744.74 " 330104 488 KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC I N/A N/A "$20,372.61 " N/A "$34,450.99 " "$36,252.74 " "$33,021.40 " "$20,168.89 " N/A "$38,707.96 " N/A "$20,372.61 " "$68,631.95 " "$22,409.87 " "$84,697.44 " "$70,095.59 " N/A N/A N/A "$141,110.20 " "$97,866.06 " "$132,720.97 " N/A "$20,983.79 " "$25,262.04 " N/A N/A N/A N/A N/A "$28,521.66 " N/A "$20,372.61 " "$20,372.61 " "$22,206.15 " N/A N/A N/A N/A N/A N/A N/A "$79,694.30 " "$64,427.13 " "$64,427.13 " "$64,427.13 " "$64,427.13 " "$38,826.01 " "$22,409.87 " "$20,372.61 " "$41,873.55 " N/A N/A N/A N/A "$20,372.61 " "$20,168.89 " "$141,110.20 " 330104 489 KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITHOUT CC/MCC I N/A N/A "$12,093.09 " N/A "$20,184.47 " "$21,240.09 " "$19,346.88 " "$11,972.16 " N/A "$22,976.88 " N/A "$12,093.09 " "$40,210.73 " "$13,302.40 " "$49,623.32 " "$41,068.25 " N/A N/A N/A "$82,674.96 " "$57,338.68 " "$77,759.80 " N/A "$12,455.89 " "$14,995.44 " N/A N/A N/A N/A N/A "$16,930.33 " N/A "$12,093.09 " "$12,093.09 " "$13,181.47 " N/A N/A N/A N/A N/A N/A N/A "$46,692.04 " "$37,747.16 " "$37,747.16 " "$37,747.16 " "$37,747.16 " "$22,747.74 " "$13,302.40 " "$12,093.09 " "$24,533.26 " N/A N/A N/A N/A "$12,093.09 " "$11,972.16 " "$82,674.96 " 330104 492 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC" I N/A N/A "$31,092.73 " N/A "$52,922.93 " "$55,690.74 " "$50,726.82 " "$30,781.80 " N/A "$59,076.18 " N/A "$31,092.73 " "$105,431.05 " "$34,202.00 " "$130,110.52 " "$107,679.45 " N/A N/A N/A "$216,770.69 " "$150,339.90 " "$203,883.32 " N/A "$32,025.51 " "$38,554.98 " N/A N/A N/A N/A N/A "$43,529.82 " N/A "$31,092.73 " "$31,092.73 " "$33,891.07 " N/A N/A N/A N/A N/A N/A N/A "$122,424.81 " "$98,971.67 " "$98,971.67 " "$98,971.67 " "$98,971.67 " "$59,643.75 " "$34,202.00 " "$31,092.73 " "$64,325.31 " N/A N/A N/A N/A "$31,092.73 " "$30,781.80 " "$216,770.69 " 330104 493 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC" I N/A N/A "$21,311.84 " N/A "$36,069.40 " "$37,955.78 " "$34,572.64 " "$21,098.73 " N/A "$40,492.51 " N/A "$21,311.84 " "$71,856.07 " "$23,443.03 " "$88,676.26 " "$73,388.46 " N/A N/A N/A "$147,739.12 " "$102,463.50 " "$138,955.79 " N/A "$21,951.20 " "$26,426.69 " N/A N/A N/A N/A N/A "$29,836.58 " N/A "$21,311.84 " "$21,311.84 " "$23,229.91 " N/A N/A N/A N/A N/A N/A N/A "$83,438.10 " "$67,453.71 " "$67,453.71 " "$67,453.71 " "$67,453.71 " "$40,649.94 " "$23,443.03 " "$21,311.84 " "$43,840.64 " N/A N/A N/A N/A "$21,311.84 " "$21,098.73 " "$147,739.12 " 330104 494 "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC" I N/A N/A "$17,020.98 " N/A "$28,675.76 " "$30,175.47 " "$27,485.82 " "$16,850.77 " N/A "$32,339.86 " N/A "$17,020.98 " "$57,126.76 " "$18,723.08 " "$70,499.08 " "$58,345.03 " N/A N/A N/A "$117,455.03 " "$81,460.17 " "$110,472.13 " N/A "$17,531.61 " "$21,106.02 " N/A N/A N/A N/A N/A "$23,829.37 " N/A "$17,020.98 " "$17,020.98 " "$18,552.87 " N/A N/A N/A N/A N/A N/A N/A "$66,334.66 " "$53,626.81 " "$53,626.81 " "$53,626.81 " "$53,626.81 " "$32,317.37 " "$18,723.08 " "$17,020.98 " "$34,854.03 " N/A N/A N/A N/A "$17,020.98 " "$16,850.77 " "$117,455.03 " 330104 495 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC I N/A N/A "$33,106.00 " N/A "$56,392.02 " "$59,341.25 " "$54,051.95 " "$32,774.94 " N/A "$62,901.39 " N/A "$33,106.00 " "$112,342.03 " "$36,416.60 " "$138,639.24 " "$114,737.82 " N/A N/A N/A "$230,979.96 " "$160,194.64 " "$217,247.83 " N/A "$34,099.18 " "$41,051.44 " N/A N/A N/A N/A N/A "$46,348.40 " N/A "$33,106.00 " "$33,106.00 " "$36,085.54 " N/A N/A N/A N/A N/A N/A N/A "$130,449.73 " "$105,459.24 " "$105,459.24 " "$105,459.24 " "$105,459.24 " "$63,553.38 " "$36,416.60 " "$33,106.00 " "$68,541.82 " N/A N/A N/A N/A "$33,106.00 " "$32,774.94 " "$230,979.96 " 330104 496 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC I N/A N/A "$18,879.18 " N/A "$31,877.65 " "$33,544.81 " "$30,554.83 " "$18,690.39 " N/A "$35,870.44 " N/A "$18,879.18 " "$63,505.43 " "$20,767.10 " "$78,370.88 " "$64,859.73 " N/A N/A N/A "$130,569.84 " "$90,555.86 " "$122,807.25 " N/A "$19,445.56 " "$23,410.18 " N/A N/A N/A N/A N/A "$26,430.85 " N/A "$18,879.18 " "$18,879.18 " "$20,578.31 " N/A N/A N/A N/A N/A N/A N/A "$73,741.46 " "$59,614.68 " "$59,614.68 " "$59,614.68 " "$59,614.68 " "$35,925.87 " "$20,767.10 " "$18,879.18 " "$38,745.76 " N/A N/A N/A N/A "$18,879.18 " "$18,690.39 " "$130,569.84 " 330104 497 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC I N/A N/A "$13,786.53 " N/A "$23,102.45 " "$24,310.68 " "$22,143.78 " "$13,648.67 " N/A "$26,194.41 " N/A "$13,786.53 " "$46,023.82 " "$15,165.18 " "$56,797.15 " "$47,005.31 " N/A N/A N/A "$94,626.91 " "$65,627.88 " "$89,001.19 " N/A "$14,200.13 " "$17,095.30 " N/A N/A N/A N/A N/A "$19,301.14 " N/A "$13,786.53 " "$13,786.53 " "$15,027.32 " N/A N/A N/A N/A N/A N/A N/A "$53,442.10 " "$43,204.11 " "$43,204.11 " "$43,204.11 " "$43,204.11 " "$26,036.29 " "$15,165.18 " "$13,786.53 " "$28,079.93 " N/A N/A N/A N/A "$13,786.53 " "$13,648.67 " "$94,626.91 " 330104 498 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC I N/A N/A "$22,962.11 " N/A "$38,912.98 " "$40,948.09 " "$37,298.23 " "$22,732.49 " N/A "$43,628.01 " N/A "$22,962.11 " "$77,520.96 " "$25,258.32 " "$95,667.19 " "$79,174.16 " N/A N/A N/A "$159,386.37 " "$110,541.38 " "$149,910.59 " N/A "$23,650.97 " "$28,473.02 " N/A N/A N/A N/A N/A "$32,146.95 " N/A "$22,962.11 " "$22,962.11 " "$25,028.70 " N/A N/A N/A N/A N/A N/A N/A "$90,016.07 " "$72,771.54 " "$72,771.54 " "$72,771.54 " "$72,771.54 " "$43,854.64 " "$25,258.32 " "$22,962.11 " "$47,296.88 " N/A N/A N/A N/A "$22,962.11 " "$22,732.49 " "$159,386.37 " 330104 499 LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC I N/A N/A "$11,997.94 " N/A "$20,020.50 " "$21,067.55 " "$19,189.72 " "$11,877.96 " N/A "$22,796.08 " N/A "$11,997.94 " "$39,884.08 " "$13,197.73 " "$49,220.21 " "$40,734.64 " N/A N/A N/A "$82,003.36 " "$56,872.89 " "$77,128.13 " N/A "$12,357.87 " "$14,877.44 " N/A N/A N/A N/A N/A "$16,797.11 " N/A "$11,997.94 " "$11,997.94 " "$13,077.75 " N/A N/A N/A N/A N/A N/A N/A "$46,312.74 " "$37,440.53 " "$37,440.53 " "$37,440.53 " "$37,440.53 " "$22,562.96 " "$13,197.73 " "$11,997.94 " "$24,333.97 " N/A N/A N/A N/A "$11,997.94 " "$11,877.96 " "$82,003.36 " 330104 500 SOFT TISSUE PROCEDURES WITH MCC I N/A N/A "$28,613.36 " N/A "$48,650.72 " "$51,195.09 " "$46,631.88 " "$28,327.23 " N/A "$54,365.39 " N/A "$28,613.36 " "$96,920.10 " "$31,474.70 " "$119,607.32 " "$98,987.00 " N/A N/A N/A "$199,271.83 " "$138,203.68 " "$187,424.80 " N/A "$29,471.77 " "$35,480.57 " N/A N/A N/A N/A N/A "$40,058.71 " N/A "$28,613.36 " "$28,613.36 " "$31,188.57 " N/A N/A N/A N/A N/A N/A N/A "$112,542.04 " "$90,982.16 " "$90,982.16 " "$90,982.16 " "$90,982.16 " "$54,828.99 " "$31,474.70 " "$28,613.36 " "$59,132.64 " N/A N/A N/A N/A "$28,613.36 " "$28,327.23 " "$199,271.83 " 330104 501 SOFT TISSUE PROCEDURES WITH CC I N/A N/A "$15,866.76 " N/A "$26,686.92 " "$28,082.61 " "$25,579.51 " "$15,708.10 " N/A "$30,146.85 " N/A "$15,866.76 " "$53,164.66 " "$17,453.44 " "$65,609.53 " "$54,298.44 " N/A N/A N/A "$109,308.79 " "$75,810.40 " "$102,810.21 " N/A "$16,342.77 " "$19,674.79 " N/A N/A N/A N/A N/A "$22,213.47 " N/A "$15,866.76 " "$15,866.76 " "$17,294.77 " N/A N/A N/A N/A N/A N/A N/A "$61,733.94 " "$49,907.46 " "$49,907.46 " "$49,907.46 " "$49,907.46 " "$30,075.96 " "$17,453.44 " "$15,866.76 " "$32,436.68 " N/A N/A N/A N/A "$15,866.76 " "$15,708.10 " "$109,308.79 " 330104 502 SOFT TISSUE PROCEDURES WITHOUT CC/MCC I N/A N/A "$12,489.58 " N/A "$20,867.66 " "$21,959.01 " "$20,001.72 " "$12,364.68 " N/A "$23,730.20 " N/A "$12,489.58 " "$41,571.75 " "$13,738.54 " "$51,302.94 " "$42,458.31 " N/A N/A N/A "$85,473.28 " "$59,279.44 " "$80,391.76 " N/A "$12,864.27 " "$15,487.08 " N/A N/A N/A N/A N/A "$17,485.41 " N/A "$12,489.58 " "$12,489.58 " "$13,613.64 " N/A N/A N/A N/A N/A N/A N/A "$48,272.44 " "$39,024.80 " "$39,024.80 " "$39,024.80 " "$39,024.80 " "$23,517.69 " "$13,738.54 " "$12,489.58 " "$25,363.65 " N/A N/A N/A N/A "$12,489.58 " "$12,364.68 " "$85,473.28 " 330104 503 FOOT PROCEDURES WITH MCC I N/A N/A "$22,699.55 " N/A "$38,460.56 " "$40,472.00 " "$36,864.58 " "$22,472.55 " N/A "$43,129.14 " N/A "$22,699.55 " "$76,619.66 " "$24,969.50 " "$94,554.92 " "$78,253.64 " N/A N/A N/A "$157,533.26 " "$109,256.16 " "$148,167.65 " N/A "$23,380.53 " "$28,147.44 " N/A N/A N/A N/A N/A "$31,779.37 " N/A "$22,699.55 " "$22,699.55 " "$24,742.51 " N/A N/A N/A N/A N/A N/A N/A "$88,969.50 " "$71,925.45 " "$71,925.45 " "$71,925.45 " "$71,925.45 " "$43,344.76 " "$24,969.50 " "$22,699.55 " "$46,746.98 " N/A N/A N/A N/A "$22,699.55 " "$22,472.55 " "$157,533.26 " 330104 504 FOOT PROCEDURES WITH CC I N/A N/A "$16,016.55 " N/A "$26,945.01 " "$28,354.20 " "$25,826.89 " "$15,856.38 " N/A "$30,431.44 " N/A "$16,016.55 " "$53,678.83 " "$17,618.20 " "$66,244.06 " "$54,823.57 " N/A N/A N/A "$110,365.94 " "$76,543.57 " "$103,804.50 " N/A "$16,497.04 " "$19,860.52 " N/A N/A N/A N/A N/A "$22,423.17 " N/A "$16,016.55 " "$16,016.55 " "$17,458.04 " N/A N/A N/A N/A N/A N/A N/A "$62,330.98 " "$50,390.12 " "$50,390.12 " "$50,390.12 " "$50,390.12 " "$30,366.83 " "$17,618.20 " "$16,016.55 " "$32,750.38 " N/A N/A N/A N/A "$16,016.55 " "$15,856.38 " "$110,365.94 " 330104 505 FOOT PROCEDURES WITHOUT CC/MCC I N/A N/A "$15,946.06 " N/A "$26,823.56 " "$28,226.40 " "$25,710.47 " "$15,786.60 " N/A "$30,297.52 " N/A "$15,946.06 " "$53,436.87 " "$17,540.67 " "$65,945.46 " "$54,576.45 " N/A N/A N/A "$109,868.46 " "$76,198.55 " "$103,336.60 " N/A "$16,424.44 " "$19,773.12 " N/A N/A N/A N/A N/A "$22,324.49 " N/A "$15,946.06 " "$15,946.06 " "$17,381.21 " N/A N/A N/A N/A N/A N/A N/A "$62,050.02 " "$50,162.99 " "$50,162.99 " "$50,162.99 " "$50,162.99 " "$30,229.95 " "$17,540.67 " "$15,946.06 " "$32,602.76 " N/A N/A N/A N/A "$15,946.06 " "$15,786.60 " "$109,868.46 " 330104 506 MAJOR THUMB OR JOINT PROCEDURES I N/A N/A "$12,800.60 " N/A "$21,403.58 " "$22,522.96 " "$20,515.41 " "$12,672.60 " N/A "$24,321.14 " N/A "$12,800.60 " "$42,639.40 " "$14,080.66 " "$52,620.50 " "$43,548.72 " N/A N/A N/A "$87,668.41 " "$60,801.85 " "$82,456.38 " N/A "$13,184.62 " "$15,872.75 " N/A N/A N/A N/A N/A "$17,920.84 " N/A "$12,800.60 " "$12,800.60 " "$13,952.66 " N/A N/A N/A N/A N/A N/A N/A "$49,512.18 " "$40,027.04 " "$40,027.04 " "$40,027.04 " "$40,027.04 " "$24,121.68 " "$14,080.66 " "$12,800.60 " "$26,015.04 " N/A N/A N/A N/A "$12,800.60 " "$12,672.60 " "$87,668.41 " 330104 507 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC I N/A N/A "$16,721.41 " N/A "$28,159.57 " "$29,632.28 " "$26,991.05 " "$16,554.20 " N/A "$31,770.68 " N/A "$16,721.41 " "$56,098.43 " "$18,393.55 " "$69,230.04 " "$57,294.77 " N/A N/A N/A "$115,340.74 " "$79,993.81 " "$108,483.54 " N/A "$17,223.05 " "$20,734.55 " N/A N/A N/A N/A N/A "$23,409.98 " N/A "$16,721.41 " "$16,721.41 " "$18,226.34 " N/A N/A N/A N/A N/A N/A N/A "$65,140.58 " "$52,661.48 " "$52,661.48 " "$52,661.48 " "$52,661.48 " "$31,735.63 " "$18,393.55 " "$16,721.41 " "$34,226.62 " N/A N/A N/A N/A "$16,721.41 " "$16,554.20 " "$115,340.74 " 330104 508 MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC I N/A N/A "$13,138.94 " N/A "$21,986.57 " "$23,136.44 " "$21,074.21 " "$13,007.55 " N/A "$24,963.98 " N/A "$13,138.94 " "$43,800.81 " "$14,452.83 " "$54,053.78 " "$44,734.90 " N/A N/A N/A "$90,056.32 " "$62,457.97 " "$84,702.32 " N/A "$13,533.10 " "$16,292.28 " N/A N/A N/A N/A N/A "$18,394.51 " N/A "$13,138.94 " "$13,138.94 " "$14,321.44 " N/A N/A N/A N/A N/A N/A N/A "$50,860.78 " "$41,117.29 " "$41,117.29 " "$41,117.29 " "$41,117.29 " "$24,778.70 " "$14,452.83 " "$13,138.94 " "$26,723.63 " N/A N/A N/A N/A "$13,138.94 " "$13,007.55 " "$90,056.32 " 330104 509 ARTHROSCOPY I N/A N/A "$13,753.05 " N/A "$23,044.76 " "$24,249.97 " "$22,088.48 " "$13,615.52 " N/A "$26,130.80 " N/A "$13,753.05 " "$45,908.89 " "$15,128.36 " "$56,655.31 " "$46,887.93 " N/A N/A N/A "$94,390.61 " "$65,463.99 " "$88,778.94 " N/A "$14,165.64 " "$17,053.78 " N/A N/A N/A N/A N/A "$19,254.27 " N/A "$13,753.05 " "$13,753.05 " "$14,990.82 " N/A N/A N/A N/A N/A N/A N/A "$53,308.65 " "$43,096.22 " "$43,096.22 " "$43,096.22 " "$43,096.22 " "$25,971.27 " "$15,128.36 " "$13,753.05 " "$28,009.81 " N/A N/A N/A N/A "$13,753.05 " "$13,615.52 " "$94,390.61 " 330104 510 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC" I N/A N/A "$25,825.62 " N/A "$43,847.13 " "$46,140.29 " "$42,027.63 " "$25,567.37 " N/A "$49,068.68 " N/A "$25,825.62 " "$87,350.58 " "$28,408.19 " "$107,797.75 " "$89,213.41 " N/A N/A N/A "$179,596.50 " "$124,557.98 " "$168,919.19 " N/A "$26,600.39 " "$32,023.77 " N/A N/A N/A N/A N/A "$36,155.87 " N/A "$25,825.62 " "$25,825.62 " "$28,149.93 " N/A N/A N/A N/A N/A N/A N/A "$101,430.07 " "$81,998.94 " "$81,998.94 " "$81,998.94 " "$81,998.94 " "$49,415.39 " "$28,408.19 " "$25,825.62 " "$53,294.11 " N/A N/A N/A N/A "$25,825.62 " "$25,567.37 " "$179,596.50 " 330104 511 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC" I N/A N/A "$17,815.72 " N/A "$30,045.18 " "$31,616.50 " "$28,798.41 " "$17,637.56 " N/A "$33,849.86 " N/A "$17,815.72 " "$59,854.86 " "$19,597.29 " "$73,865.78 " "$61,131.31 " N/A N/A N/A "$123,064.12 " "$85,350.31 " "$115,747.75 " N/A "$18,350.19 " "$22,091.49 " N/A N/A N/A N/A N/A "$24,942.00 " N/A "$17,815.72 " "$17,815.72 " "$19,419.13 " N/A N/A N/A N/A N/A N/A N/A "$69,502.48 " "$56,187.77 " "$56,187.77 " "$56,187.77 " "$56,187.77 " "$33,860.69 " "$19,597.29 " "$17,815.72 " "$36,518.49 " N/A N/A N/A N/A "$17,815.72 " "$17,637.56 " "$123,064.12 " 330104 512 "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC" I N/A N/A "$14,533.69 " N/A "$24,389.88 " "$25,665.44 " "$23,377.79 " "$14,388.35 " N/A "$27,614.01 " N/A "$14,533.69 " "$48,588.59 " "$15,987.06 " "$59,962.29 " "$49,624.79 " N/A N/A N/A "$99,900.20 " "$69,285.13 " "$93,960.97 " N/A "$14,969.70 " "$18,021.77 " N/A N/A N/A N/A N/A "$20,347.16 " N/A "$14,533.69 " "$14,533.69 " "$15,841.72 " N/A N/A N/A N/A N/A N/A N/A "$56,420.28 " "$45,611.75 " "$45,611.75 " "$45,611.75 " "$45,611.75 " "$27,487.22 " "$15,987.06 " "$14,533.69 " "$29,644.74 " N/A N/A N/A N/A "$14,533.69 " "$14,388.35 " "$99,900.20 " 330104 513 "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC" I N/A N/A "$14,423.55 " N/A "$24,200.11 " "$25,465.74 " "$23,195.89 " "$14,279.32 " N/A "$27,404.75 " N/A "$14,423.55 " "$48,210.53 " "$15,865.91 " "$59,495.73 " "$49,238.66 " N/A N/A N/A "$99,122.89 " "$68,746.03 " "$93,229.87 " N/A "$14,856.26 " "$17,885.21 " N/A N/A N/A N/A N/A "$20,192.97 " N/A "$14,423.55 " "$14,423.55 " "$15,721.67 " N/A N/A N/A N/A N/A N/A N/A "$55,981.28 " "$45,256.85 " "$45,256.85 " "$45,256.85 " "$45,256.85 " "$27,273.34 " "$15,865.91 " "$14,423.55 " "$29,414.08 " N/A N/A N/A N/A "$14,423.55 " "$14,279.32 " "$99,122.89 " 330104 514 "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC" I N/A N/A "$9,478.04 " N/A "$15,678.45 " "$16,498.42 " "$15,027.85 " "$9,383.26 " N/A "$18,008.28 " N/A "$9,478.04 " "$31,234.01 " "$10,425.85 " "$38,545.32 " "$31,900.10 " N/A N/A N/A "$64,218.45 " "$44,538.29 " "$60,400.56 " N/A "$9,762.39 " "$11,752.78 " N/A N/A N/A N/A N/A "$13,269.26 " N/A "$9,478.04 " "$9,478.04 " "$10,331.07 " N/A N/A N/A N/A N/A N/A N/A "$36,268.42 " "$29,320.42 " "$29,320.42 " "$29,320.42 " "$29,320.42 " "$17,669.50 " "$10,425.85 " "$9,478.04 " "$19,056.41 " N/A N/A N/A N/A "$9,478.04 " "$9,383.26 " "$64,218.45 " 330104 515 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC I N/A N/A "$27,849.47 " N/A "$47,334.44 " "$49,809.97 " "$45,370.23 " "$27,570.97 " N/A "$52,913.99 " N/A "$27,849.47 " "$94,297.86 " "$30,634.41 " "$116,371.26 " "$96,308.84 " N/A N/A N/A "$193,880.39 " "$134,464.48 " "$182,353.89 " N/A "$28,684.95 " "$34,533.34 " N/A N/A N/A N/A N/A "$38,989.25 " N/A "$27,849.47 " "$27,849.47 " "$30,355.92 " N/A N/A N/A N/A N/A N/A N/A "$109,497.14 " "$88,520.58 " "$88,520.58 " "$88,520.58 " "$88,520.58 " "$53,345.56 " "$30,634.41 " "$27,849.47 " "$57,532.76 " N/A N/A N/A N/A "$27,849.47 " "$27,570.97 " "$193,880.39 " 330104 516 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC I N/A N/A "$18,298.55 " N/A "$30,877.15 " "$32,491.99 " "$29,595.86 " "$18,115.56 " N/A "$34,767.24 " N/A "$18,298.55 " "$61,512.28 " "$20,128.40 " "$75,911.18 " "$62,824.08 " N/A N/A N/A "$126,471.85 " "$87,713.73 " "$118,952.89 " N/A "$18,847.50 " "$22,690.20 " N/A N/A N/A N/A N/A "$25,617.97 " N/A "$18,298.55 " "$18,298.55 " "$19,945.42 " N/A N/A N/A N/A N/A N/A N/A "$71,427.06 " "$57,743.65 " "$57,743.65 " "$57,743.65 " "$57,743.65 " "$34,798.32 " "$20,128.40 " "$18,298.55 " "$37,529.71 " N/A N/A N/A N/A "$18,298.55 " "$18,115.56 " "$126,471.85 " 330104 517 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$13,682.56 " N/A "$22,923.30 " "$24,122.16 " "$21,972.06 " "$13,545.74 " N/A "$25,996.87 " N/A "$13,682.56 " "$45,666.93 " "$15,050.82 " "$56,356.72 " "$46,640.81 " N/A N/A N/A "$93,893.13 " "$65,118.97 " "$88,311.03 " N/A "$14,093.04 " "$16,966.38 " N/A N/A N/A N/A N/A "$19,155.59 " N/A "$13,682.56 " "$13,682.56 " "$14,913.99 " N/A N/A N/A N/A N/A N/A N/A "$53,027.69 " "$42,869.08 " "$42,869.08 " "$42,869.08 " "$42,869.08 " "$25,834.39 " "$15,050.82 " "$13,682.56 " "$27,862.18 " N/A N/A N/A N/A "$13,682.56 " "$13,545.74 " "$93,893.13 " 330104 518 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR I N/A N/A "$33,223.18 " N/A "$56,593.94 " "$59,553.74 " "$54,245.49 " "$32,890.95 " N/A "$63,124.04 " N/A "$33,223.18 " "$112,744.29 " "$36,545.50 " "$139,135.66 " "$115,148.65 " N/A N/A N/A "$231,807.02 " "$160,768.25 " "$218,025.72 " N/A "$34,219.88 " "$41,196.74 " N/A N/A N/A N/A N/A "$46,512.45 " N/A "$33,223.18 " "$33,223.18 " "$36,213.27 " N/A N/A N/A N/A N/A N/A N/A "$130,916.82 " "$105,836.86 " "$105,836.86 " "$105,836.86 " "$105,836.86 " "$63,780.95 " "$36,545.50 " "$33,223.18 " "$68,787.25 " N/A N/A N/A N/A "$33,223.18 " "$32,890.95 " "$231,807.02 " 330104 519 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC I N/A N/A "$17,994.57 " N/A "$30,353.37 " "$31,940.82 " "$29,093.81 " "$17,814.63 " N/A "$34,189.69 " N/A "$17,994.57 " "$60,468.83 " "$19,794.03 " "$74,623.47 " "$61,758.38 " N/A N/A N/A "$124,326.47 " "$86,225.81 " "$116,935.06 " N/A "$18,534.41 " "$22,313.27 " N/A N/A N/A N/A N/A "$25,192.40 " N/A "$17,994.57 " "$17,994.57 " "$19,614.09 " N/A N/A N/A N/A N/A N/A N/A "$70,215.42 " "$56,764.13 " "$56,764.13 " "$56,764.13 " "$56,764.13 " "$34,208.02 " "$19,794.03 " "$17,994.57 " "$36,893.08 " N/A N/A N/A N/A "$17,994.57 " "$17,814.63 " "$124,326.47 " 330104 520 BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC I N/A N/A "$13,417.36 " N/A "$22,466.32 " "$23,641.28 " "$21,534.05 " "$13,283.18 " N/A "$25,492.98 " N/A "$13,417.36 " "$44,756.55 " "$14,759.09 " "$55,233.24 " "$45,711.02 " N/A N/A N/A "$92,021.36 " "$63,820.81 " "$86,550.54 " N/A "$13,819.88 " "$16,637.52 " N/A N/A N/A N/A N/A "$18,784.30 " N/A "$13,417.36 " "$13,417.36 " "$14,624.92 " N/A N/A N/A N/A N/A N/A N/A "$51,970.58 " "$42,014.48 " "$42,014.48 " "$42,014.48 " "$42,014.48 " "$25,319.38 " "$14,759.09 " "$13,417.36 " "$27,306.75 " N/A N/A N/A N/A "$13,417.36 " "$13,283.18 " "$92,021.36 " 330104 521 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC I N/A N/A "$26,980.72 " N/A "$45,837.49 " "$48,234.74 " "$43,935.40 " "$26,710.91 " N/A "$51,263.37 " N/A "$26,980.72 " "$91,315.70 " "$29,678.79 " "$112,691.04 " "$93,263.09 " N/A N/A N/A "$187,748.95 " "$130,212.06 " "$176,586.97 " N/A "$27,790.14 " "$33,456.09 " N/A N/A N/A N/A N/A "$37,773.01 " N/A "$26,980.72 " "$26,980.72 " "$29,408.99 " N/A N/A N/A N/A N/A N/A N/A "$106,034.30 " "$85,721.13 " "$85,721.13 " "$85,721.13 " "$85,721.13 " "$51,658.51 " "$29,678.79 " "$26,980.72 " "$55,713.30 " N/A N/A N/A N/A "$26,980.72 " "$26,710.91 " "$187,748.95 " 330104 522 HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC I N/A N/A "$19,524.13 " N/A "$32,988.97 " "$34,714.25 " "$31,620.04 " "$19,328.89 " N/A "$37,095.85 " N/A "$19,524.13 " "$65,719.36 " "$21,476.54 " "$81,103.06 " "$67,120.88 " N/A N/A N/A "$135,121.79 " "$93,712.83 " "$127,088.58 " N/A "$20,109.86 " "$24,209.92 " N/A N/A N/A N/A N/A "$27,333.78 " N/A "$19,524.13 " "$19,524.13 " "$21,281.30 " N/A N/A N/A N/A N/A N/A N/A "$76,312.25 " "$61,692.98 " "$61,692.98 " "$61,692.98 " "$61,692.98 " "$37,178.32 " "$21,476.54 " "$19,524.13 " "$40,096.52 " N/A N/A N/A N/A "$19,524.13 " "$19,328.89 " "$135,121.79 " 330104 533 FRACTURES OF FEMUR WITH MCC I N/A N/A "$12,945.98 " N/A "$21,654.09 " "$22,786.57 " "$20,755.52 " "$12,816.52 " N/A "$24,597.36 " N/A "$12,945.98 " "$43,138.44 " "$14,240.58 " "$53,236.36 " "$44,058.41 " N/A N/A N/A "$88,694.47 " "$61,513.47 " "$83,421.43 " N/A "$13,334.36 " "$16,053.01 " N/A N/A N/A N/A N/A "$18,124.37 " N/A "$12,945.98 " "$12,945.98 " "$14,111.12 " N/A N/A N/A N/A N/A N/A N/A "$50,091.66 " "$40,495.51 " "$40,495.51 " "$40,495.51 " "$40,495.51 " "$24,403.99 " "$14,240.58 " "$12,945.98 " "$26,319.51 " N/A N/A N/A N/A "$12,945.98 " "$12,816.52 " "$88,694.47 " 330104 534 FRACTURES OF FEMUR WITHOUT MCC I N/A N/A "$7,391.64 " N/A "$12,083.35 " "$12,715.30 " "$11,581.94 " "$7,317.73 " N/A "$14,044.12 " N/A "$7,391.64 " "$24,072.00 " "$8,130.81 " "$29,706.81 " "$24,585.35 " N/A N/A N/A "$49,493.04 " "$34,325.58 " "$46,550.60 " N/A "$7,613.39 " "$9,165.64 " N/A N/A N/A N/A N/A "$10,348.30 " N/A "$7,391.64 " "$7,391.64 " "$8,056.89 " N/A N/A N/A N/A N/A N/A N/A "$27,952.01 " "$22,597.19 " "$22,597.19 " "$22,597.19 " "$22,597.19 " "$13,617.85 " "$8,130.81 " "$7,391.64 " "$14,686.74 " N/A N/A N/A N/A "$7,391.64 " "$7,317.73 " "$49,493.04 " 330104 535 FRACTURES OF HIP AND PELVIS WITH MCC I N/A N/A "$11,740.66 " N/A "$19,577.19 " "$20,601.05 " "$18,764.80 " "$11,623.25 " N/A "$22,307.26 " N/A "$11,740.66 " "$39,000.93 " "$12,914.73 " "$48,130.33 " "$39,832.66 " N/A N/A N/A "$80,187.56 " "$55,613.56 " "$75,420.28 " N/A "$12,092.88 " "$14,558.42 " N/A N/A N/A N/A N/A "$16,436.93 " N/A "$11,740.66 " "$11,740.66 " "$12,797.32 " N/A N/A N/A N/A N/A N/A N/A "$45,287.24 " "$36,611.48 " "$36,611.48 " "$36,611.48 " "$36,611.48 " "$22,063.35 " "$12,914.73 " "$11,740.66 " "$23,795.14 " N/A N/A N/A N/A "$11,740.66 " "$11,623.25 " "$80,187.56 " 330104 536 FRACTURES OF HIP AND PELVIS WITHOUT MCC I N/A N/A "$7,226.00 " N/A "$11,797.93 " "$12,414.95 " "$11,308.36 " "$7,153.74 " N/A "$13,729.40 " N/A "$7,226.00 " "$23,503.39 " "$7,948.60 " "$29,005.10 " "$24,004.62 " N/A N/A N/A "$48,323.96 " "$33,514.77 " "$45,451.02 " N/A "$7,442.78 " "$8,960.24 " N/A N/A N/A N/A N/A "$10,116.40 " N/A "$7,226.00 " "$7,226.00 " "$7,876.34 " N/A N/A N/A N/A N/A N/A N/A "$27,291.75 " "$22,063.42 " "$22,063.42 " "$22,063.42 " "$22,063.42 " "$13,296.18 " "$7,948.60 " "$7,226.00 " "$14,339.83 " N/A N/A N/A N/A "$7,226.00 " "$7,153.74 " "$48,323.96 " 330104 537 "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC" I N/A N/A "$9,131.78 " N/A "$15,081.80 " "$15,870.56 " "$14,455.96 " "$9,040.46 " N/A "$17,350.38 " N/A "$9,131.78 " "$30,045.38 " "$10,044.96 " "$37,078.46 " "$30,686.13 " N/A N/A N/A "$61,774.58 " "$42,843.36 " "$58,101.98 " N/A "$9,405.73 " "$11,323.41 " N/A N/A N/A N/A N/A "$12,784.49 " N/A "$9,131.78 " "$9,131.78 " "$9,953.64 " N/A N/A N/A N/A N/A N/A N/A "$34,888.21 " "$28,204.61 " "$28,204.61 " "$28,204.61 " "$28,204.61 " "$16,997.07 " "$10,044.96 " "$9,131.78 " "$18,331.21 " N/A N/A N/A N/A "$9,131.78 " "$9,040.46 " "$61,774.58 " 330104 538 "SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC" I N/A N/A "$6,513.21 " N/A "$10,569.71 " "$11,122.49 " "$10,131.10 " "$6,448.07 " N/A "$12,375.09 " N/A "$6,513.21 " "$21,056.57 " "$7,164.53 " "$25,985.53 " "$21,505.62 " N/A N/A N/A "$43,293.20 " "$30,025.71 " "$40,719.35 " N/A "$6,708.60 " "$8,076.38 " N/A N/A N/A N/A N/A "$9,118.49 " N/A "$6,513.21 " "$6,513.21 " "$7,099.40 " N/A N/A N/A N/A N/A N/A N/A "$24,450.54 " "$19,766.51 " "$19,766.51 " "$19,766.51 " "$19,766.51 " "$11,911.98 " "$7,164.53 " "$6,513.21 " "$12,846.98 " N/A N/A N/A N/A "$6,513.21 " "$6,448.07 " "$43,293.20 " 330104 539 OSTEOMYELITIS WITH MCC I N/A N/A "$17,964.62 " N/A "$30,301.75 " "$31,886.50 " "$29,044.34 " "$17,784.97 " N/A "$34,132.77 " N/A "$17,964.62 " "$60,366.00 " "$19,761.08 " "$74,496.57 " "$61,653.35 " N/A N/A N/A "$124,115.04 " "$86,079.18 " "$116,736.20 " N/A "$18,503.56 " "$22,276.13 " N/A N/A N/A N/A N/A "$25,150.46 " N/A "$17,964.62 " "$17,964.62 " "$19,581.43 " N/A N/A N/A N/A N/A N/A N/A "$70,096.01 " "$56,667.59 " "$56,667.59 " "$56,667.59 " "$56,667.59 " "$34,149.85 " "$19,761.08 " "$17,964.62 " "$36,830.34 " N/A N/A N/A N/A "$17,964.62 " "$17,784.97 " "$124,115.04 " 330104 540 OSTEOMYELITIS WITH CC I N/A N/A "$12,243.76 " N/A "$20,444.08 " "$21,513.28 " "$19,595.72 " "$12,121.32 " N/A "$23,263.14 " N/A "$12,243.76 " "$40,727.92 " "$13,468.13 " "$50,261.58 " "$41,596.47 " N/A N/A N/A "$83,738.32 " "$58,076.16 " "$78,759.94 " N/A "$12,611.07 " "$15,182.26 " N/A N/A N/A N/A N/A "$17,141.26 " N/A "$12,243.76 " "$12,243.76 " "$13,345.70 " N/A N/A N/A N/A N/A N/A N/A "$47,292.59 " "$38,232.67 " "$38,232.67 " "$38,232.67 " "$38,232.67 " "$23,040.33 " "$13,468.13 " "$12,243.76 " "$24,848.81 " N/A N/A N/A N/A "$12,243.76 " "$12,121.32 " "$83,738.32 " 330104 541 OSTEOMYELITIS WITHOUT CC/MCC I N/A N/A "$7,586.36 " N/A "$12,418.88 " "$13,068.37 " "$11,903.54 " "$7,510.50 " N/A "$14,414.09 " N/A "$7,586.36 " "$24,740.41 " "$8,345.00 " "$30,531.69 " "$25,268.02 " N/A N/A N/A "$50,867.33 " "$35,278.70 " "$47,843.18 " N/A "$7,813.95 " "$9,407.09 " N/A N/A N/A N/A N/A "$10,620.91 " N/A "$7,586.36 " "$7,586.36 " "$8,269.14 " N/A N/A N/A N/A N/A N/A N/A "$28,728.16 " "$23,224.66 " "$23,224.66 " "$23,224.66 " "$23,224.66 " "$13,995.98 " "$8,345.00 " "$7,586.36 " "$15,094.55 " N/A N/A N/A N/A "$7,586.36 " "$7,510.50 " "$50,867.33 " 330104 542 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC I N/A N/A "$16,485.28 " N/A "$27,752.70 " "$29,204.13 " "$26,601.06 " "$16,320.43 " N/A "$31,322.04 " N/A "$16,485.28 " "$55,287.86 " "$18,133.81 " "$68,229.73 " "$56,466.92 " N/A N/A N/A "$113,674.18 " "$78,837.98 " "$106,916.06 " N/A "$16,979.84 " "$20,441.75 " N/A N/A N/A N/A N/A "$23,079.40 " N/A "$16,485.28 " "$16,485.28 " "$17,968.96 " N/A N/A N/A N/A N/A N/A N/A "$64,199.36 " "$51,900.58 " "$51,900.58 " "$51,900.58 " "$51,900.58 " "$31,277.08 " "$18,133.81 " "$16,485.28 " "$33,732.08 " N/A N/A N/A N/A "$16,485.28 " "$16,320.43 " "$113,674.18 " 330104 543 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC I N/A N/A "$9,974.09 " N/A "$16,533.20 " "$17,397.86 " "$15,847.13 " "$9,874.35 " N/A "$18,950.78 " N/A "$9,974.09 " "$32,936.81 " "$10,971.50 " "$40,646.71 " "$33,639.21 " N/A N/A N/A "$67,719.46 " "$46,966.39 " "$63,693.43 " N/A "$10,273.32 " "$12,367.88 " N/A N/A N/A N/A N/A "$13,963.73 " N/A "$9,974.09 " "$9,974.09 " "$10,871.76 " N/A N/A N/A N/A N/A N/A N/A "$38,245.68 " "$30,918.89 " "$30,918.89 " "$30,918.89 " "$30,918.89 " "$18,632.79 " "$10,971.50 " "$9,974.09 " "$20,095.32 " N/A N/A N/A N/A "$9,974.09 " "$9,874.35 " "$67,719.46 " 330104 544 PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC I N/A N/A "$7,234.81 " N/A "$11,813.11 " "$12,430.93 " "$11,322.91 " "$7,162.46 " N/A "$13,746.14 " N/A "$7,234.81 " "$23,533.63 " "$7,958.29 " "$29,042.43 " "$24,035.51 " N/A N/A N/A "$48,386.15 " "$33,557.90 " "$45,509.51 " N/A "$7,451.86 " "$8,971.17 " N/A N/A N/A N/A N/A "$10,128.74 " N/A "$7,234.81 " "$7,234.81 " "$7,885.95 " N/A N/A N/A N/A N/A N/A N/A "$27,326.87 " "$22,091.82 " "$22,091.82 " "$22,091.82 " "$22,091.82 " "$13,313.29 " "$7,958.29 " "$7,234.81 " "$14,358.28 " N/A N/A N/A N/A "$7,234.81 " "$7,162.46 " "$48,386.15 " 330104 545 CONNECTIVE TISSUE DISORDERS WITH MCC I N/A N/A "$22,481.92 " N/A "$38,085.57 " "$40,077.39 " "$36,505.15 " "$22,257.10 " N/A "$42,715.65 " N/A "$22,481.92 " "$75,872.61 " "$24,730.11 " "$93,632.99 " "$77,490.65 " N/A N/A N/A "$155,997.29 " "$108,190.90 " "$146,723.00 " N/A "$23,156.38 " "$27,877.58 " N/A N/A N/A N/A N/A "$31,474.69 " N/A "$22,481.92 " "$22,481.92 " "$24,505.29 " N/A N/A N/A N/A N/A N/A N/A "$88,102.03 " "$71,224.17 " "$71,224.17 " "$71,224.17 " "$71,224.17 " "$42,922.15 " "$24,730.11 " "$22,481.92 " "$46,291.20 " N/A N/A N/A N/A "$22,481.92 " "$22,257.10 " "$155,997.29 " 330104 546 CONNECTIVE TISSUE DISORDERS WITH CC I N/A N/A "$11,001.43 " N/A "$18,303.42 " "$19,260.67 " "$17,543.89 " "$10,891.42 " N/A "$20,902.72 " N/A "$11,001.43 " "$36,463.37 " "$12,101.58 " "$44,998.78 " "$37,240.98 " N/A N/A N/A "$74,970.24 " "$51,995.12 " "$70,513.13 " N/A "$11,331.48 " "$13,641.78 " N/A N/A N/A N/A N/A "$15,402.01 " N/A "$11,001.43 " "$11,001.43 " "$11,991.56 " N/A N/A N/A N/A N/A N/A N/A "$42,340.67 " "$34,229.40 " "$34,229.40 " "$34,229.40 " "$34,229.40 " "$20,627.82 " "$12,101.58 " "$11,001.43 " "$22,246.94 " N/A N/A N/A N/A "$11,001.43 " "$10,891.42 " "$74,970.24 " 330104 547 CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC I N/A N/A "$8,439.25 " N/A "$13,888.49 " "$14,614.84 " "$13,312.17 " "$8,354.86 " N/A "$16,034.57 " N/A "$8,439.25 " "$27,668.13 " "$9,283.17 " "$34,144.73 " "$28,258.17 " N/A N/A N/A "$56,886.84 " "$39,453.49 " "$53,504.82 " N/A "$8,692.43 " "$10,464.67 " N/A N/A N/A N/A N/A "$11,814.95 " N/A "$8,439.25 " "$8,439.25 " "$9,198.78 " N/A N/A N/A N/A N/A N/A N/A "$32,127.78 " "$25,973.00 " "$25,973.00 " "$25,973.00 " "$25,973.00 " "$15,652.23 " "$9,283.17 " "$8,439.25 " "$16,880.80 " N/A N/A N/A N/A "$8,439.25 " "$8,354.86 " "$56,886.84 " 330104 548 SEPTIC ARTHRITIS WITH MCC I N/A N/A "$17,471.21 " N/A "$29,451.56 " "$30,991.84 " "$28,229.42 " "$17,296.50 " N/A "$33,195.30 " N/A "$17,471.21 " "$58,672.28 " "$19,218.33 " "$72,406.38 " "$59,923.51 " N/A N/A N/A "$120,632.68 " "$83,664.01 " "$113,460.87 " N/A "$17,995.35 " "$21,664.30 " N/A N/A N/A N/A N/A "$24,459.70 " N/A "$17,471.21 " "$17,471.21 " "$19,043.62 " N/A N/A N/A N/A N/A N/A N/A "$68,129.29 " "$55,077.64 " "$55,077.64 " "$55,077.64 " "$55,077.64 " "$33,191.69 " "$19,218.33 " "$17,471.21 " "$35,796.97 " N/A N/A N/A N/A "$17,471.21 " "$17,296.50 " "$120,632.68 " 330104 549 SEPTIC ARTHRITIS WITH CC I N/A N/A "$11,055.18 " N/A "$18,396.03 " "$19,358.12 " "$17,632.66 " "$10,944.63 " N/A "$21,004.84 " N/A "$11,055.18 " "$36,647.87 " "$12,160.70 " "$45,226.46 " "$37,429.41 " N/A N/A N/A "$75,349.56 " "$52,258.20 " "$70,869.91 " N/A "$11,386.84 " "$13,708.42 " N/A N/A N/A N/A N/A "$15,477.25 " N/A "$11,055.18 " "$11,055.18 " "$12,050.15 " N/A N/A N/A N/A N/A N/A N/A "$42,554.90 " "$34,402.59 " "$34,402.59 " "$34,402.59 " "$34,402.59 " "$20,732.19 " "$12,160.70 " "$11,055.18 " "$22,359.50 " N/A N/A N/A N/A "$11,055.18 " "$10,944.63 " "$75,349.56 " 330104 550 SEPTIC ARTHRITIS WITHOUT CC/MCC I N/A N/A "$9,615.49 " N/A "$15,915.29 " "$16,747.64 " "$15,254.86 " "$9,519.34 " N/A "$18,269.44 " N/A "$9,615.49 " "$31,705.83 " "$10,577.04 " "$39,127.59 " "$32,381.99 " N/A N/A N/A "$65,188.54 " "$45,211.08 " "$61,312.97 " N/A "$9,903.96 " "$11,923.21 " N/A N/A N/A N/A N/A "$13,461.69 " N/A "$9,615.49 " "$9,615.49 " "$10,480.89 " N/A N/A N/A N/A N/A N/A N/A "$36,816.30 " "$29,763.33 " "$29,763.33 " "$29,763.33 " "$29,763.33 " "$17,936.41 " "$10,577.04 " "$9,615.49 " "$19,344.28 " N/A N/A N/A N/A "$9,615.49 " "$9,519.34 " "$65,188.54 " 330104 551 MEDICAL BACK PROBLEMS WITH MCC I N/A N/A "$15,123.13 " N/A "$25,405.56 " "$26,734.24 " "$24,351.32 " "$14,971.90 " N/A "$28,733.95 " N/A "$15,123.13 " "$50,611.98 " "$16,635.44 " "$62,459.32 " "$51,691.33 " N/A N/A N/A "$104,060.38 " "$72,170.40 " "$97,873.82 " N/A "$15,576.83 " "$18,752.68 " N/A N/A N/A N/A N/A "$21,172.38 " N/A "$15,123.13 " "$15,123.13 " "$16,484.21 " N/A N/A N/A N/A N/A N/A N/A "$58,769.81 " "$47,511.17 " "$47,511.17 " "$47,511.17 " "$47,511.17 " "$28,631.87 " "$16,635.44 " "$15,123.13 " "$30,879.25 " N/A N/A N/A N/A "$15,123.13 " "$14,971.90 " "$104,060.38 " 330104 552 MEDICAL BACK PROBLEMS WITHOUT MCC I N/A N/A "$8,841.90 " N/A "$14,582.31 " "$15,344.95 " "$13,977.20 " "$8,753.48 " N/A "$16,799.62 " N/A "$8,841.90 " "$29,050.32 " "$9,726.09 " "$35,850.47 " "$29,669.85 " N/A N/A N/A "$59,728.69 " "$41,424.44 " "$56,177.72 " N/A "$9,107.16 " "$10,963.96 " N/A N/A N/A N/A N/A "$12,378.67 " N/A "$8,841.90 " "$8,841.90 " "$9,637.68 " N/A N/A N/A N/A N/A N/A N/A "$33,732.76 " "$27,270.52 " "$27,270.52 " "$27,270.52 " "$27,270.52 " "$16,434.15 " "$9,726.09 " "$8,841.90 " "$17,724.11 " N/A N/A N/A N/A "$8,841.90 " "$8,753.48 " "$59,728.69 " 330104 553 BONE DISEASES AND ARTHROPATHIES WITH MCC I N/A N/A "$12,061.37 " N/A "$20,129.81 " "$21,182.58 " "$19,294.50 " "$11,940.76 " N/A "$22,916.61 " N/A "$12,061.37 " "$40,101.85 " "$13,267.51 " "$49,488.95 " "$40,957.05 " N/A N/A N/A "$82,451.09 " "$57,183.42 " "$77,549.24 " N/A "$12,423.22 " "$14,956.10 " N/A N/A N/A N/A N/A "$16,885.92 " N/A "$12,061.37 " "$12,061.37 " "$13,146.90 " N/A N/A N/A N/A N/A N/A N/A "$46,565.61 " "$37,644.95 " "$37,644.95 " "$37,644.95 " "$37,644.95 " "$22,686.15 " "$13,267.51 " "$12,061.37 " "$24,466.83 " N/A N/A N/A N/A "$12,061.37 " "$11,940.76 " "$82,451.09 " 330104 554 BONE DISEASES AND ARTHROPATHIES WITHOUT MCC I N/A N/A "$7,605.75 " N/A "$12,452.28 " "$13,103.52 " "$11,935.55 " "$7,529.69 " N/A "$14,450.92 " N/A "$7,605.75 " "$24,806.95 " "$8,366.32 " "$30,613.80 " "$25,335.98 " N/A N/A N/A "$51,004.14 " "$35,373.59 " "$47,971.86 " N/A "$7,833.92 " "$9,431.13 " N/A N/A N/A N/A N/A "$10,648.05 " N/A "$7,605.75 " "$7,605.75 " "$8,290.26 " N/A N/A N/A N/A N/A N/A N/A "$28,805.42 " "$23,287.12 " "$23,287.12 " "$23,287.12 " "$23,287.12 " "$14,033.62 " "$8,366.32 " "$7,605.75 " "$15,135.15 " N/A N/A N/A N/A "$7,605.75 " "$7,529.69 " "$51,004.14 " 330104 555 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC I N/A N/A "$12,108.07 " N/A "$20,210.28 " "$21,267.25 " "$19,371.62 " "$11,986.99 " N/A "$23,005.34 " N/A "$12,108.07 " "$40,262.14 " "$13,318.88 " "$49,686.77 " "$41,120.77 " N/A N/A N/A "$82,780.67 " "$57,411.99 " "$77,859.23 " N/A "$12,471.31 " "$15,014.01 " N/A N/A N/A N/A N/A "$16,951.30 " N/A "$12,108.07 " "$12,108.07 " "$13,197.80 " N/A N/A N/A N/A N/A N/A N/A "$46,751.74 " "$37,795.43 " "$37,795.43 " "$37,795.43 " "$37,795.43 " "$22,776.83 " "$13,318.88 " "$12,108.07 " "$24,564.63 " N/A N/A N/A N/A "$12,108.07 " "$11,986.99 " "$82,780.67 " 330104 556 SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC I N/A N/A "$7,498.26 " N/A "$12,267.06 " "$12,908.61 " "$11,758.02 " "$7,423.27 " N/A "$14,246.69 " N/A "$7,498.26 " "$24,437.96 " "$8,248.08 " "$30,158.44 " "$24,959.12 " N/A N/A N/A "$50,245.48 " "$34,847.42 " "$47,258.30 " N/A "$7,723.20 " "$9,297.84 " N/A N/A N/A N/A N/A "$10,497.56 " N/A "$7,498.26 " "$7,498.26 " "$8,173.10 " N/A N/A N/A N/A N/A N/A N/A "$28,376.96 " "$22,940.74 " "$22,940.74 " "$22,940.74 " "$22,940.74 " "$13,824.88 " "$8,248.08 " "$7,498.26 " "$14,910.02 " N/A N/A N/A N/A "$7,498.26 " "$7,423.27 " "$50,245.48 " 330104 557 "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC" I N/A N/A "$12,995.32 " N/A "$21,739.11 " "$22,876.03 " "$20,837.01 " "$12,865.37 " N/A "$24,691.11 " N/A "$12,995.32 " "$43,307.82 " "$14,294.85 " "$53,445.38 " "$44,231.39 " N/A N/A N/A "$89,042.70 " "$61,754.98 " "$83,748.97 " N/A "$13,385.18 " "$16,114.20 " N/A N/A N/A N/A N/A "$18,193.45 " N/A "$12,995.32 " "$12,995.32 " "$14,164.90 " N/A N/A N/A N/A N/A N/A N/A "$50,288.33 " "$40,654.50 " "$40,654.50 " "$40,654.50 " "$40,654.50 " "$24,499.81 " "$14,294.85 " "$12,995.32 " "$26,422.85 " N/A N/A N/A N/A "$12,995.32 " "$12,865.37 " "$89,042.70 " 330104 558 "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC" I N/A N/A "$8,035.71 " N/A "$13,193.16 " "$13,883.14 " "$12,645.69 " "$7,955.36 " N/A "$15,267.86 " N/A "$8,035.71 " "$26,282.91 " "$8,839.29 " "$32,435.25 " "$26,843.41 " N/A N/A N/A "$54,038.77 " "$37,478.23 " "$50,826.07 " N/A "$8,276.79 " "$9,964.29 " N/A N/A N/A N/A N/A "$11,250.00 " N/A "$8,035.71 " "$8,035.71 " "$8,758.93 " N/A N/A N/A N/A N/A N/A N/A "$30,519.28 " "$24,672.65 " "$24,672.65 " "$24,672.65 " "$24,672.65 " "$14,868.59 " "$8,839.29 " "$8,035.71 " "$16,035.66 " N/A N/A N/A N/A "$8,035.71 " "$7,955.36 " "$54,038.77 " 330104 559 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC" I N/A N/A "$16,106.42 " N/A "$27,099.87 " "$28,517.16 " "$25,975.32 " "$15,945.35 " N/A "$30,602.19 " N/A "$16,106.42 " "$53,987.32 " "$17,717.06 " "$66,624.77 " "$55,138.65 " N/A N/A N/A "$111,000.22 " "$76,983.48 " "$104,401.08 " N/A "$16,589.61 " "$19,971.96 " N/A N/A N/A N/A N/A "$22,548.98 " N/A "$16,106.42 " "$16,106.42 " "$17,556.00 " N/A N/A N/A N/A N/A N/A N/A "$62,689.20 " "$50,679.72 " "$50,679.72 " "$50,679.72 " "$50,679.72 " "$30,541.35 " "$17,717.06 " "$16,106.42 " "$32,938.60 " N/A N/A N/A N/A "$16,106.42 " "$15,945.35 " "$111,000.22 " 330104 560 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC" I N/A N/A "$10,032.24 " N/A "$16,633.40 " "$17,503.31 " "$15,943.17 " "$9,931.92 " N/A "$19,061.26 " N/A "$10,032.24 " "$33,136.42 " "$11,035.47 " "$40,893.05 " "$33,843.08 " N/A N/A N/A "$68,129.89 " "$47,251.04 " "$64,079.45 " N/A "$10,333.21 " "$12,439.98 " N/A N/A N/A N/A N/A "$14,045.14 " N/A "$10,032.24 " "$10,032.24 " "$10,935.15 " N/A N/A N/A N/A N/A N/A N/A "$38,477.47 " "$31,106.28 " "$31,106.28 " "$31,106.28 " "$31,106.28 " "$18,745.72 " "$11,035.47 " "$10,032.24 " "$20,217.11 " N/A N/A N/A N/A "$10,032.24 " "$9,931.92 " "$68,129.89 " 330104 561 "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC" I N/A N/A "$7,341.42 " N/A "$11,996.82 " "$12,624.24 " "$11,498.99 " "$7,268.01 " N/A "$13,948.70 " N/A "$7,341.42 " "$23,899.60 " "$8,075.57 " "$29,494.06 " "$24,409.28 " N/A N/A N/A "$49,138.59 " "$34,079.75 " "$46,217.22 " N/A "$7,561.67 " "$9,103.36 " N/A N/A N/A N/A N/A "$10,277.99 " N/A "$7,341.42 " "$7,341.42 " "$8,002.15 " N/A N/A N/A N/A N/A N/A N/A "$27,751.82 " "$22,435.36 " "$22,435.36 " "$22,435.36 " "$22,435.36 " "$13,520.32 " "$8,075.57 " "$7,341.42 " "$14,581.56 " N/A N/A N/A N/A "$7,341.42 " "$7,268.01 " "$49,138.59 " 330104 562 "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC" I N/A N/A "$13,267.57 " N/A "$22,208.23 " "$23,369.69 " "$21,286.67 " "$13,134.90 " N/A "$25,208.39 " N/A "$13,267.57 " "$44,242.39 " "$14,594.33 " "$54,598.72 " "$45,185.89 " N/A N/A N/A "$90,964.22 " "$63,087.64 " "$85,556.25 " N/A "$13,665.60 " "$16,451.79 " N/A N/A N/A N/A N/A "$18,574.60 " N/A "$13,267.57 " "$13,267.57 " "$14,461.66 " N/A N/A N/A N/A N/A N/A N/A "$51,373.54 " "$41,531.82 " "$41,531.82 " "$41,531.82 " "$41,531.82 " "$25,028.51 " "$14,594.33 " "$13,267.57 " "$26,993.05 " N/A N/A N/A N/A "$13,267.57 " "$13,134.90 " "$90,964.22 " 330104 563 "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC" I N/A N/A "$7,966.99 " N/A "$13,074.74 " "$13,758.53 " "$12,532.18 " "$7,887.32 " N/A "$15,137.28 " N/A "$7,966.99 " "$26,046.99 " "$8,763.69 " "$32,144.12 " "$26,602.47 " N/A N/A N/A "$53,553.72 " "$37,141.83 " "$50,369.87 " N/A "$8,206.00 " "$9,879.07 " N/A N/A N/A N/A N/A "$11,153.79 " N/A "$7,966.99 " "$7,966.99 " "$8,684.02 " N/A N/A N/A N/A N/A N/A N/A "$30,245.34 " "$24,451.19 " "$24,451.19 " "$24,451.19 " "$24,451.19 " "$14,735.13 " "$8,763.69 " "$7,966.99 " "$15,891.72 " N/A N/A N/A N/A "$7,966.99 " "$7,887.32 " "$53,553.72 " 330104 564 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC I N/A N/A "$14,064.95 " N/A "$23,582.20 " "$24,815.52 " "$22,603.62 " "$13,924.30 " N/A "$26,723.41 " N/A "$14,064.95 " "$46,979.56 " "$15,471.45 " "$57,976.61 " "$47,981.44 " N/A N/A N/A "$96,591.96 " "$66,990.72 " "$90,849.41 " N/A "$14,486.90 " "$17,440.54 " N/A N/A N/A N/A N/A "$19,690.93 " N/A "$14,064.95 " "$14,064.95 " "$15,330.80 " N/A N/A N/A N/A N/A N/A N/A "$54,551.90 " "$44,101.29 " "$44,101.29 " "$44,101.29 " "$44,101.29 " "$26,576.96 " "$15,471.45 " "$14,064.95 " "$28,663.04 " N/A N/A N/A N/A "$14,064.95 " "$13,924.30 " "$96,591.96 " 330104 565 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC I N/A N/A "$9,078.91 " N/A "$14,990.71 " "$15,774.70 " "$14,368.64 " "$8,988.13 " N/A "$17,249.94 " N/A "$9,078.91 " "$29,863.91 " "$9,986.81 " "$36,854.51 " "$30,500.79 " N/A N/A N/A "$61,401.47 " "$42,584.59 " "$57,751.05 " N/A "$9,351.28 " "$11,257.85 " N/A N/A N/A N/A N/A "$12,710.48 " N/A "$9,078.91 " "$9,078.91 " "$9,896.02 " N/A N/A N/A N/A N/A N/A N/A "$34,677.49 " "$28,034.26 " "$28,034.26 " "$28,034.26 " "$28,034.26 " "$16,894.41 " "$9,986.81 " "$9,078.91 " "$18,220.49 " N/A N/A N/A N/A "$9,078.91 " "$8,988.13 " "$61,401.47 " 330104 566 OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC I N/A N/A "$6,922.91 " N/A "$11,275.67 " "$11,865.38 " "$10,807.77 " "$6,853.68 " N/A "$13,153.53 " N/A "$6,922.91 " "$22,462.96 " "$7,615.20 " "$27,721.13 " "$22,942.00 " N/A N/A N/A "$46,184.80 " "$32,031.17 " "$43,439.04 " N/A "$7,130.60 " "$8,584.41 " N/A N/A N/A N/A N/A "$9,692.07 " N/A "$6,922.91 " "$6,922.91 " "$7,545.97 " N/A N/A N/A N/A N/A N/A N/A "$26,083.62 " "$21,086.74 " "$21,086.74 " "$21,086.74 " "$21,086.74 " "$12,707.60 " "$7,615.20 " "$6,922.91 " "$13,705.04 " N/A N/A N/A N/A "$6,922.91 " "$6,853.68 " "$46,184.80 " 330104 570 SKIN DEBRIDEMENT WITH MCC I N/A N/A "$26,081.14 " N/A "$44,287.41 " "$46,603.59 " "$42,449.64 " "$25,820.33 " N/A "$49,554.16 " N/A "$26,081.14 " "$88,227.69 " "$28,689.25 " "$108,880.17 " "$90,109.22 " N/A N/A N/A "$181,399.86 " "$125,808.69 " "$170,615.34 " N/A "$26,863.57 " "$32,340.61 " N/A N/A N/A N/A N/A "$36,513.59 " N/A "$26,081.14 " "$26,081.14 " "$28,428.44 " N/A N/A N/A N/A N/A N/A N/A "$102,448.55 " "$82,822.30 " "$82,822.30 " "$82,822.30 " "$82,822.30 " "$49,911.58 " "$28,689.25 " "$26,081.14 " "$53,829.25 " N/A N/A N/A N/A "$26,081.14 " "$25,820.33 " "$181,399.86 " 330104 571 SKIN DEBRIDEMENT WITH CC I N/A N/A "$14,904.62 " N/A "$25,029.05 " "$26,338.03 " "$23,990.43 " "$14,755.58 " N/A "$28,318.78 " N/A "$14,904.62 " "$49,861.91 " "$16,395.09 " "$61,533.67 " "$50,925.25 " N/A N/A N/A "$102,518.19 " "$71,100.82 " "$96,423.32 " N/A "$15,351.76 " "$18,481.73 " N/A N/A N/A N/A N/A "$20,866.47 " N/A "$14,904.62 " "$14,904.62 " "$16,246.04 " N/A N/A N/A N/A N/A N/A N/A "$57,898.83 " "$46,807.05 " "$46,807.05 " "$46,807.05 " "$46,807.05 " "$28,207.55 " "$16,395.09 " "$14,904.62 " "$30,421.62 " N/A N/A N/A N/A "$14,904.62 " "$14,755.58 " "$102,518.19 " 330104 572 SKIN DEBRIDEMENT WITHOUT CC/MCC I N/A N/A "$10,983.81 " N/A "$18,273.06 " "$19,228.71 " "$17,514.79 " "$10,873.97 " N/A "$20,869.24 " N/A "$10,983.81 " "$36,402.88 " "$12,082.19 " "$44,924.13 " "$37,179.20 " N/A N/A N/A "$74,845.87 " "$51,908.86 " "$70,396.16 " N/A "$11,313.33 " "$13,619.93 " N/A N/A N/A N/A N/A "$15,377.34 " N/A "$10,983.81 " "$10,983.81 " "$11,972.36 " N/A N/A N/A N/A N/A N/A N/A "$42,270.43 " "$34,172.61 " "$34,172.61 " "$34,172.61 " "$34,172.61 " "$20,593.60 " "$12,082.19 " "$10,983.81 " "$22,210.03 " N/A N/A N/A N/A "$10,983.81 " "$10,873.97 " "$74,845.87 " 330104 573 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC I N/A N/A "$52,102.99 " N/A "$89,125.93 " "$93,787.11 " "$85,427.52 " "$51,581.96 " N/A "$98,995.67 " N/A "$52,102.99 " "$177,553.27 " "$57,313.29 " "$219,115.24 " "$181,339.74 " N/A N/A N/A "$365,057.04 " "$253,182.92 " "$343,353.80 " N/A "$53,666.08 " "$64,607.70 " N/A N/A N/A N/A N/A "$72,944.18 " N/A "$52,102.99 " "$52,102.99 " "$56,792.26 " N/A N/A N/A N/A N/A N/A N/A "$206,171.96 " "$166,675.24 " "$166,675.24 " "$166,675.24 " "$166,675.24 " "$100,444.25 " "$57,313.29 " "$52,102.99 " "$108,328.34 " N/A N/A N/A N/A "$52,102.99 " "$51,581.96 " "$365,057.04 " 330104 574 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC I N/A N/A "$32,138.57 " N/A "$54,725.04 " "$57,587.09 " "$52,454.14 " "$31,817.18 " N/A "$61,063.28 " N/A "$32,138.57 " "$109,021.13 " "$35,352.43 " "$134,540.97 " "$111,346.09 " N/A N/A N/A "$224,152.05 " "$155,459.19 " "$210,825.84 " N/A "$33,102.73 " "$39,851.83 " N/A N/A N/A N/A N/A "$44,994.00 " N/A "$32,138.57 " "$32,138.57 " "$35,031.04 " N/A N/A N/A N/A N/A N/A N/A "$126,593.55 " "$102,341.80 " "$102,341.80 " "$102,341.80 " "$102,341.80 " "$61,674.71 " "$35,352.43 " "$32,138.57 " "$66,515.68 " N/A N/A N/A N/A "$32,138.57 " "$31,817.18 " "$224,152.05 " 330104 575 SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC I N/A N/A "$18,437.76 " N/A "$31,117.03 " "$32,744.41 " "$29,825.78 " "$18,253.38 " N/A "$35,031.74 " N/A "$18,437.76 " "$61,990.15 " "$20,281.53 " "$76,500.91 " "$63,312.14 " N/A N/A N/A "$127,454.38 " "$88,395.15 " "$119,877.00 " N/A "$18,990.89 " "$22,862.82 " N/A N/A N/A N/A N/A "$25,812.86 " N/A "$18,437.76 " "$18,437.76 " "$20,097.16 " N/A N/A N/A N/A N/A N/A N/A "$71,981.95 " "$58,192.24 " "$58,192.24 " "$58,192.24 " "$58,192.24 " "$35,068.66 " "$20,281.53 " "$18,437.76 " "$37,821.27 " N/A N/A N/A N/A "$18,437.76 " "$18,253.38 " "$127,454.38 " 330104 576 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC I N/A N/A "$50,151.39 " N/A "$85,763.12 " "$90,248.42 " "$82,204.25 " "$49,649.88 " N/A "$95,287.64 " N/A "$50,151.39 " "$170,854.01 " "$55,166.53 " "$210,847.80 " "$174,497.61 " N/A N/A N/A "$351,283.07 " "$243,630.07 " "$330,398.71 " N/A "$51,655.93 " "$62,187.73 " N/A N/A N/A N/A N/A "$70,211.95 " N/A "$50,151.39 " "$50,151.39 " "$54,665.02 " N/A N/A N/A N/A N/A N/A N/A "$198,392.88 " "$160,386.41 " "$160,386.41 " "$160,386.41 " "$160,386.41 " "$96,654.39 " "$55,166.53 " "$50,151.39 " "$104,241.00 " N/A N/A N/A N/A "$50,151.39 " "$49,649.88 " "$351,283.07 " 330104 577 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC I N/A N/A "$23,451.99 " N/A "$39,757.10 " "$41,836.35 " "$38,107.32 " "$23,217.47 " N/A "$44,558.78 " N/A "$23,451.99 " "$79,202.58 " "$25,797.19 " "$97,742.45 " "$80,891.64 " N/A N/A N/A "$162,843.86 " "$112,939.29 " "$153,162.53 " N/A "$24,155.55 " "$29,080.47 " N/A N/A N/A N/A N/A "$32,832.79 " N/A "$23,451.99 " "$23,451.99 " "$25,562.67 " N/A N/A N/A N/A N/A N/A N/A "$91,968.74 " "$74,350.13 " "$74,350.13 " "$74,350.13 " "$74,350.13 " "$44,805.96 " "$25,797.19 " "$23,451.99 " "$48,322.87 " N/A N/A N/A N/A "$23,451.99 " "$23,217.47 " "$162,843.86 " 330104 578 SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC I N/A N/A "$15,467.63 " N/A "$25,999.17 " "$27,358.90 " "$24,920.30 " "$15,312.96 " N/A "$29,388.50 " N/A "$15,467.63 " "$51,794.56 " "$17,014.40 " "$63,918.72 " "$52,899.12 " N/A N/A N/A "$106,491.81 " "$73,856.70 " "$100,160.70 " N/A "$15,931.66 " "$19,179.87 " N/A N/A N/A N/A N/A "$21,654.69 " N/A "$15,467.63 " "$15,467.63 " "$16,859.72 " N/A N/A N/A N/A N/A N/A N/A "$60,143.00 " "$48,621.30 " "$48,621.30 " "$48,621.30 " "$48,621.30 " "$29,300.88 " "$17,014.40 " "$15,467.63 " "$31,600.76 " N/A N/A N/A N/A "$15,467.63 " "$15,312.96 " "$106,491.81 " 330104 579 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC" I N/A N/A "$28,148.15 " N/A "$47,849.11 " "$50,351.56 " "$45,863.54 " "$27,866.67 " N/A "$53,481.49 " N/A "$28,148.15 " "$95,323.17 " "$30,962.97 " "$117,636.57 " "$97,356.01 " N/A N/A N/A "$195,988.46 " "$135,926.52 " "$184,336.63 " N/A "$28,992.60 " "$34,903.71 " N/A N/A N/A N/A N/A "$39,407.41 " N/A "$28,148.15 " "$28,148.15 " "$30,681.49 " N/A N/A N/A N/A N/A N/A N/A "$110,687.70 " "$89,483.07 " "$89,483.07 " "$89,483.07 " "$89,483.07 " "$53,925.59 " "$30,962.97 " "$28,148.15 " "$58,158.32 " N/A N/A N/A N/A "$28,148.15 " "$27,866.67 " "$195,988.46 " 330104 580 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC" I N/A N/A "$15,676.45 " N/A "$26,358.99 " "$27,737.53 " "$25,265.18 " "$15,519.69 " N/A "$29,785.26 " N/A "$15,676.45 " "$52,511.37 " "$17,244.10 " "$64,803.32 " "$53,631.22 " N/A N/A N/A "$107,965.60 " "$74,878.83 " "$101,546.87 " N/A "$16,146.74 " "$19,438.80 " N/A N/A N/A N/A N/A "$21,947.03 " N/A "$15,676.45 " "$15,676.45 " "$17,087.33 " N/A N/A N/A N/A N/A N/A N/A "$60,975.34 " "$49,294.19 " "$49,294.19 " "$49,294.19 " "$49,294.19 " "$29,706.38 " "$17,244.10 " "$15,676.45 " "$32,038.10 " N/A N/A N/A N/A "$15,676.45 " "$15,519.69 " "$107,965.60 " 330104 581 "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC" I N/A N/A "$12,815.58 " N/A "$21,429.39 " "$22,550.12 " "$20,540.15 " "$12,687.42 " N/A "$24,349.60 " N/A "$12,815.58 " "$42,690.82 " "$14,097.14 " "$52,683.96 " "$43,601.24 " N/A N/A N/A "$87,774.13 " "$60,875.17 " "$82,555.81 " N/A "$13,200.05 " "$15,891.32 " N/A N/A N/A N/A N/A "$17,941.81 " N/A "$12,815.58 " "$12,815.58 " "$13,968.98 " N/A N/A N/A N/A N/A N/A N/A "$49,571.88 " "$40,075.31 " "$40,075.31 " "$40,075.31 " "$40,075.31 " "$24,150.76 " "$14,097.14 " "$12,815.58 " "$26,046.41 " N/A N/A N/A N/A "$12,815.58 " "$12,687.42 " "$87,774.13 " 330104 582 MASTECTOMY FOR MALIGNANCY WITH CC/MCC I N/A N/A "$17,426.28 " N/A "$29,374.13 " "$30,910.36 " "$28,155.21 " "$17,252.01 " N/A "$33,109.93 " N/A "$17,426.28 " "$58,518.03 " "$19,168.90 " "$72,216.02 " "$59,765.97 " N/A N/A N/A "$120,315.54 " "$83,444.05 " "$113,162.58 " N/A "$17,949.07 " "$21,608.58 " N/A N/A N/A N/A N/A "$24,396.79 " N/A "$17,426.28 " "$17,426.28 " "$18,994.64 " N/A N/A N/A N/A N/A N/A N/A "$67,950.18 " "$54,932.84 " "$54,932.84 " "$54,932.84 " "$54,932.84 " "$33,104.43 " "$19,168.90 " "$17,426.28 " "$35,702.86 " N/A N/A N/A N/A "$17,426.28 " "$17,252.01 " "$120,315.54 " 330104 583 MASTECTOMY FOR MALIGNANCY WITHOUT CC/MCC I N/A N/A "$13,690.49 " N/A "$22,936.97 " "$24,136.54 " "$21,985.16 " "$13,553.59 " N/A "$26,011.94 " N/A "$13,690.49 " "$45,694.15 " "$15,059.54 " "$56,390.31 " "$46,668.61 " N/A N/A N/A "$93,949.10 " "$65,157.78 " "$88,363.67 " N/A "$14,101.21 " "$16,976.21 " N/A N/A N/A N/A N/A "$19,166.69 " N/A "$13,690.49 " "$13,690.49 " "$14,922.64 " N/A N/A N/A N/A N/A N/A N/A "$53,059.30 " "$42,894.63 " "$42,894.63 " "$42,894.63 " "$42,894.63 " "$25,849.79 " "$15,059.54 " "$13,690.49 " "$27,878.79 " N/A N/A N/A N/A "$13,690.49 " "$13,553.59 " "$93,949.10 " 330104 584 "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC" I N/A N/A "$19,197.25 " N/A "$32,425.72 " "$34,121.54 " "$31,080.16 " "$19,005.28 " N/A "$36,474.78 " N/A "$19,197.25 " "$64,597.27 " "$21,116.98 " "$79,718.31 " "$65,974.86 " N/A N/A N/A "$132,814.72 " "$92,112.78 " "$124,918.67 " N/A "$19,773.17 " "$23,804.59 " N/A N/A N/A N/A N/A "$26,876.15 " N/A "$19,197.25 " "$19,197.25 " "$20,925.00 " N/A N/A N/A N/A N/A N/A N/A "$75,009.30 " "$60,639.63 " "$60,639.63 " "$60,639.63 " "$60,639.63 " "$36,543.54 " "$21,116.98 " "$19,197.25 " "$39,411.92 " N/A N/A N/A N/A "$19,197.25 " "$19,005.28 " "$132,814.72 " 330104 585 "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC" I N/A N/A "$16,600.70 " N/A "$27,951.58 " "$29,413.41 " "$26,791.69 " "$16,434.70 " N/A "$31,541.34 " N/A "$16,600.70 " "$55,684.07 " "$18,260.77 " "$68,718.69 " "$56,871.58 " N/A N/A N/A "$114,488.80 " "$79,402.96 " "$107,682.26 " N/A "$17,098.73 " "$20,584.87 " N/A N/A N/A N/A N/A "$23,240.99 " N/A "$16,600.70 " "$16,600.70 " "$18,094.77 " N/A N/A N/A N/A N/A N/A N/A "$64,659.43 " "$52,272.51 " "$52,272.51 " "$52,272.51 " "$52,272.51 " "$31,501.22 " "$18,260.77 " "$16,600.70 " "$33,973.82 " N/A N/A N/A N/A "$16,600.70 " "$16,434.70 " "$114,488.80 " 330104 592 SKIN ULCERS WITH MCC I N/A N/A "$16,097.61 " N/A "$27,084.69 " "$28,501.18 " "$25,960.77 " "$15,936.63 " N/A "$30,585.45 " N/A "$16,097.61 " "$53,957.08 " "$17,707.37 " "$66,587.44 " "$55,107.76 " N/A N/A N/A "$110,938.04 " "$76,940.35 " "$104,342.59 " N/A "$16,580.54 " "$19,961.03 " N/A N/A N/A N/A N/A "$22,536.65 " N/A "$16,097.61 " "$16,097.61 " "$17,546.39 " N/A N/A N/A N/A N/A N/A N/A "$62,654.08 " "$50,651.33 " "$50,651.33 " "$50,651.33 " "$50,651.33 " "$30,524.24 " "$17,707.37 " "$16,097.61 " "$32,920.15 " N/A N/A N/A N/A "$16,097.61 " "$15,936.63 " "$110,938.04 " 330104 593 SKIN ULCERS WITH CC I N/A N/A "$10,528.29 " N/A "$17,488.15 " "$18,402.75 " "$16,762.45 " "$10,423.01 " N/A "$20,003.76 " N/A "$10,528.29 " "$34,839.22 " "$11,581.12 " "$42,994.44 " "$35,582.19 " N/A N/A N/A "$71,630.90 " "$49,679.14 " "$67,372.33 " N/A "$10,844.14 " "$13,055.08 " N/A N/A N/A N/A N/A "$14,739.61 " N/A "$10,528.29 " "$10,528.29 " "$11,475.84 " N/A N/A N/A N/A N/A N/A N/A "$40,454.73 " "$32,704.74 " "$32,704.74 " "$32,704.74 " "$32,704.74 " "$19,709.01 " "$11,581.12 " "$10,528.29 " "$21,256.01 " N/A N/A N/A N/A "$10,528.29 " "$10,423.01 " "$71,630.90 " 330104 594 SKIN ULCERS WITHOUT CC/MCC I N/A N/A "$7,197.81 " N/A "$11,749.35 " "$12,363.83 " "$11,261.79 " "$7,125.83 " N/A "$13,675.83 " N/A "$7,197.81 " "$23,406.61 " "$7,917.59 " "$28,885.66 " "$23,905.77 " N/A N/A N/A "$48,124.97 " "$33,376.76 " "$45,263.86 " N/A "$7,413.74 " "$8,925.28 " N/A N/A N/A N/A N/A "$10,076.93 " N/A "$7,197.81 " "$7,197.81 " "$7,845.61 " N/A N/A N/A N/A N/A N/A N/A "$27,179.37 " "$21,972.57 " "$21,972.57 " "$21,972.57 " "$21,972.57 " "$13,241.43 " "$7,917.59 " "$7,197.81 " "$14,280.78 " N/A N/A N/A N/A "$7,197.81 " "$7,125.83 " "$48,124.97 " 330104 595 MAJOR SKIN DISORDERS WITH MCC I N/A N/A "$19,246.59 " N/A "$32,510.73 " "$34,211.01 " "$31,161.65 " "$19,054.12 " N/A "$36,568.52 " N/A "$19,246.59 " "$64,766.64 " "$21,171.25 " "$79,927.33 " "$66,147.85 " N/A N/A N/A "$133,162.96 " "$92,354.30 " "$125,246.20 " N/A "$19,823.99 " "$23,865.77 " N/A N/A N/A N/A N/A "$26,945.23 " N/A "$19,246.59 " "$19,246.59 " "$20,978.78 " N/A N/A N/A N/A N/A N/A N/A "$75,205.97 " "$60,798.63 " "$60,798.63 " "$60,798.63 " "$60,798.63 " "$36,639.35 " "$21,171.25 " "$19,246.59 " "$39,515.25 " N/A N/A N/A N/A "$19,246.59 " "$19,054.12 " "$133,162.96 " 330104 596 MAJOR SKIN DISORDERS WITHOUT MCC I N/A N/A "$9,998.76 " N/A "$16,575.71 " "$17,442.60 " "$15,887.87 " "$9,898.78 " N/A "$18,997.65 " N/A "$9,998.76 " "$33,021.49 " "$10,998.64 " "$40,751.22 " "$33,725.70 " N/A N/A N/A "$67,893.58 " "$47,087.15 " "$63,857.20 " N/A "$10,298.73 " "$12,398.47 " N/A N/A N/A N/A N/A "$13,998.27 " N/A "$9,998.76 " "$9,998.76 " "$10,898.65 " N/A N/A N/A N/A N/A N/A N/A "$38,344.02 " "$30,998.39 " "$30,998.39 " "$30,998.39 " "$30,998.39 " "$18,680.70 " "$10,998.64 " "$9,998.76 " "$20,146.99 " N/A N/A N/A N/A "$9,998.76 " "$9,898.78 " "$67,893.58 " 330104 597 MALIGNANT BREAST DISORDERS WITH MCC I N/A N/A "$15,216.53 " N/A "$25,566.49 " "$26,903.58 " "$24,505.57 " "$15,064.36 " N/A "$28,911.40 " N/A "$15,216.53 " "$50,932.58 " "$16,738.18 " "$62,854.96 " "$52,018.76 " N/A N/A N/A "$104,719.54 " "$72,627.55 " "$98,493.79 " N/A "$15,673.02 " "$18,868.49 " N/A N/A N/A N/A N/A "$21,303.14 " N/A "$15,216.53 " "$15,216.53 " "$16,586.01 " N/A N/A N/A N/A N/A N/A N/A "$59,142.08 " "$47,812.13 " "$47,812.13 " "$47,812.13 " "$47,812.13 " "$28,813.24 " "$16,738.18 " "$15,216.53 " "$31,074.85 " N/A N/A N/A N/A "$15,216.53 " "$15,064.36 " "$104,719.54 " 330104 598 MALIGNANT BREAST DISORDERS WITH CC I N/A N/A "$9,789.95 " N/A "$16,215.89 " "$17,063.97 " "$15,542.99 " "$9,692.05 " N/A "$18,600.90 " N/A "$9,789.95 " "$32,304.68 " "$10,768.94 " "$39,866.62 " "$32,993.61 " N/A N/A N/A "$66,419.80 " "$46,065.02 " "$62,471.03 " N/A "$10,083.65 " "$12,139.53 " N/A N/A N/A N/A N/A "$13,705.93 " N/A "$9,789.95 " "$9,789.95 " "$10,671.04 " N/A N/A N/A N/A N/A N/A N/A "$37,511.67 " "$30,325.50 " "$30,325.50 " "$30,325.50 " "$30,325.50 " "$18,275.19 " "$10,768.94 " "$9,789.95 " "$19,709.65 " N/A N/A N/A N/A "$9,789.95 " "$9,692.05 " "$66,419.80 " 330104 599 MALIGNANT BREAST DISORDERS WITHOUT CC/MCC I N/A N/A "$6,966.08 " N/A "$11,350.06 " "$11,943.66 " "$10,879.08 " "$6,896.42 " N/A "$13,235.56 " N/A "$6,966.08 " "$22,611.16 " "$7,662.69 " "$27,904.02 " "$23,093.36 " N/A N/A N/A "$46,489.51 " "$32,242.49 " "$43,725.63 " N/A "$7,175.06 " "$8,637.94 " N/A N/A N/A N/A N/A "$9,752.52 " N/A "$6,966.08 " "$6,966.08 " "$7,593.03 " N/A N/A N/A N/A N/A N/A N/A "$26,255.71 " "$21,225.86 " "$21,225.86 " "$21,225.86 " "$21,225.86 " "$12,791.44 " "$7,662.69 " "$6,966.08 " "$13,795.46 " N/A N/A N/A N/A "$6,966.08 " "$6,896.42 " "$46,489.51 " 330104 600 NON-MALIGNANT BREAST DISORDERS WITH CC/MCC I N/A N/A "$9,552.06 " N/A "$15,805.98 " "$16,632.61 " "$15,150.09 " "$9,456.53 " N/A "$18,148.91 " N/A "$9,552.06 " "$31,488.07 " "$10,507.26 " "$38,858.85 " "$32,159.58 " N/A N/A N/A "$64,740.80 " "$44,900.56 " "$60,891.86 " N/A "$9,838.62 " "$11,844.55 " N/A N/A N/A N/A N/A "$13,372.88 " N/A "$9,552.06 " "$9,552.06 " "$10,411.74 " N/A N/A N/A N/A N/A N/A N/A "$36,563.43 " "$29,558.91 " "$29,558.91 " "$29,558.91 " "$29,558.91 " "$17,813.22 " "$10,507.26 " "$9,552.06 " "$19,211.42 " N/A N/A N/A N/A "$9,552.06 " "$9,456.53 " "$64,740.80 " 330104 601 NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC I N/A N/A "$6,581.05 " N/A "$10,686.61 " "$11,245.51 " "$10,243.15 " "$6,515.24 " N/A "$12,503.99 " N/A "$6,581.05 " "$21,289.46 " "$7,239.15 " "$26,272.93 " "$21,743.47 " N/A N/A N/A "$43,772.02 " "$30,357.80 " "$41,169.70 " N/A "$6,778.48 " "$8,160.50 " N/A N/A N/A N/A N/A "$9,213.47 " N/A "$6,581.05 " "$6,581.05 " "$7,173.34 " N/A N/A N/A N/A N/A N/A N/A "$24,720.97 " "$19,985.13 " "$19,985.13 " "$19,985.13 " "$19,985.13 " "$12,043.73 " "$7,239.15 " "$6,581.05 " "$12,989.07 " N/A N/A N/A N/A "$6,581.05 " "$6,515.24 " "$43,772.02 " 330104 602 CELLULITIS WITH MCC I N/A N/A "$13,077.26 " N/A "$21,880.30 " "$23,024.61 " "$20,972.34 " "$12,946.49 " N/A "$24,846.80 " N/A "$13,077.26 " "$43,589.09 " "$14,384.99 " "$53,792.50 " "$44,518.67 " N/A N/A N/A "$89,621.02 " "$62,156.07 " "$84,292.91 " N/A "$13,469.58 " "$16,215.80 " N/A N/A N/A N/A N/A "$18,308.17 " N/A "$13,077.26 " "$13,077.26 " "$14,254.21 " N/A N/A N/A N/A N/A N/A N/A "$50,614.94 " "$40,918.55 " "$40,918.55 " "$40,918.55 " "$40,918.55 " "$24,658.93 " "$14,384.99 " "$13,077.26 " "$26,594.46 " N/A N/A N/A N/A "$13,077.26 " "$12,946.49 " "$89,621.02 " 330104 603 CELLULITIS WITHOUT MCC I N/A N/A "$8,148.49 " N/A "$13,387.49 " "$14,087.64 " "$12,831.95 " "$8,067.01 " N/A "$15,482.14 " N/A "$8,148.49 " "$26,670.04 " "$8,963.34 " "$32,913.01 " "$27,238.80 " N/A N/A N/A "$54,834.73 " "$38,030.27 " "$51,574.72 " N/A "$8,392.95 " "$10,104.13 " N/A N/A N/A N/A N/A "$11,407.89 " N/A "$8,148.49 " "$8,148.49 " "$8,881.86 " N/A N/A N/A N/A N/A N/A N/A "$30,968.82 " "$25,036.07 " "$25,036.07 " "$25,036.07 " "$25,036.07 " "$15,087.60 " "$8,963.34 " "$8,148.49 " "$16,271.86 " N/A N/A N/A N/A "$8,148.49 " "$8,067.01 " "$54,834.73 " 330104 604 "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC" I N/A N/A "$13,676.40 " N/A "$22,912.67 " "$24,110.98 " "$21,961.88 " "$13,539.63 " N/A "$25,985.15 " N/A "$13,676.40 " "$45,645.75 " "$15,044.04 " "$56,330.59 " "$46,619.19 " N/A N/A N/A "$93,849.60 " "$65,088.78 " "$88,270.09 " N/A "$14,086.69 " "$16,958.73 " N/A N/A N/A N/A N/A "$19,146.95 " N/A "$13,676.40 " "$13,676.40 " "$14,907.27 " N/A N/A N/A N/A N/A N/A N/A "$53,003.10 " "$42,849.21 " "$42,849.21 " "$42,849.21 " "$42,849.21 " "$25,822.41 " "$15,044.04 " "$13,676.40 " "$27,849.27 " N/A N/A N/A N/A "$13,676.40 " "$13,539.63 " "$93,849.60 " 330104 605 "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC" I N/A N/A "$8,400.48 " N/A "$13,821.69 " "$14,544.55 " "$13,248.14 " "$8,316.48 " N/A "$15,960.92 " N/A "$8,400.48 " "$27,535.05 " "$9,240.53 " "$33,980.50 " "$28,122.26 " N/A N/A N/A "$56,613.22 " "$39,263.73 " "$53,247.48 " N/A "$8,652.50 " "$10,416.60 " N/A N/A N/A N/A N/A "$11,760.68 " N/A "$8,400.48 " "$8,400.48 " "$9,156.53 " N/A N/A N/A N/A N/A N/A N/A "$31,973.25 " "$25,848.08 " "$25,848.08 " "$25,848.08 " "$25,848.08 " "$15,576.94 " "$9,240.53 " "$8,400.48 " "$16,799.61 " N/A N/A N/A N/A "$8,400.48 " "$8,316.48 " "$56,613.22 " 330104 606 MINOR SKIN DISORDERS WITH MCC I N/A N/A "$13,902.83 " N/A "$23,302.85 " "$24,521.56 " "$22,335.86 " "$13,763.81 " N/A "$26,415.38 " N/A "$13,902.83 " "$46,423.05 " "$15,293.12 " "$57,289.84 " "$47,413.06 " N/A N/A N/A "$95,447.76 " "$66,197.17 " "$89,773.23 " N/A "$14,319.92 " "$17,239.51 " N/A N/A N/A N/A N/A "$19,463.97 " N/A "$13,902.83 " "$13,902.83 " "$15,154.09 " N/A N/A N/A N/A N/A N/A N/A "$53,905.69 " "$43,578.88 " "$43,578.88 " "$43,578.88 " "$43,578.88 " "$26,262.14 " "$15,293.12 " "$13,902.83 " "$28,323.51 " N/A N/A N/A N/A "$13,902.83 " "$13,763.81 " "$95,447.76 " 330104 607 MINOR SKIN DISORDERS WITHOUT MCC I N/A N/A "$7,852.45 " N/A "$12,877.37 " "$13,550.84 " "$12,343.01 " "$7,773.93 " N/A "$14,919.65 " N/A "$7,852.45 " "$25,653.81 " "$8,637.69 " "$31,658.90 " "$26,200.90 " N/A N/A N/A "$52,745.32 " "$36,581.17 " "$49,609.52 " N/A "$8,088.02 " "$9,737.04 " N/A N/A N/A N/A N/A "$10,993.43 " N/A "$7,852.45 " "$7,852.45 " "$8,559.17 " N/A N/A N/A N/A N/A N/A N/A "$29,788.78 " "$24,082.09 " "$24,082.09 " "$24,082.09 " "$24,082.09 " "$14,512.70 " "$8,637.69 " "$7,852.45 " "$15,651.83 " N/A N/A N/A N/A "$7,852.45 " "$7,773.93 " "$52,745.32 " 330104 614 ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC I N/A N/A "$21,083.64 " N/A "$35,676.18 " "$37,542.00 " "$34,195.74 " "$20,872.81 " N/A "$40,058.93 " N/A "$21,083.64 " "$71,072.73 " "$23,192.01 " "$87,709.55 " "$72,588.41 " N/A N/A N/A "$146,128.53 " "$101,346.49 " "$137,440.95 " N/A "$21,716.15 " "$26,143.72 " N/A N/A N/A N/A N/A "$29,517.10 " N/A "$21,083.64 " "$21,083.64 " "$22,981.17 " N/A N/A N/A N/A N/A N/A N/A "$82,528.49 " "$66,718.36 " "$66,718.36 " "$66,718.36 " "$66,718.36 " "$40,206.79 " "$23,192.01 " "$21,083.64 " "$43,362.70 " N/A N/A N/A N/A "$21,083.64 " "$20,872.81 " "$146,128.53 " 330104 615 ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC I N/A N/A "$13,382.11 " N/A "$22,405.60 " "$23,577.38 " "$21,475.84 " "$13,248.29 " N/A "$25,426.02 " N/A "$13,382.11 " "$44,635.57 " "$14,720.33 " "$55,083.94 " "$45,587.46 " N/A N/A N/A "$91,772.62 " "$63,648.30 " "$86,316.59 " N/A "$13,783.58 " "$16,593.82 " N/A N/A N/A N/A N/A "$18,734.96 " N/A "$13,382.11 " "$13,382.11 " "$14,586.51 " N/A N/A N/A N/A N/A N/A N/A "$51,830.10 " "$41,900.91 " "$41,900.91 " "$41,900.91 " "$41,900.91 " "$25,250.94 " "$14,720.33 " "$13,382.11 " "$27,232.94 " N/A N/A N/A N/A "$13,382.11 " "$13,248.29 " "$91,772.62 " 330104 616 "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC" I N/A N/A "$33,547.42 " N/A "$57,152.64 " "$60,141.65 " "$54,781.00 " "$33,211.94 " N/A "$63,740.09 " N/A "$33,547.42 " "$113,857.30 " "$36,902.16 " "$140,509.21 " "$116,285.40 " N/A N/A N/A "$234,095.43 " "$162,355.36 " "$220,178.08 " N/A "$34,553.84 " "$41,598.80 " N/A N/A N/A N/A N/A "$46,966.39 " N/A "$33,547.42 " "$33,547.42 " "$36,566.69 " N/A N/A N/A N/A N/A N/A N/A "$132,209.24 " "$106,881.68 " "$106,881.68 " "$106,881.68 " "$106,881.68 " "$64,410.60 " "$36,902.16 " "$33,547.42 " "$69,466.32 " N/A N/A N/A N/A "$33,547.42 " "$33,211.94 " "$234,095.43 " 330104 617 "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" I N/A N/A "$17,507.34 " N/A "$29,513.81 " "$31,057.34 " "$28,289.09 " "$17,332.26 " N/A "$33,263.94 " N/A "$17,507.34 " "$58,796.28 " "$19,258.07 " "$72,559.41 " "$60,050.16 " N/A N/A N/A "$120,887.64 " "$83,840.83 " "$113,700.67 " N/A "$18,032.56 " "$21,709.10 " N/A N/A N/A N/A N/A "$24,510.27 " N/A "$17,507.34 " "$17,507.34 " "$19,083.00 " N/A N/A N/A N/A N/A N/A N/A "$68,273.28 " "$55,194.05 " "$55,194.05 " "$55,194.05 " "$55,194.05 " "$33,261.84 " "$19,258.07 " "$17,507.34 " "$35,872.63 " N/A N/A N/A N/A "$17,507.34 " "$17,332.26 " "$120,887.64 " 330104 618 "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC" I N/A N/A "$10,713.32 " N/A "$17,806.97 " "$18,738.25 " "$17,068.04 " "$10,606.19 " N/A "$20,355.31 " N/A "$10,713.32 " "$35,474.36 " "$11,784.65 " "$43,778.26 " "$36,230.88 " N/A N/A N/A "$72,936.79 " "$50,584.83 " "$68,600.58 " N/A "$11,034.72 " "$13,284.52 " N/A N/A N/A N/A N/A "$14,998.65 " N/A "$10,713.32 " "$10,713.32 " "$11,677.52 " N/A N/A N/A N/A N/A N/A N/A "$41,192.25 " "$33,300.98 " "$33,300.98 " "$33,300.98 " "$33,300.98 " "$20,068.32 " "$11,784.65 " "$10,713.32 " "$21,643.52 " N/A N/A N/A N/A "$10,713.32 " "$10,606.19 " "$72,936.79 " 330104 619 O.R. PROCEDURES FOR OBESITY WITH MCC I N/A N/A "$25,857.34 " N/A "$43,901.79 " "$46,197.80 " "$42,080.02 " "$25,598.77 " N/A "$49,128.95 " N/A "$25,857.34 " "$87,459.47 " "$28,443.08 " "$107,932.12 " "$89,324.61 " N/A N/A N/A "$179,820.36 " "$124,713.24 " "$169,129.75 " N/A "$26,633.06 " "$32,063.10 " N/A N/A N/A N/A N/A "$36,200.28 " N/A "$25,857.34 " "$25,857.34 " "$28,184.50 " N/A N/A N/A N/A N/A N/A N/A "$101,556.50 " "$82,101.15 " "$82,101.15 " "$82,101.15 " "$82,101.15 " "$49,476.99 " "$28,443.08 " "$25,857.34 " "$53,360.54 " N/A N/A N/A N/A "$25,857.34 " "$25,598.77 " "$179,820.36 " 330104 620 O.R. PROCEDURES FOR OBESITY WITH CC I N/A N/A "$15,230.62 " N/A "$25,590.78 " "$26,929.15 " "$24,528.85 " "$15,078.32 " N/A "$28,938.18 " N/A "$15,230.62 " "$50,980.97 " "$16,753.69 " "$62,914.68 " "$52,068.18 " N/A N/A N/A "$104,819.04 " "$72,696.56 " "$98,587.37 " N/A "$15,687.54 " "$18,885.97 " N/A N/A N/A N/A N/A "$21,322.87 " N/A "$15,230.62 " "$15,230.62 " "$16,601.38 " N/A N/A N/A N/A N/A N/A N/A "$59,198.27 " "$47,857.56 " "$47,857.56 " "$47,857.56 " "$47,857.56 " "$28,840.62 " "$16,753.69 " "$15,230.62 " "$31,104.38 " N/A N/A N/A N/A "$15,230.62 " "$15,078.32 " "$104,819.04 " 330104 621 O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC I N/A N/A "$14,079.93 " N/A "$23,608.01 " "$24,842.68 " "$22,628.36 " "$13,939.13 " N/A "$26,751.87 " N/A "$14,079.93 " "$47,030.97 " "$15,487.92 " "$58,040.06 " "$48,033.95 " N/A N/A N/A "$96,697.68 " "$67,064.04 " "$90,948.84 " N/A "$14,502.33 " "$17,459.11 " N/A N/A N/A N/A N/A "$19,711.90 " N/A "$14,079.93 " "$14,079.93 " "$15,347.13 " N/A N/A N/A N/A N/A N/A N/A "$54,611.60 " "$44,149.56 " "$44,149.56 " "$44,149.56 " "$44,149.56 " "$26,606.05 " "$15,487.92 " "$14,079.93 " "$28,694.41 " N/A N/A N/A N/A "$14,079.93 " "$13,939.13 " "$96,697.68 " 330104 622 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC" I N/A N/A "$32,283.95 " N/A "$54,975.54 " "$57,850.69 " "$52,694.25 " "$31,961.11 " N/A "$61,339.50 " N/A "$32,283.95 " "$109,520.17 " "$35,512.34 " "$135,156.83 " "$111,855.78 " N/A N/A N/A "$225,178.10 " "$156,170.80 " "$211,790.90 " N/A "$33,252.47 " "$40,032.10 " N/A N/A N/A N/A N/A "$45,197.53 " N/A "$32,283.95 " "$32,283.95 " "$35,189.50 " N/A N/A N/A N/A N/A N/A N/A "$127,173.03 " "$102,810.27 " "$102,810.27 " "$102,810.27 " "$102,810.27 " "$61,957.02 " "$35,512.34 " "$32,283.95 " "$66,820.16 " N/A N/A N/A N/A "$32,283.95 " "$31,961.11 " "$225,178.10 " 330104 623 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" I N/A N/A "$16,983.97 " N/A "$28,612.00 " "$30,108.37 " "$27,424.70 " "$16,814.13 " N/A "$32,269.55 " N/A "$16,983.97 " "$56,999.73 " "$18,682.37 " "$70,342.32 " "$58,215.29 " N/A N/A N/A "$117,193.85 " "$81,279.03 " "$110,226.48 " N/A "$17,493.49 " "$21,060.13 " N/A N/A N/A N/A N/A "$23,777.56 " N/A "$16,983.97 " "$16,983.97 " "$18,512.53 " N/A N/A N/A N/A N/A N/A N/A "$66,187.15 " "$53,507.56 " "$53,507.56 " "$53,507.56 " "$53,507.56 " "$32,245.51 " "$18,682.37 " "$16,983.97 " "$34,776.52 " N/A N/A N/A N/A "$16,983.97 " "$16,814.13 " "$117,193.85 " 330104 624 "SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC" I N/A N/A "$9,093.01 " N/A "$15,015.00 " "$15,800.26 " "$14,391.93 " "$9,002.08 " N/A "$17,276.72 " N/A "$9,093.01 " "$29,912.31 " "$10,002.31 " "$36,914.23 " "$30,550.21 " N/A N/A N/A "$61,500.97 " "$42,653.59 " "$57,844.63 " N/A "$9,365.80 " "$11,275.34 " N/A N/A N/A N/A N/A "$12,730.22 " N/A "$9,093.01 " "$9,093.01 " "$9,911.38 " N/A N/A N/A N/A N/A N/A N/A "$34,733.68 " "$28,079.69 " "$28,079.69 " "$28,079.69 " "$28,079.69 " "$16,921.79 " "$10,002.31 " "$9,093.01 " "$18,250.02 " N/A N/A N/A N/A "$9,093.01 " "$9,002.08 " "$61,500.97 " 330104 625 "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC" I N/A N/A "$25,729.59 " N/A "$43,681.65 " "$45,966.15 " "$41,869.01 " "$25,472.29 " N/A "$48,886.21 " N/A "$25,729.59 " "$87,020.91 " "$28,302.54 " "$107,390.91 " "$88,876.71 " N/A N/A N/A "$178,918.68 " "$124,087.88 " "$168,281.67 " N/A "$26,501.47 " "$31,904.69 " N/A N/A N/A N/A N/A "$36,021.42 " N/A "$25,729.59 " "$25,729.59 " "$28,045.25 " N/A N/A N/A N/A N/A N/A N/A "$101,047.26 " "$81,689.46 " "$81,689.46 " "$81,689.46 " "$81,689.46 " "$49,228.89 " "$28,302.54 " "$25,729.59 " "$53,092.97 " N/A N/A N/A N/A "$25,729.59 " "$25,472.29 " "$178,918.68 " 330104 626 "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC" I N/A N/A "$14,645.59 " N/A "$24,582.69 " "$25,868.34 " "$23,562.60 " "$14,499.13 " N/A "$27,826.61 " N/A "$14,645.59 " "$48,972.70 " "$16,110.14 " "$60,436.32 " "$50,017.09 " N/A N/A N/A "$100,689.95 " "$69,832.86 " "$94,703.77 " N/A "$15,084.95 " "$18,160.53 " N/A N/A N/A N/A N/A "$20,503.82 " N/A "$14,645.59 " "$14,645.59 " "$15,963.69 " N/A N/A N/A N/A N/A N/A N/A "$56,866.30 " "$45,972.33 " "$45,972.33 " "$45,972.33 " "$45,972.33 " "$27,704.51 " "$16,110.14 " "$14,645.59 " "$29,879.10 " N/A N/A N/A N/A "$14,645.59 " "$14,499.13 " "$100,689.95 " 330104 627 "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC" I N/A N/A "$11,620.83 " N/A "$19,370.71 " "$20,383.78 " "$18,566.90 " "$11,504.63 " N/A "$22,079.58 " N/A "$11,620.83 " "$38,589.60 " "$12,782.92 " "$47,622.71 " "$39,412.55 " N/A N/A N/A "$79,341.84 " "$55,027.02 " "$74,624.84 " N/A "$11,969.46 " "$14,409.83 " N/A N/A N/A N/A N/A "$16,269.17 " N/A "$11,620.83 " "$11,620.83 " "$12,666.71 " N/A N/A N/A N/A N/A N/A N/A "$44,809.61 " "$36,225.35 " "$36,225.35 " "$36,225.35 " "$36,225.35 " "$21,830.65 " "$12,782.92 " "$11,620.83 " "$23,544.18 " N/A N/A N/A N/A "$11,620.83 " "$11,504.63 " "$79,341.84 " 330104 628 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC" I N/A N/A "$32,492.76 " N/A "$55,335.35 " "$58,229.32 " "$53,039.13 " "$32,167.84 " N/A "$61,736.25 " N/A "$32,492.76 " "$110,236.98 " "$35,742.04 " "$136,041.43 " "$112,587.87 " N/A N/A N/A "$226,651.89 " "$157,192.93 " "$213,177.06 " N/A "$33,467.55 " "$40,291.03 " N/A N/A N/A N/A N/A "$45,489.87 " N/A "$32,492.76 " "$32,492.76 " "$35,417.11 " N/A N/A N/A N/A N/A N/A N/A "$128,005.38 " "$103,483.16 " "$103,483.16 " "$103,483.16 " "$103,483.16 " "$62,362.53 " "$35,742.04 " "$32,492.76 " "$67,257.49 " N/A N/A N/A N/A "$32,492.76 " "$32,167.84 " "$226,651.89 " 330104 629 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC" I N/A N/A "$20,148.82 " N/A "$34,065.37 " "$35,846.95 " "$32,651.78 " "$19,947.33 " N/A "$38,282.75 " N/A "$20,148.82 " "$67,863.73 " "$22,163.70 " "$83,749.39 " "$69,310.98 " N/A N/A N/A "$139,530.70 " "$96,770.61 " "$131,235.37 " N/A "$20,753.28 " "$24,984.53 " N/A N/A N/A N/A N/A "$28,208.35 " N/A "$20,148.82 " "$20,148.82 " "$21,962.21 " N/A N/A N/A N/A N/A N/A N/A "$78,802.26 " "$63,705.97 " "$63,705.97 " "$63,705.97 " "$63,705.97 " "$38,391.42 " "$22,163.70 " "$20,148.82 " "$41,404.84 " N/A N/A N/A N/A "$20,148.82 " "$19,947.33 " "$139,530.70 " 330104 630 "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC" I N/A N/A "$12,751.26 " N/A "$21,318.56 " "$22,433.50 " "$20,433.92 " "$12,623.75 " N/A "$24,227.40 " N/A "$12,751.26 " "$42,470.03 " "$14,026.39 " "$52,411.48 " "$43,375.74 " N/A N/A N/A "$87,320.18 " "$60,560.34 " "$82,128.85 " N/A "$13,133.80 " "$15,811.56 " N/A N/A N/A N/A N/A "$17,851.77 " N/A "$12,751.26 " "$12,751.26 " "$13,898.87 " N/A N/A N/A N/A N/A N/A N/A "$49,315.50 " "$39,868.05 " "$39,868.05 " "$39,868.05 " "$39,868.05 " "$24,025.86 " "$14,026.39 " "$12,751.26 " "$25,911.70 " N/A N/A N/A N/A "$12,751.26 " "$12,623.75 " "$87,320.18 " 330104 637 DIABETES WITH MCC I N/A N/A "$12,676.37 " N/A "$21,189.52 " "$22,297.70 " "$20,310.23 " "$12,549.61 " N/A "$24,085.10 " N/A "$12,676.37 " "$42,212.95 " "$13,944.01 " "$52,094.22 " "$43,113.17 " N/A N/A N/A "$86,791.60 " "$60,193.75 " "$81,631.70 " N/A "$13,056.66 " "$15,718.70 " N/A N/A N/A N/A N/A "$17,746.92 " N/A "$12,676.37 " "$12,676.37 " "$13,817.24 " N/A N/A N/A N/A N/A N/A N/A "$49,016.98 " "$39,626.71 " "$39,626.71 " "$39,626.71 " "$39,626.71 " "$23,880.43 " "$13,944.01 " "$12,676.37 " "$25,754.85 " N/A N/A N/A N/A "$12,676.37 " "$12,549.61 " "$86,791.60 " 330104 638 DIABETES WITH CC I N/A N/A "$8,097.39 " N/A "$13,299.43 " "$13,994.98 " "$12,747.55 " "$8,016.42 " N/A "$15,385.04 " N/A "$8,097.39 " "$26,494.62 " "$8,907.13 " "$32,696.52 " "$27,059.64 " N/A N/A N/A "$54,474.06 " "$37,780.13 " "$51,235.49 " N/A "$8,340.31 " "$10,040.76 " N/A N/A N/A N/A N/A "$11,336.35 " N/A "$8,097.39 " "$8,097.39 " "$8,826.16 " N/A N/A N/A N/A N/A N/A N/A "$30,765.12 " "$24,871.39 " "$24,871.39 " "$24,871.39 " "$24,871.39 " "$14,988.36 " "$8,907.13 " "$8,097.39 " "$16,164.83 " N/A N/A N/A N/A "$8,097.39 " "$8,016.42 " "$54,474.06 " 330104 639 DIABETES WITHOUT CC/MCC I N/A N/A "$5,672.66 " N/A "$9,121.35 " "$9,598.38 " "$8,742.84 " "$5,615.93 " N/A "$10,778.05 " N/A "$5,672.66 " "$18,171.20 " "$6,239.92 " "$22,424.74 " "$18,558.71 " N/A N/A N/A "$37,360.75 " "$25,911.30 " "$35,139.59 " N/A "$5,842.83 " "$7,034.09 " N/A N/A N/A N/A N/A "$7,941.72 " N/A "$5,672.66 " "$5,672.66 " "$6,183.19 " N/A N/A N/A N/A N/A N/A N/A "$21,100.10 " "$17,057.91 " "$17,057.91 " "$17,057.91 " "$17,057.91 " "$10,279.69 " "$6,239.92 " "$5,672.66 " "$11,086.56 " N/A N/A N/A N/A "$5,672.66 " "$5,615.93 " "$37,360.75 " 330104 640 "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC" I N/A N/A "$11,527.44 " N/A "$19,209.78 " "$20,214.43 " "$18,412.65 " "$11,412.16 " N/A "$21,902.13 " N/A "$11,527.44 " "$38,269.00 " "$12,680.18 " "$47,227.07 " "$39,085.12 " N/A N/A N/A "$78,682.68 " "$54,569.86 " "$74,004.87 " N/A "$11,873.26 " "$14,294.02 " N/A N/A N/A N/A N/A "$16,138.41 " N/A "$11,527.44 " "$11,527.44 " "$12,564.91 " N/A N/A N/A N/A N/A N/A N/A "$44,437.34 " "$35,924.40 " "$35,924.40 " "$35,924.40 " "$35,924.40 " "$21,649.28 " "$12,680.18 " "$11,527.44 " "$23,348.58 " N/A N/A N/A N/A "$11,527.44 " "$11,412.16 " "$78,682.68 " 330104 641 "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC" I N/A N/A "$7,165.21 " N/A "$11,693.18 " "$12,304.72 " "$11,207.95 " "$7,093.55 " N/A "$13,613.89 " N/A "$7,165.21 " "$23,294.70 " "$7,881.73 " "$28,747.56 " "$23,791.48 " N/A N/A N/A "$47,894.89 " "$33,217.19 " "$45,047.46 " N/A "$7,380.16 " "$8,884.86 " N/A N/A N/A N/A N/A "$10,031.29 " N/A "$7,165.21 " "$7,165.21 " "$7,810.08 " N/A N/A N/A N/A N/A N/A N/A "$27,049.42 " "$21,867.52 " "$21,867.52 " "$21,867.52 " "$21,867.52 " "$13,178.12 " "$7,881.73 " "$7,165.21 " "$14,212.50 " N/A N/A N/A N/A "$7,165.21 " "$7,093.55 " "$47,894.89 " 330104 642 INBORN AND OTHER DISORDERS OF METABOLISM I N/A N/A "$12,743.33 " N/A "$21,304.90 " "$22,419.12 " "$20,420.82 " "$12,615.90 " N/A "$24,212.33 " N/A "$12,743.33 " "$42,442.81 " "$14,017.66 " "$52,377.89 " "$43,347.94 " N/A N/A N/A "$87,264.21 " "$60,521.52 " "$82,076.21 " N/A "$13,125.63 " "$15,801.73 " N/A N/A N/A N/A N/A "$17,840.66 " N/A "$12,743.33 " "$12,743.33 " "$13,890.23 " N/A N/A N/A N/A N/A N/A N/A "$49,283.90 " "$39,842.49 " "$39,842.49 " "$39,842.49 " "$39,842.49 " "$24,010.46 " "$14,017.66 " "$12,743.33 " "$25,895.09 " N/A N/A N/A N/A "$12,743.33 " "$12,615.90 " "$87,264.21 " 330104 643 ENDOCRINE DISORDERS WITH MCC I N/A N/A "$14,861.45 " N/A "$24,954.65 " "$26,259.75 " "$23,919.12 " "$14,712.84 " N/A "$28,236.76 " N/A "$14,861.45 " "$49,713.71 " "$16,347.60 " "$61,350.77 " "$50,773.89 " N/A N/A N/A "$102,213.48 " "$70,889.49 " "$96,136.73 " N/A "$15,307.29 " "$18,428.20 " N/A N/A N/A N/A N/A "$20,806.03 " N/A "$14,861.45 " "$14,861.45 " "$16,198.98 " N/A N/A N/A N/A N/A N/A N/A "$57,726.74 " "$46,667.93 " "$46,667.93 " "$46,667.93 " "$46,667.93 " "$28,123.71 " "$16,347.60 " "$14,861.45 " "$30,331.20 " N/A N/A N/A N/A "$14,861.45 " "$14,712.84 " "$102,213.48 " 330104 644 ENDOCRINE DISORDERS WITH CC I N/A N/A "$9,358.22 " N/A "$15,471.98 " "$16,281.14 " "$14,829.94 " "$9,264.64 " N/A "$17,780.61 " N/A "$9,358.22 " "$30,822.68 " "$10,294.04 " "$38,037.70 " "$31,480.00 " N/A N/A N/A "$63,372.73 " "$43,951.74 " "$59,605.12 " N/A "$9,638.96 " "$11,604.19 " N/A N/A N/A N/A N/A "$13,101.50 " N/A "$9,358.22 " "$9,358.22 " "$10,200.46 " N/A N/A N/A N/A N/A N/A N/A "$35,790.79 " "$28,934.29 " "$28,934.29 " "$28,934.29 " "$28,934.29 " "$17,436.80 " "$10,294.04 " "$9,358.22 " "$18,805.45 " N/A N/A N/A N/A "$9,358.22 " "$9,264.64 " "$63,372.73 " 330104 645 ENDOCRINE DISORDERS WITHOUT CC/MCC I N/A N/A "$6,922.03 " N/A "$11,274.15 " "$11,863.78 " "$10,806.32 " "$6,852.81 " N/A "$13,151.85 " N/A "$6,922.03 " "$22,459.94 " "$7,614.23 " "$27,717.40 " "$22,938.91 " N/A N/A N/A "$46,178.58 " "$32,026.85 " "$43,433.19 " N/A "$7,129.69 " "$8,583.32 " N/A N/A N/A N/A N/A "$9,690.84 " N/A "$6,922.03 " "$6,922.03 " "$7,545.01 " N/A N/A N/A N/A N/A N/A N/A "$26,080.11 " "$21,083.90 " "$21,083.90 " "$21,083.90 " "$21,083.90 " "$12,705.89 " "$7,614.23 " "$6,922.03 " "$13,703.20 " N/A N/A N/A N/A "$6,922.03 " "$6,852.81 " "$46,178.58 " 330104 650 KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC I N/A N/A "$41,295.65 " N/A "$70,503.69 " "$74,190.95 " "$67,578.03 " "$40,882.69 " N/A "$78,461.73 " N/A "$41,295.65 " "$140,454.76 " "$45,425.21 " "$173,332.64 " "$143,450.07 " N/A N/A N/A "$288,780.92 " "$200,282.12 " "$271,612.42 " N/A "$42,534.51 " "$51,206.60 " N/A N/A N/A N/A N/A "$57,813.90 " N/A "$41,295.65 " "$41,295.65 " "$45,012.25 " N/A N/A N/A N/A N/A N/A N/A "$163,093.77 " "$131,849.61 " "$131,849.61 " "$131,849.61 " "$131,849.61 " "$79,457.13 " "$45,425.21 " "$41,295.65 " "$85,693.89 " N/A N/A N/A N/A "$41,295.65 " "$40,882.69 " "$288,780.92 " 330104 651 KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC I N/A N/A "$31,624.02 " N/A "$53,838.41 " "$56,654.09 " "$51,604.30 " "$31,307.78 " N/A "$60,085.63 " N/A "$31,624.02 " "$107,254.82 " "$34,786.42 " "$132,361.21 " "$109,542.12 " N/A N/A N/A "$220,520.45 " "$152,940.51 " "$207,410.15 " N/A "$32,572.74 " "$39,213.78 " N/A N/A N/A N/A N/A "$44,273.63 " N/A "$31,624.02 " "$31,624.02 " "$34,470.18 " N/A N/A N/A N/A N/A N/A N/A "$124,542.54 " "$100,683.71 " "$100,683.71 " "$100,683.71 " "$100,683.71 " "$60,675.48 " "$34,786.42 " "$31,624.02 " "$65,438.03 " N/A N/A N/A N/A "$31,624.02 " "$31,307.78 " "$220,520.45 " 330104 652 KIDNEY TRANSPLANT I N/A N/A "$27,561.35 " N/A "$46,837.99 " "$49,287.56 " "$44,894.38 " "$27,285.74 " N/A "$52,366.57 " N/A "$27,561.35 " "$93,308.85 " "$30,317.49 " "$115,150.74 " "$95,298.74 " N/A N/A N/A "$191,846.94 " "$133,054.19 " "$180,441.33 " N/A "$28,388.19 " "$34,176.08 " N/A N/A N/A N/A N/A "$38,585.89 " N/A "$27,561.35 " "$27,561.35 " "$30,041.88 " N/A N/A N/A N/A N/A N/A N/A "$108,348.71 " "$87,592.16 " "$87,592.16 " "$87,592.16 " "$87,592.16 " "$52,786.06 " "$30,317.49 " "$27,561.35 " "$56,929.35 " N/A N/A N/A N/A "$27,561.35 " "$27,285.74 " "$191,846.94 " 330104 653 MAJOR BLADDER PROCEDURES WITH MCC I N/A N/A "$49,338.15 " N/A "$84,361.82 " "$88,773.84 " "$80,861.10 " "$48,844.77 " N/A "$93,742.49 " N/A "$49,338.15 " "$168,062.39 " "$54,271.97 " "$207,402.72 " "$171,646.46 " N/A N/A N/A "$345,543.39 " "$239,649.36 " "$325,000.27 " N/A "$50,818.30 " "$61,179.31 " N/A N/A N/A N/A N/A "$69,073.42 " N/A "$49,338.15 " "$49,338.15 " "$53,778.59 " N/A N/A N/A N/A N/A N/A N/A "$195,151.30 " "$157,765.83 " "$157,765.83 " "$157,765.83 " "$157,765.83 " "$95,075.14 " "$54,271.97 " "$49,338.15 " "$102,537.79 " N/A N/A N/A N/A "$49,338.15 " "$48,844.77 " "$345,543.39 " 330104 654 MAJOR BLADDER PROCEDURES WITH CC I N/A N/A "$25,423.85 " N/A "$43,154.83 " "$45,411.78 " "$41,364.06 " "$25,169.61 " N/A "$48,305.32 " N/A "$25,423.85 " "$85,971.41 " "$27,966.24 " "$106,095.74 " "$87,804.82 " N/A N/A N/A "$176,760.86 " "$122,591.34 " "$166,252.14 " N/A "$26,186.57 " "$31,525.57 " N/A N/A N/A N/A N/A "$35,593.39 " N/A "$25,423.85 " "$25,423.85 " "$27,712.00 " N/A N/A N/A N/A N/A N/A N/A "$99,828.60 " "$80,704.26 " "$80,704.26 " "$80,704.26 " "$80,704.26 " "$48,635.17 " "$27,966.24 " "$25,423.85 " "$52,452.65 " N/A N/A N/A N/A "$25,423.85 " "$25,169.61 " "$176,760.86 " 330104 655 MAJOR BLADDER PROCEDURES WITHOUT CC/MCC I N/A N/A "$19,399.02 " N/A "$32,773.38 " "$34,487.39 " "$31,413.40 " "$19,205.03 " N/A "$36,858.13 " N/A "$19,399.02 " "$65,289.88 " "$21,338.92 " "$80,573.05 " "$66,682.24 " N/A N/A N/A "$134,238.76 " "$93,100.41 " "$126,258.05 " N/A "$19,980.99 " "$24,054.78 " N/A N/A N/A N/A N/A "$27,158.63 " N/A "$19,399.02 " "$19,399.02 " "$21,144.93 " N/A N/A N/A N/A N/A N/A N/A "$75,813.54 " "$61,289.81 " "$61,289.81 " "$61,289.81 " "$61,289.81 " "$36,935.36 " "$21,338.92 " "$19,399.02 " "$39,834.49 " N/A N/A N/A N/A "$19,399.02 " "$19,205.03 " "$134,238.76 " 330104 656 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC I N/A N/A "$29,501.49 " N/A "$50,181.06 " "$52,805.47 " "$48,098.73 " "$29,206.48 " N/A "$56,052.84 " N/A "$29,501.49 " "$99,968.80 " "$32,451.64 " "$123,369.66 " "$102,100.72 " N/A N/A N/A "$205,540.08 " "$142,550.98 " "$193,320.39 " N/A "$30,386.54 " "$36,581.85 " N/A N/A N/A N/A N/A "$41,302.09 " N/A "$29,501.49 " "$29,501.49 " "$32,156.63 " N/A N/A N/A N/A N/A N/A N/A "$116,082.14 " "$93,844.08 " "$93,844.08 " "$93,844.08 " "$93,844.08 " "$56,553.68 " "$32,451.64 " "$29,501.49 " "$60,992.70 " N/A N/A N/A N/A "$29,501.49 " "$29,206.48 " "$205,540.08 " 330104 657 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC I N/A N/A "$16,925.82 " N/A "$28,511.80 " "$30,002.93 " "$27,328.66 " "$16,756.56 " N/A "$32,159.06 " N/A "$16,925.82 " "$56,800.11 " "$18,618.41 " "$70,095.97 " "$58,011.42 " N/A N/A N/A "$116,783.43 " "$80,994.38 " "$109,840.46 " N/A "$17,433.60 " "$20,988.02 " N/A N/A N/A N/A N/A "$23,696.15 " N/A "$16,925.82 " "$16,925.82 " "$18,449.15 " N/A N/A N/A N/A N/A N/A N/A "$65,955.36 " "$53,320.18 " "$53,320.18 " "$53,320.18 " "$53,320.18 " "$32,132.58 " "$18,618.41 " "$16,925.82 " "$34,654.73 " N/A N/A N/A N/A "$16,925.82 " "$16,756.56 " "$116,783.43 " 330104 658 KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC I N/A N/A "$14,291.39 " N/A "$23,972.38 " "$25,226.10 " "$22,977.61 " "$14,148.48 " N/A "$27,153.64 " N/A "$14,291.39 " "$47,756.85 " "$15,720.53 " "$58,935.86 " "$48,775.31 " N/A N/A N/A "$98,190.11 " "$68,099.11 " "$92,352.55 " N/A "$14,720.13 " "$17,721.32 " N/A N/A N/A N/A N/A "$20,007.95 " N/A "$14,291.39 " "$14,291.39 " "$15,577.62 " N/A N/A N/A N/A N/A N/A N/A "$55,454.48 " "$44,830.97 " "$44,830.97 " "$44,830.97 " "$44,830.97 " "$27,016.69 " "$15,720.53 " "$14,291.39 " "$29,137.29 " N/A N/A N/A N/A "$14,291.39 " "$14,148.48 " "$98,190.11 " 330104 659 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC I N/A N/A "$23,083.70 " N/A "$39,122.50 " "$41,168.55 " "$37,499.05 " "$22,852.86 " N/A "$43,859.03 " N/A "$23,083.70 " "$77,938.34 " "$25,392.07 " "$96,182.28 " "$79,600.44 " N/A N/A N/A "$160,244.53 " "$111,136.54 " "$150,717.73 " N/A "$23,776.21 " "$28,623.79 " N/A N/A N/A N/A N/A "$32,317.18 " N/A "$23,083.70 " "$23,083.70 " "$25,161.23 " N/A N/A N/A N/A N/A N/A N/A "$90,500.73 " "$73,163.34 " "$73,163.34 " "$73,163.34 " "$73,163.34 " "$44,090.76 " "$25,392.07 " "$23,083.70 " "$47,551.54 " N/A N/A N/A N/A "$23,083.70 " "$22,852.86 " "$160,244.53 " 330104 660 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC I N/A N/A "$12,812.94 " N/A "$21,424.84 " "$22,545.33 " "$20,535.78 " "$12,684.81 " N/A "$24,344.58 " N/A "$12,812.94 " "$42,681.74 " "$14,094.23 " "$52,672.76 " "$43,591.97 " N/A N/A N/A "$87,755.47 " "$60,862.23 " "$82,538.27 " N/A "$13,197.32 " "$15,888.04 " N/A N/A N/A N/A N/A "$17,938.11 " N/A "$12,812.94 " "$12,812.94 " "$13,966.10 " N/A N/A N/A N/A N/A N/A N/A "$49,561.34 " "$40,066.79 " "$40,066.79 " "$40,066.79 " "$40,066.79 " "$24,145.63 " "$14,094.23 " "$12,812.94 " "$26,040.87 " N/A N/A N/A N/A "$12,812.94 " "$12,684.81 " "$87,755.47 " 330104 661 KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC I N/A N/A "$9,876.29 " N/A "$16,364.68 " "$17,220.53 " "$15,685.60 " "$9,777.53 " N/A "$18,764.96 " N/A "$9,876.29 " "$32,601.09 " "$10,863.92 " "$40,232.40 " "$33,296.33 " N/A N/A N/A "$67,029.21 " "$46,487.67 " "$63,044.22 " N/A "$10,172.58 " "$12,246.60 " N/A N/A N/A N/A N/A "$13,826.81 " N/A "$9,876.29 " "$9,876.29 " "$10,765.16 " N/A N/A N/A N/A N/A N/A N/A "$37,855.85 " "$30,603.74 " "$30,603.74 " "$30,603.74 " "$30,603.74 " "$18,442.87 " "$10,863.92 " "$9,876.29 " "$19,890.49 " N/A N/A N/A N/A "$9,876.29 " "$9,777.53 " "$67,029.21 " 330104 662 MINOR BLADDER PROCEDURES WITH MCC I N/A N/A "$27,152.53 " N/A "$46,133.54 " "$48,546.27 " "$44,219.16 " "$26,881.01 " N/A "$51,589.81 " N/A "$27,152.53 " "$91,905.48 " "$29,867.78 " "$113,418.87 " "$93,865.44 " N/A N/A N/A "$188,961.56 " "$131,053.05 " "$177,727.49 " N/A "$27,967.11 " "$33,669.14 " N/A N/A N/A N/A N/A "$38,013.54 " N/A "$27,152.53 " "$27,152.53 " "$29,596.26 " N/A N/A N/A N/A N/A N/A N/A "$106,719.14 " "$86,274.77 " "$86,274.77 " "$86,274.77 " "$86,274.77 " "$51,992.16 " "$29,867.78 " "$27,152.53 " "$56,073.13 " N/A N/A N/A N/A "$27,152.53 " "$26,881.01 " "$188,961.56 " 330104 663 MINOR BLADDER PROCEDURES WITH CC I N/A N/A "$13,815.61 " N/A "$23,152.55 " "$24,363.40 " "$22,191.80 " "$13,677.45 " N/A "$26,249.65 " N/A "$13,815.61 " "$46,123.62 " "$15,197.17 " "$56,920.32 " "$47,107.25 " N/A N/A N/A "$94,832.12 " "$65,770.20 " "$89,194.20 " N/A "$14,230.08 " "$17,131.35 " N/A N/A N/A N/A N/A "$19,341.85 " N/A "$13,815.61 " "$13,815.61 " "$15,059.01 " N/A N/A N/A N/A N/A N/A N/A "$53,558.00 " "$43,297.80 " "$43,297.80 " "$43,297.80 " "$43,297.80 " "$26,092.75 " "$15,197.17 " "$13,815.61 " "$28,140.82 " N/A N/A N/A N/A "$13,815.61 " "$13,677.45 " "$94,832.12 " 330104 664 MINOR BLADDER PROCEDURES WITHOUT CC/MCC I N/A N/A "$10,306.26 " N/A "$17,105.56 " "$18,000.16 " "$16,395.74 " "$10,203.20 " N/A "$19,581.90 " N/A "$10,306.26 " "$34,077.04 " "$11,336.89 " "$42,053.85 " "$34,803.76 " N/A N/A N/A "$70,063.84 " "$48,592.32 " "$65,898.43 " N/A "$10,615.45 " "$12,779.76 " N/A N/A N/A N/A N/A "$14,428.77 " N/A "$10,306.26 " "$10,306.26 " "$11,233.82 " N/A N/A N/A N/A N/A N/A N/A "$39,569.70 " "$31,989.27 " "$31,989.27 " "$31,989.27 " "$31,989.27 " "$19,277.84 " "$11,336.89 " "$10,306.26 " "$20,791.00 " N/A N/A N/A N/A "$10,306.26 " "$10,203.20 " "$70,063.84 " 330104 665 PROSTATECTOMY WITH MCC I N/A N/A "$27,342.85 " N/A "$46,461.47 " "$48,891.35 " "$44,533.49 " "$27,069.42 " N/A "$51,951.41 " N/A "$27,342.85 " "$92,558.77 " "$30,077.13 " "$114,225.09 " "$94,532.67 " N/A N/A N/A "$190,304.76 " "$131,984.62 " "$178,990.83 " N/A "$28,163.13 " "$33,905.13 " N/A N/A N/A N/A N/A "$38,279.98 " N/A "$27,342.85 " "$27,342.85 " "$29,803.70 " N/A N/A N/A N/A N/A N/A N/A "$107,477.74 " "$86,888.04 " "$86,888.04 " "$86,888.04 " "$86,888.04 " "$52,361.73 " "$30,077.13 " "$27,342.85 " "$56,471.72 " N/A N/A N/A N/A "$27,342.85 " "$27,069.42 " "$190,304.76 " 330104 666 PROSTATECTOMY WITH CC I N/A N/A "$15,550.46 " N/A "$26,141.89 " "$27,509.07 " "$25,057.09 " "$15,394.95 " N/A "$29,545.87 " N/A "$15,550.46 " "$52,078.87 " "$17,105.50 " "$64,269.57 " "$53,189.49 " N/A N/A N/A "$107,076.35 " "$74,262.10 " "$100,710.49 " N/A "$16,016.97 " "$19,282.56 " N/A N/A N/A N/A N/A "$21,770.64 " N/A "$15,550.46 " "$15,550.46 " "$16,950.00 " N/A N/A N/A N/A N/A N/A N/A "$60,473.13 " "$48,888.18 " "$48,888.18 " "$48,888.18 " "$48,888.18 " "$29,461.71 " "$17,105.50 " "$15,550.46 " "$31,774.22 " N/A N/A N/A N/A "$15,550.46 " "$15,394.95 " "$107,076.35 " 330104 667 PROSTATECTOMY WITHOUT CC/MCC I N/A N/A "$9,048.08 " N/A "$14,937.57 " "$15,718.79 " "$14,317.71 " "$8,957.60 " N/A "$17,191.35 " N/A "$9,048.08 " "$29,758.06 " "$9,952.88 " "$36,723.87 " "$30,392.67 " N/A N/A N/A "$61,183.82 " "$42,433.64 " "$57,546.34 " N/A "$9,319.52 " "$11,219.62 " N/A N/A N/A N/A N/A "$12,667.31 " N/A "$9,048.08 " "$9,048.08 " "$9,862.40 " N/A N/A N/A N/A N/A N/A N/A "$34,554.57 " "$27,934.89 " "$27,934.89 " "$27,934.89 " "$27,934.89 " "$16,834.53 " "$9,952.88 " "$9,048.08 " "$18,155.91 " N/A N/A N/A N/A "$9,048.08 " "$8,957.60 " "$61,183.82 " 330104 668 TRANSURETHRAL PROCEDURES WITH MCC I N/A N/A "$25,251.16 " N/A "$42,857.27 " "$45,098.65 " "$41,078.84 " "$24,998.65 " N/A "$47,977.20 " N/A "$25,251.16 " "$85,378.61 " "$27,776.27 " "$105,364.18 " "$87,199.38 " N/A N/A N/A "$175,542.04 " "$121,746.03 " "$165,105.78 " N/A "$26,008.69 " "$31,311.44 " N/A N/A N/A N/A N/A "$35,351.62 " N/A "$25,251.16 " "$25,251.16 " "$27,523.76 " N/A N/A N/A N/A N/A N/A N/A "$99,140.25 " "$80,147.78 " "$80,147.78 " "$80,147.78 " "$80,147.78 " "$48,299.82 " "$27,776.27 " "$25,251.16 " "$52,090.97 " N/A N/A N/A N/A "$25,251.16 " "$24,998.65 " "$175,542.04 " 330104 669 TRANSURETHRAL PROCEDURES WITH CC I N/A N/A "$14,249.10 " N/A "$23,899.50 " "$25,149.42 " "$22,907.76 " "$14,106.61 " N/A "$27,073.29 " N/A "$14,249.10 " "$47,611.68 " "$15,674.01 " "$58,756.70 " "$48,627.04 " N/A N/A N/A "$97,891.63 " "$67,892.10 " "$92,071.81 " N/A "$14,676.57 " "$17,668.88 " N/A N/A N/A N/A N/A "$19,948.74 " N/A "$14,249.10 " "$14,249.10 " "$15,531.52 " N/A N/A N/A N/A N/A N/A N/A "$55,285.90 " "$44,694.69 " "$44,694.69 " "$44,694.69 " "$44,694.69 " "$26,934.56 " "$15,674.01 " "$14,249.10 " "$29,048.71 " N/A N/A N/A N/A "$14,249.10 " "$14,106.61 " "$97,891.63 " 330104 670 TRANSURETHRAL PROCEDURES WITHOUT CC/MCC I N/A N/A "$9,079.80 " N/A "$14,992.23 " "$15,776.30 " "$14,370.10 " "$8,989.00 " N/A "$17,251.61 " N/A "$9,079.80 " "$29,866.94 " "$9,987.78 " "$36,858.24 " "$30,503.88 " N/A N/A N/A "$61,407.69 " "$42,588.90 " "$57,756.90 " N/A "$9,352.19 " "$11,258.95 " N/A N/A N/A N/A N/A "$12,711.71 " N/A "$9,079.80 " "$9,079.80 " "$9,896.98 " N/A N/A N/A N/A N/A N/A N/A "$34,681.00 " "$28,037.10 " "$28,037.10 " "$28,037.10 " "$28,037.10 " "$16,896.12 " "$9,987.78 " "$9,079.80 " "$18,222.34 " N/A N/A N/A N/A "$9,079.80 " "$8,989.00 " "$61,407.69 " 330104 671 URETHRAL PROCEDURES WITH CC/MCC I N/A N/A "$16,516.12 " N/A "$27,805.83 " "$29,260.04 " "$26,651.99 " "$16,350.96 " N/A "$31,380.63 " N/A "$16,516.12 " "$55,393.72 " "$18,167.73 " "$68,360.37 " "$56,575.03 " N/A N/A N/A "$113,891.83 " "$78,988.93 " "$107,120.77 " N/A "$17,011.60 " "$20,479.99 " N/A N/A N/A N/A N/A "$23,122.57 " N/A "$16,516.12 " "$16,516.12 " "$18,002.57 " N/A N/A N/A N/A N/A N/A N/A "$64,322.28 " "$51,999.95 " "$51,999.95 " "$51,999.95 " "$51,999.95 " "$31,336.97 " "$18,167.73 " "$16,516.12 " "$33,796.67 " N/A N/A N/A N/A "$16,516.12 " "$16,350.96 " "$113,891.83 " 330104 672 URETHRAL PROCEDURES WITHOUT CC/MCC I N/A N/A "$9,557.34 " N/A "$15,815.09 " "$16,642.20 " "$15,158.82 " "$9,461.77 " N/A "$18,158.95 " N/A "$9,557.34 " "$31,506.22 " "$10,513.08 " "$38,881.24 " "$32,178.11 " N/A N/A N/A "$64,778.11 " "$44,926.44 " "$60,926.95 " N/A "$9,844.06 " "$11,851.10 " N/A N/A N/A N/A N/A "$13,380.28 " N/A "$9,557.34 " "$9,557.34 " "$10,417.50 " N/A N/A N/A N/A N/A N/A N/A "$36,584.50 " "$29,575.95 " "$29,575.95 " "$29,575.95 " "$29,575.95 " "$17,823.49 " "$10,513.08 " "$9,557.34 " "$19,222.49 " N/A N/A N/A N/A "$9,557.34 " "$9,461.77 " "$64,778.11 " 330104 673 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC I N/A N/A "$31,164.09 " N/A "$53,045.91 " "$55,820.14 " "$50,844.69 " "$30,852.45 " N/A "$59,211.78 " N/A "$31,164.09 " "$105,676.03 " "$34,280.50 " "$130,412.85 " "$107,929.66 " N/A N/A N/A "$217,274.39 " "$150,689.23 " "$204,357.07 " N/A "$32,099.02 " "$38,643.48 " N/A N/A N/A N/A N/A "$43,629.73 " N/A "$31,164.09 " "$31,164.09 " "$33,968.86 " N/A N/A N/A N/A N/A N/A N/A "$122,709.28 " "$99,201.65 " "$99,201.65 " "$99,201.65 " "$99,201.65 " "$59,782.34 " "$34,280.50 " "$31,164.09 " "$64,474.78 " N/A N/A N/A N/A "$31,164.09 " "$30,852.45 " "$217,274.39 " 330104 674 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC I N/A N/A "$21,265.15 " N/A "$35,988.93 " "$37,871.11 " "$34,495.52 " "$21,052.50 " N/A "$40,403.78 " N/A "$21,265.15 " "$71,695.77 " "$23,391.66 " "$88,478.44 " "$73,224.74 " N/A N/A N/A "$147,409.54 " "$102,234.92 " "$138,645.80 " N/A "$21,903.10 " "$26,368.78 " N/A N/A N/A N/A N/A "$29,771.21 " N/A "$21,265.15 " "$21,265.15 " "$23,179.01 " N/A N/A N/A N/A N/A N/A N/A "$83,251.96 " "$67,303.24 " "$67,303.24 " "$67,303.24 " "$67,303.24 " "$40,559.25 " "$23,391.66 " "$21,265.15 " "$43,742.84 " N/A N/A N/A N/A "$21,265.15 " "$21,052.50 " "$147,409.54 " 330104 675 OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC I N/A N/A "$15,237.67 " N/A "$25,602.92 " "$26,941.93 " "$24,540.49 " "$15,085.30 " N/A "$28,951.58 " N/A "$15,237.67 " "$51,005.17 " "$16,761.44 " "$62,944.54 " "$52,092.90 " N/A N/A N/A "$104,868.78 " "$72,731.06 " "$98,634.16 " N/A "$15,694.80 " "$18,894.71 " N/A N/A N/A N/A N/A "$21,332.74 " N/A "$15,237.67 " "$15,237.67 " "$16,609.06 " N/A N/A N/A N/A N/A N/A N/A "$59,226.37 " "$47,880.27 " "$47,880.27 " "$47,880.27 " "$47,880.27 " "$28,854.30 " "$16,761.44 " "$15,237.67 " "$31,119.14 " N/A N/A N/A N/A "$15,237.67 " "$15,085.30 " "$104,868.78 " 330104 682 RENAL FAILURE WITH MCC I N/A N/A "$13,477.27 " N/A "$22,569.56 " "$23,749.92 " "$21,633.00 " "$13,342.50 " N/A "$25,606.82 " N/A "$13,477.27 " "$44,962.22 " "$14,825.00 " "$55,487.05 " "$45,921.07 " N/A N/A N/A "$92,444.22 " "$64,114.08 " "$86,948.26 " N/A "$13,881.59 " "$16,711.82 " N/A N/A N/A N/A N/A "$18,868.18 " N/A "$13,477.27 " "$13,477.27 " "$14,690.23 " N/A N/A N/A N/A N/A N/A N/A "$52,209.39 " "$42,207.55 " "$42,207.55 " "$42,207.55 " "$42,207.55 " "$25,435.73 " "$14,825.00 " "$13,477.27 " "$27,432.23 " N/A N/A N/A N/A "$13,477.27 " "$13,342.50 " "$92,444.22 " 330104 683 RENAL FAILURE WITH CC I N/A N/A "$8,263.91 " N/A "$13,586.37 " "$14,296.92 " "$13,022.58 " "$8,181.28 " N/A "$15,701.44 " N/A "$8,263.91 " "$27,066.25 " "$9,090.31 " "$33,401.96 " "$27,643.46 " N/A N/A N/A "$55,649.36 " "$38,595.25 " "$52,340.91 " N/A "$8,511.83 " "$10,247.25 " N/A N/A N/A N/A N/A "$11,569.48 " N/A "$8,263.91 " "$8,263.91 " "$9,007.67 " N/A N/A N/A N/A N/A N/A N/A "$31,428.89 " "$25,408.00 " "$25,408.00 " "$25,408.00 " "$25,408.00 " "$15,311.74 " "$9,090.31 " "$8,263.91 " "$16,513.59 " N/A N/A N/A N/A "$8,263.91 " "$8,181.28 " "$55,649.36 " 330104 684 RENAL FAILURE WITHOUT CC/MCC I N/A N/A "$5,707.90 " N/A "$9,182.07 " "$9,662.28 " "$8,801.05 " "$5,650.82 " N/A "$10,845.01 " N/A "$5,707.90 " "$18,292.18 " "$6,278.69 " "$22,574.04 " "$18,682.27 " N/A N/A N/A "$37,609.49 " "$26,083.81 " "$35,373.54 " N/A "$5,879.14 " "$7,077.79 " N/A N/A N/A N/A N/A "$7,991.06 " N/A "$5,707.90 " "$5,707.90 " "$6,221.61 " N/A N/A N/A N/A N/A N/A N/A "$21,240.58 " "$17,171.48 " "$17,171.48 " "$17,171.48 " "$17,171.48 " "$10,348.13 " "$6,278.69 " "$5,707.90 " "$11,160.37 " N/A N/A N/A N/A "$5,707.90 " "$5,650.82 " "$37,609.49 " 330104 686 KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC I N/A N/A "$15,338.12 " N/A "$25,776.00 " "$27,124.05 " "$24,706.39 " "$15,184.73 " N/A "$29,142.42 " N/A "$15,338.12 " "$51,349.96 " "$16,871.93 " "$63,370.05 " "$52,445.04 " N/A N/A N/A "$105,577.69 " "$73,222.72 " "$99,300.93 " N/A "$15,798.26 " "$19,019.26 " N/A N/A N/A N/A N/A "$21,473.36 " N/A "$15,338.12 " "$15,338.12 " "$16,718.55 " N/A N/A N/A N/A N/A N/A N/A "$59,626.74 " "$48,203.94 " "$48,203.94 " "$48,203.94 " "$48,203.94 " "$29,049.36 " "$16,871.93 " "$15,338.12 " "$31,329.50 " N/A N/A N/A N/A "$15,338.12 " "$15,184.73 " "$105,577.69 " 330104 687 KIDNEY AND URINARY TRACT NEOPLASMS WITH CC I N/A N/A "$9,540.60 " N/A "$15,786.24 " "$16,611.84 " "$15,131.17 " "$9,445.20 " N/A "$18,127.14 " N/A "$9,540.60 " "$31,448.75 " "$10,494.66 " "$38,810.33 " "$32,119.42 " N/A N/A N/A "$64,659.96 " "$44,844.49 " "$60,815.82 " N/A "$9,826.82 " "$11,830.35 " N/A N/A N/A N/A N/A "$13,356.84 " N/A "$9,540.60 " "$9,540.60 " "$10,399.26 " N/A N/A N/A N/A N/A N/A N/A "$36,517.78 " "$29,522.00 " "$29,522.00 " "$29,522.00 " "$29,522.00 " "$17,790.98 " "$10,494.66 " "$9,540.60 " "$19,187.43 " N/A N/A N/A N/A "$9,540.60 " "$9,445.20 " "$64,659.96 " 330104 688 KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC I N/A N/A "$8,012.81 " N/A "$13,153.68 " "$13,841.61 " "$12,607.85 " "$7,932.68 " N/A "$15,224.33 " N/A "$8,012.81 " "$26,204.27 " "$8,814.09 " "$32,338.21 " "$26,763.10 " N/A N/A N/A "$53,877.08 " "$37,366.10 " "$50,674.00 " N/A "$8,253.19 " "$9,935.88 " N/A N/A N/A N/A N/A "$11,217.93 " N/A "$8,012.81 " "$8,012.81 " "$8,733.96 " N/A N/A N/A N/A N/A N/A N/A "$30,427.97 " "$24,598.83 " "$24,598.83 " "$24,598.83 " "$24,598.83 " "$14,824.10 " "$8,814.09 " "$8,012.81 " "$15,987.68 " N/A N/A N/A N/A "$8,012.81 " "$7,932.68 " "$53,877.08 " 330104 689 KIDNEY AND URINARY TRACT INFECTIONS WITH MCC I N/A N/A "$10,486.00 " N/A "$17,415.27 " "$18,326.07 " "$16,692.60 " "$10,381.14 " N/A "$19,923.40 " N/A "$10,486.00 " "$34,694.04 " "$11,534.60 " "$42,815.28 " "$35,433.92 " N/A N/A N/A "$71,332.41 " "$49,472.13 " "$67,091.58 " N/A "$10,800.58 " "$13,002.64 " N/A N/A N/A N/A N/A "$14,680.40 " N/A "$10,486.00 " "$10,486.00 " "$11,429.74 " N/A N/A N/A N/A N/A N/A N/A "$40,286.15 " "$32,568.46 " "$32,568.46 " "$32,568.46 " "$32,568.46 " "$19,626.88 " "$11,534.60 " "$10,486.00 " "$21,167.44 " N/A N/A N/A N/A "$10,486.00 " "$10,381.14 " "$71,332.41 " 330104 690 KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC I N/A N/A "$7,389.00 " N/A "$12,078.80 " "$12,710.51 " "$11,577.57 " "$7,315.11 " N/A "$14,039.10 " N/A "$7,389.00 " "$24,062.92 " "$8,127.90 " "$29,695.61 " "$24,576.08 " N/A N/A N/A "$49,474.39 " "$34,312.64 " "$46,533.05 " N/A "$7,610.67 " "$9,162.36 " N/A N/A N/A N/A N/A "$10,344.60 " N/A "$7,389.00 " "$7,389.00 " "$8,054.01 " N/A N/A N/A N/A N/A N/A N/A "$27,941.47 " "$22,588.68 " "$22,588.68 " "$22,588.68 " "$22,588.68 " "$13,612.72 " "$8,127.90 " "$7,389.00 " "$14,681.21 " N/A N/A N/A N/A "$7,389.00 " "$7,315.11 " "$49,474.39 " 330104 693 URINARY STONES WITH MCC I N/A N/A "$12,985.63 " N/A "$21,722.41 " "$22,858.46 " "$20,821.00 " "$12,855.77 " N/A "$24,672.69 " N/A "$12,985.63 " "$43,274.55 " "$14,284.19 " "$53,404.32 " "$44,197.41 " N/A N/A N/A "$88,974.30 " "$61,707.54 " "$83,684.63 " N/A "$13,375.20 " "$16,102.18 " N/A N/A N/A N/A N/A "$18,179.88 " N/A "$12,985.63 " "$12,985.63 " "$14,154.34 " N/A N/A N/A N/A N/A N/A N/A "$50,249.70 " "$40,623.27 " "$40,623.27 " "$40,623.27 " "$40,623.27 " "$24,480.99 " "$14,284.19 " "$12,985.63 " "$26,402.55 " N/A N/A N/A N/A "$12,985.63 " "$12,855.77 " "$88,974.30 " 330104 694 URINARY STONES WITHOUT MCC I N/A N/A "$7,402.22 " N/A "$12,101.57 " "$12,734.47 " "$11,599.40 " "$7,328.20 " N/A "$14,064.21 " N/A "$7,402.22 " "$24,108.29 " "$8,142.44 " "$29,751.60 " "$24,622.42 " N/A N/A N/A "$49,567.66 " "$34,377.33 " "$46,620.78 " N/A "$7,624.28 " "$9,178.75 " N/A N/A N/A N/A N/A "$10,363.10 " N/A "$7,402.22 " "$7,402.22 " "$8,068.42 " N/A N/A N/A N/A N/A N/A N/A "$27,994.15 " "$22,631.26 " "$22,631.26 " "$22,631.26 " "$22,631.26 " "$13,638.38 " "$8,142.44 " "$7,402.22 " "$14,708.89 " N/A N/A N/A N/A "$7,402.22 " "$7,328.20 " "$49,567.66 " 330104 695 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC I N/A N/A "$10,496.57 " N/A "$17,433.49 " "$18,345.24 " "$16,710.06 " "$10,391.61 " N/A "$19,943.49 " N/A "$10,496.57 " "$34,730.33 " "$11,546.23 " "$42,860.07 " "$35,470.99 " N/A N/A N/A "$71,407.04 " "$49,523.88 " "$67,161.77 " N/A "$10,811.47 " "$13,015.75 " N/A N/A N/A N/A N/A "$14,695.20 " N/A "$10,496.57 " "$10,496.57 " "$11,441.27 " N/A N/A N/A N/A N/A N/A N/A "$40,328.30 " "$32,602.53 " "$32,602.53 " "$32,602.53 " "$32,602.53 " "$19,647.41 " "$11,546.23 " "$10,496.57 " "$21,189.58 " N/A N/A N/A N/A "$10,496.57 " "$10,391.61 " "$71,407.04 " 330104 696 KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC I N/A N/A "$6,485.01 " N/A "$10,521.13 " "$11,071.37 " "$10,084.54 " "$6,420.16 " N/A "$12,321.52 " N/A "$6,485.01 " "$20,959.78 " "$7,133.51 " "$25,866.09 " "$21,406.77 " N/A N/A N/A "$43,094.20 " "$29,887.70 " "$40,532.18 " N/A "$6,679.56 " "$8,041.41 " N/A N/A N/A N/A N/A "$9,079.02 " N/A "$6,485.01 " "$6,485.01 " "$7,068.66 " N/A N/A N/A N/A N/A N/A N/A "$24,338.16 " "$19,675.66 " "$19,675.66 " "$19,675.66 " "$19,675.66 " "$11,857.23 " "$7,133.51 " "$6,485.01 " "$12,787.93 " N/A N/A N/A N/A "$6,485.01 " "$6,420.16 " "$43,094.20 " 330104 697 URETHRAL STRICTURE I N/A N/A "$9,122.97 " N/A "$15,066.62 " "$15,854.58 " "$14,441.40 " "$9,031.74 " N/A "$17,333.64 " N/A "$9,122.97 " "$30,015.14 " "$10,035.27 " "$37,041.13 " "$30,655.24 " N/A N/A N/A "$61,712.39 " "$42,800.23 " "$58,043.49 " N/A "$9,396.66 " "$11,312.48 " N/A N/A N/A N/A N/A "$12,772.16 " N/A "$9,122.97 " "$9,122.97 " "$9,944.04 " N/A N/A N/A N/A N/A N/A N/A "$34,853.09 " "$28,176.22 " "$28,176.22 " "$28,176.22 " "$28,176.22 " "$16,979.96 " "$10,035.27 " "$9,122.97 " "$18,312.76 " N/A N/A N/A N/A "$9,122.97 " "$9,031.74 " "$61,712.39 " 330104 698 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC I N/A N/A "$14,498.44 " N/A "$24,329.15 " "$25,601.54 " "$23,319.58 " "$14,353.46 " N/A "$27,547.05 " N/A "$14,498.44 " "$48,467.61 " "$15,948.29 " "$59,812.99 " "$49,501.22 " N/A N/A N/A "$99,651.46 " "$69,112.62 " "$93,727.02 " N/A "$14,933.40 " "$17,978.07 " N/A N/A N/A N/A N/A "$20,297.82 " N/A "$14,498.44 " "$14,498.44 " "$15,803.30 " N/A N/A N/A N/A N/A N/A N/A "$56,279.80 " "$45,498.18 " "$45,498.18 " "$45,498.18 " "$45,498.18 " "$27,418.78 " "$15,948.29 " "$14,498.44 " "$29,570.93 " N/A N/A N/A N/A "$14,498.44 " "$14,353.46 " "$99,651.46 " 330104 699 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC I N/A N/A "$9,296.54 " N/A "$15,365.70 " "$16,169.31 " "$14,728.08 " "$9,203.58 " N/A "$17,663.43 " N/A "$9,296.54 " "$30,610.96 " "$10,226.20 " "$37,776.43 " "$31,263.77 " N/A N/A N/A "$62,937.44 " "$43,649.85 " "$59,195.70 " N/A "$9,575.44 " "$11,527.71 " N/A N/A N/A N/A N/A "$13,015.16 " N/A "$9,296.54 " "$9,296.54 " "$10,133.23 " N/A N/A N/A N/A N/A N/A N/A "$35,544.95 " "$28,735.54 " "$28,735.54 " "$28,735.54 " "$28,735.54 " "$17,317.03 " "$10,226.20 " "$9,296.54 " "$18,676.28 " N/A N/A N/A N/A "$9,296.54 " "$9,203.58 " "$62,937.44 " 330104 700 OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC I N/A N/A "$6,906.17 " N/A "$11,246.83 " "$11,835.02 " "$10,780.12 " "$6,837.11 " N/A "$13,121.72 " N/A "$6,906.17 " "$22,405.50 " "$7,596.79 " "$27,650.21 " "$22,883.31 " N/A N/A N/A "$46,066.65 " "$31,949.22 " "$43,327.91 " N/A "$7,113.35 " "$8,563.65 " N/A N/A N/A N/A N/A "$9,668.64 " N/A "$6,906.17 " "$6,906.17 " "$7,527.72 " N/A N/A N/A N/A N/A N/A N/A "$26,016.90 " "$21,032.79 " "$21,032.79 " "$21,032.79 " "$21,032.79 " "$12,675.09 " "$7,596.79 " "$6,906.17 " "$13,669.98 " N/A N/A N/A N/A "$6,906.17 " "$6,837.11 " "$46,066.65 " 330104 707 MAJOR MALE PELVIC PROCEDURES WITH CC/MCC I N/A N/A "$17,959.33 " N/A "$30,292.64 " "$31,876.91 " "$29,035.61 " "$17,779.74 " N/A "$34,122.73 " N/A "$17,959.33 " "$60,347.85 " "$19,755.26 " "$74,474.17 " "$61,634.82 " N/A N/A N/A "$124,077.73 " "$86,053.30 " "$116,701.11 " N/A "$18,498.11 " "$22,269.57 " N/A N/A N/A N/A N/A "$25,143.06 " N/A "$17,959.33 " "$17,959.33 " "$19,575.67 " N/A N/A N/A N/A N/A N/A N/A "$70,074.94 " "$56,650.56 " "$56,650.56 " "$56,650.56 " "$56,650.56 " "$34,139.58 " "$19,755.26 " "$17,959.33 " "$36,819.27 " N/A N/A N/A N/A "$17,959.33 " "$17,779.74 " "$124,077.73 " 330104 708 MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC I N/A N/A "$13,460.53 " N/A "$22,540.72 " "$23,719.57 " "$21,605.35 " "$13,325.93 " N/A "$25,575.01 " N/A "$13,460.53 " "$44,904.75 " "$14,806.58 " "$55,416.13 " "$45,862.38 " N/A N/A N/A "$92,326.07 " "$64,032.14 " "$86,837.13 " N/A "$13,864.35 " "$16,691.06 " N/A N/A N/A N/A N/A "$18,844.74 " N/A "$13,460.53 " "$13,460.53 " "$14,671.98 " N/A N/A N/A N/A N/A N/A N/A "$52,142.66 " "$42,153.60 " "$42,153.60 " "$42,153.60 " "$42,153.60 " "$25,403.22 " "$14,806.58 " "$13,460.53 " "$27,397.17 " N/A N/A N/A N/A "$13,460.53 " "$13,325.93 " "$92,326.07 " 330104 709 PENIS PROCEDURES WITH CC/MCC I N/A N/A "$21,630.80 " N/A "$36,618.98 " "$38,534.11 " "$35,099.42 " "$21,414.49 " N/A "$41,098.51 " N/A "$21,630.80 " "$72,950.94 " "$23,793.88 " "$90,027.42 " "$74,506.68 " N/A N/A N/A "$149,990.22 " "$104,024.74 " "$141,073.06 " N/A "$22,279.72 " "$26,822.19 " N/A N/A N/A N/A N/A "$30,283.11 " N/A "$21,630.80 " "$21,630.80 " "$23,577.57 " N/A N/A N/A N/A N/A N/A N/A "$84,709.44 " "$68,481.50 " "$68,481.50 " "$68,481.50 " "$68,481.50 " "$41,269.32 " "$23,793.88 " "$21,630.80 " "$44,508.64 " N/A N/A N/A N/A "$21,630.80 " "$21,414.49 " "$149,990.22 " 330104 710 PENIS PROCEDURES WITHOUT CC/MCC I N/A N/A "$13,079.02 " N/A "$21,883.33 " "$23,027.81 " "$20,975.25 " "$12,948.23 " N/A "$24,850.14 " N/A "$13,079.02 " "$43,595.14 " "$14,386.93 " "$53,799.97 " "$44,524.85 " N/A N/A N/A "$89,633.46 " "$62,164.70 " "$84,304.60 " N/A "$13,471.39 " "$16,217.99 " N/A N/A N/A N/A N/A "$18,310.63 " N/A "$13,079.02 " "$13,079.02 " "$14,256.14 " N/A N/A N/A N/A N/A N/A N/A "$50,621.97 " "$40,924.23 " "$40,924.23 " "$40,924.23 " "$40,924.23 " "$24,662.35 " "$14,386.93 " "$13,079.02 " "$26,598.15 " N/A N/A N/A N/A "$13,079.02 " "$12,948.23 " "$89,633.46 " 330104 711 TESTES PROCEDURES WITH CC/MCC I N/A N/A "$18,383.13 " N/A "$31,022.90 " "$32,645.36 " "$29,735.56 " "$18,199.30 " N/A "$34,927.95 " N/A "$18,383.13 " "$61,802.63 " "$20,221.44 " "$76,269.50 " "$63,120.63 " N/A N/A N/A "$127,068.83 " "$88,127.76 " "$119,514.38 " N/A "$18,934.63 " "$22,795.08 " N/A N/A N/A N/A N/A "$25,736.38 " N/A "$18,383.13 " "$18,383.13 " "$20,037.61 " N/A N/A N/A N/A N/A N/A N/A "$71,764.21 " "$58,016.21 " "$58,016.21 " "$58,016.21 " "$58,016.21 " "$34,962.57 " "$20,221.44 " "$18,383.13 " "$37,706.86 " N/A N/A N/A N/A "$18,383.13 " "$18,199.30 " "$127,068.83 " 330104 712 TESTES PROCEDURES WITHOUT CC/MCC I N/A N/A "$11,318.62 " N/A "$18,849.97 " "$19,835.80 " "$18,067.76 " "$11,205.44 " N/A "$21,505.38 " N/A "$11,318.62 " "$37,552.19 " "$12,450.49 " "$46,342.47 " "$38,353.02 " N/A N/A N/A "$77,208.90 " "$53,547.72 " "$72,618.70 " N/A "$11,658.18 " "$14,035.09 " N/A N/A N/A N/A N/A "$15,846.07 " N/A "$11,318.62 " "$11,318.62 " "$12,337.30 " N/A N/A N/A N/A N/A N/A N/A "$43,604.99 " "$35,251.51 " "$35,251.51 " "$35,251.51 " "$35,251.51 " "$21,243.78 " "$12,450.49 " "$11,318.62 " "$22,911.24 " N/A N/A N/A N/A "$11,318.62 " "$11,205.44 " "$77,208.90 " 330104 713 TRANSURETHRAL PROSTATECTOMY WITH CC/MCC I N/A N/A "$13,435.86 " N/A "$22,498.21 " "$23,674.83 " "$21,564.61 " "$13,301.50 " N/A "$25,528.14 " N/A "$13,435.86 " "$44,820.07 " "$14,779.45 " "$55,311.62 " "$45,775.89 " N/A N/A N/A "$92,151.95 " "$63,911.38 " "$86,673.37 " N/A "$13,838.94 " "$16,660.47 " N/A N/A N/A N/A N/A "$18,810.21 " N/A "$13,435.86 " "$13,435.86 " "$14,645.09 " N/A N/A N/A N/A N/A N/A N/A "$52,044.33 " "$42,074.10 " "$42,074.10 " "$42,074.10 " "$42,074.10 " "$25,355.31 " "$14,779.45 " "$13,435.86 " "$27,345.50 " N/A N/A N/A N/A "$13,435.86 " "$13,301.50 " "$92,151.95 " 330104 714 TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC I N/A N/A "$8,821.64 " N/A "$14,547.39 " "$15,308.20 " "$13,943.73 " "$8,733.42 " N/A "$16,761.11 " N/A "$8,821.64 " "$28,980.76 " "$9,703.80 " "$35,764.62 " "$29,598.80 " N/A N/A N/A "$59,585.67 " "$41,325.25 " "$56,043.20 " N/A "$9,086.29 " "$10,938.83 " N/A N/A N/A N/A N/A "$12,350.29 " N/A "$8,821.64 " "$8,821.64 " "$9,615.59 " N/A N/A N/A N/A N/A N/A N/A "$33,651.98 " "$27,205.21 " "$27,205.21 " "$27,205.21 " "$27,205.21 " "$16,394.80 " "$9,703.80 " "$8,821.64 " "$17,681.66 " N/A N/A N/A N/A "$8,821.64 " "$8,733.42 " "$59,585.67 " 330104 715 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC I N/A N/A "$20,055.42 " N/A "$33,904.44 " "$35,677.60 " "$32,497.53 " "$19,854.87 " N/A "$38,105.30 " N/A "$20,055.42 " "$67,543.13 " "$22,060.97 " "$83,353.74 " "$68,983.55 " N/A N/A N/A "$138,871.54 " "$96,313.45 " "$130,615.40 " N/A "$20,657.09 " "$24,868.72 " N/A N/A N/A N/A N/A "$28,077.59 " N/A "$20,055.42 " "$20,055.42 " "$21,860.41 " N/A N/A N/A N/A N/A N/A N/A "$78,429.98 " "$63,405.01 " "$63,405.01 " "$63,405.01 " "$63,405.01 " "$38,210.05 " "$22,060.97 " "$20,055.42 " "$41,209.24 " N/A N/A N/A N/A "$20,055.42 " "$19,854.87 " "$138,871.54 " 330104 716 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC I N/A N/A "$11,959.17 " N/A "$19,953.70 " "$20,997.26 " "$19,125.69 " "$11,839.58 " N/A "$22,722.42 " N/A "$11,959.17 " "$39,751.00 " "$13,155.09 " "$49,055.98 " "$40,598.73 " N/A N/A N/A "$81,729.75 " "$56,683.13 " "$76,870.78 " N/A "$12,317.94 " "$14,829.37 " N/A N/A N/A N/A N/A "$16,742.84 " N/A "$11,959.17 " "$11,959.17 " "$13,035.49 " N/A N/A N/A N/A N/A N/A N/A "$46,158.22 " "$37,315.61 " "$37,315.61 " "$37,315.61 " "$37,315.61 " "$22,487.67 " "$13,155.09 " "$11,959.17 " "$24,252.78 " N/A N/A N/A N/A "$11,959.17 " "$11,839.58 " "$81,729.75 " 330104 717 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC I N/A N/A "$15,976.90 " N/A "$26,876.69 " "$28,282.31 " "$25,761.41 " "$15,817.13 " N/A "$30,356.11 " N/A "$15,976.90 " "$53,542.72 " "$17,574.59 " "$66,076.09 " "$54,684.57 " N/A N/A N/A "$110,086.11 " "$76,349.50 " "$103,541.31 " N/A "$16,456.21 " "$19,811.35 " N/A N/A N/A N/A N/A "$22,367.66 " N/A "$15,976.90 " "$15,976.90 " "$17,414.82 " N/A N/A N/A N/A N/A N/A N/A "$62,172.94 " "$50,262.36 " "$50,262.36 " "$50,262.36 " "$50,262.36 " "$30,289.83 " "$17,574.59 " "$15,976.90 " "$32,667.35 " N/A N/A N/A N/A "$15,976.90 " "$15,817.13 " "$110,086.11 " 330104 718 OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC I N/A N/A "$11,560.04 " N/A "$19,265.96 " "$20,273.54 " "$18,466.49 " "$11,444.44 " N/A "$21,964.07 " N/A "$11,560.04 " "$38,380.91 " "$12,716.04 " "$47,365.17 " "$39,199.41 " N/A N/A N/A "$78,912.77 " "$54,729.43 " "$74,221.27 " N/A "$11,906.84 " "$14,334.45 " N/A N/A N/A N/A N/A "$16,184.05 " N/A "$11,560.04 " "$11,560.04 " "$12,600.44 " N/A N/A N/A N/A N/A N/A N/A "$44,567.28 " "$36,029.45 " "$36,029.45 " "$36,029.45 " "$36,029.45 " "$21,712.59 " "$12,716.04 " "$11,560.04 " "$23,416.86 " N/A N/A N/A N/A "$11,560.04 " "$11,444.44 " "$78,912.77 " 330104 722 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC" I N/A N/A "$15,337.23 " N/A "$25,774.48 " "$27,122.46 " "$24,704.93 " "$15,183.86 " N/A "$29,140.74 " N/A "$15,337.23 " "$51,346.94 " "$16,870.96 " "$63,366.31 " "$52,441.95 " N/A N/A N/A "$105,571.47 " "$73,218.41 " "$99,295.08 " N/A "$15,797.35 " "$19,018.17 " N/A N/A N/A N/A N/A "$21,472.13 " N/A "$15,337.23 " "$15,337.23 " "$16,717.59 " N/A N/A N/A N/A N/A N/A N/A "$59,623.22 " "$48,201.10 " "$48,201.10 " "$48,201.10 " "$48,201.10 " "$29,047.65 " "$16,870.96 " "$15,337.23 " "$31,327.66 " N/A N/A N/A N/A "$15,337.23 " "$15,183.86 " "$105,571.47 " 330104 723 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC" I N/A N/A "$10,532.70 " N/A "$17,495.74 " "$18,410.74 " "$16,769.72 " "$10,427.37 " N/A "$20,012.13 " N/A "$10,532.70 " "$34,854.34 " "$11,585.97 " "$43,013.10 " "$35,597.64 " N/A N/A N/A "$71,661.99 " "$49,700.71 " "$67,401.57 " N/A "$10,848.68 " "$13,060.55 " N/A N/A N/A N/A N/A "$14,745.78 " N/A "$10,532.70 " "$10,532.70 " "$11,480.64 " N/A N/A N/A N/A N/A N/A N/A "$40,472.29 " "$32,718.94 " "$32,718.94 " "$32,718.94 " "$32,718.94 " "$19,717.56 " "$11,585.97 " "$10,532.70 " "$21,265.24 " N/A N/A N/A N/A "$10,532.70 " "$10,427.37 " "$71,661.99 " 330104 724 "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC" I N/A N/A "$7,120.27 " N/A "$11,615.75 " "$12,223.24 " "$11,133.74 " "$7,049.07 " N/A "$13,528.52 " N/A "$7,120.27 " "$23,140.45 " "$7,832.30 " "$28,557.20 " "$23,633.94 " N/A N/A N/A "$47,577.74 " "$32,997.23 " "$44,749.17 " N/A "$7,333.88 " "$8,829.14 " N/A N/A N/A N/A N/A "$9,968.38 " N/A "$7,120.27 " "$7,120.27 " "$7,761.10 " N/A N/A N/A N/A N/A N/A N/A "$26,870.31 " "$21,722.72 " "$21,722.72 " "$21,722.72 " "$21,722.72 " "$13,090.86 " "$7,832.30 " "$7,120.27 " "$14,118.39 " N/A N/A N/A N/A "$7,120.27 " "$7,049.07 " "$47,577.74 " 330104 725 BENIGN PROSTATIC HYPERTROPHY WITH MCC I N/A N/A "$11,386.47 " N/A "$18,966.87 " "$19,958.82 " "$18,179.81 " "$11,272.60 " N/A "$21,634.29 " N/A "$11,386.47 " "$37,785.08 " "$12,525.11 " "$46,629.87 " "$38,590.88 " N/A N/A N/A "$77,687.72 " "$53,879.81 " "$73,069.06 " N/A "$11,728.06 " "$14,119.22 " N/A N/A N/A N/A N/A "$15,941.05 " N/A "$11,386.47 " "$11,386.47 " "$12,411.25 " N/A N/A N/A N/A N/A N/A N/A "$43,875.42 " "$35,470.13 " "$35,470.13 " "$35,470.13 " "$35,470.13 " "$21,375.52 " "$12,525.11 " "$11,386.47 " "$23,053.33 " N/A N/A N/A N/A "$11,386.47 " "$11,272.60 " "$77,687.72 " 330104 726 BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC I N/A N/A "$7,177.54 " N/A "$11,714.43 " "$12,327.08 " "$11,228.32 " "$7,105.77 " N/A "$13,637.33 " N/A "$7,177.54 " "$23,337.04 " "$7,895.30 " "$28,799.82 " "$23,834.72 " N/A N/A N/A "$47,981.95 " "$33,277.56 " "$45,129.34 " N/A "$7,392.87 " "$8,900.15 " N/A N/A N/A N/A N/A "$10,048.56 " N/A "$7,177.54 " "$7,177.54 " "$7,823.52 " N/A N/A N/A N/A N/A N/A N/A "$27,098.59 " "$21,907.27 " "$21,907.27 " "$21,907.27 " "$21,907.27 " "$13,202.08 " "$7,895.30 " "$7,177.54 " "$14,238.33 " N/A N/A N/A N/A "$7,177.54 " "$7,105.77 " "$47,981.95 " 330104 727 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC I N/A N/A "$13,038.49 " N/A "$21,813.50 " "$22,954.32 " "$20,908.31 " "$12,908.11 " N/A "$24,773.14 " N/A "$13,038.49 " "$43,456.02 " "$14,342.34 " "$53,628.27 " "$44,382.75 " N/A N/A N/A "$89,347.41 " "$61,966.31 " "$84,035.56 " N/A "$13,429.65 " "$16,167.73 " N/A N/A N/A N/A N/A "$18,253.89 " N/A "$13,038.49 " "$13,038.49 " "$14,211.96 " N/A N/A N/A N/A N/A N/A N/A "$50,460.42 " "$40,793.63 " "$40,793.63 " "$40,793.63 " "$40,793.63 " "$24,583.65 " "$14,342.34 " "$13,038.49 " "$26,513.27 " N/A N/A N/A N/A "$13,038.49 " "$12,908.11 " "$89,347.41 " 330104 728 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC I N/A N/A "$7,618.96 " N/A "$12,475.05 " "$13,127.48 " "$11,957.38 " "$7,542.77 " N/A "$14,476.03 " N/A "$7,618.96 " "$24,852.32 " "$8,380.86 " "$30,669.79 " "$25,382.31 " N/A N/A N/A "$51,097.41 " "$35,438.28 " "$48,059.59 " N/A "$7,847.53 " "$9,447.51 " N/A N/A N/A N/A N/A "$10,666.55 " N/A "$7,618.96 " "$7,618.96 " "$8,304.67 " N/A N/A N/A N/A N/A N/A N/A "$28,858.10 " "$23,329.71 " "$23,329.71 " "$23,329.71 " "$23,329.71 " "$14,059.29 " "$8,380.86 " "$7,618.96 " "$15,162.83 " N/A N/A N/A N/A "$7,618.96 " "$7,542.77 " "$51,097.41 " 330104 729 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC I N/A N/A "$9,875.41 " N/A "$16,363.16 " "$17,218.93 " "$15,684.15 " "$9,776.66 " N/A "$18,763.28 " N/A "$9,875.41 " "$32,598.06 " "$10,862.95 " "$40,228.67 " "$33,293.24 " N/A N/A N/A "$67,022.99 " "$46,483.36 " "$63,038.37 " N/A "$10,171.67 " "$12,245.51 " N/A N/A N/A N/A N/A "$13,825.58 " N/A "$9,875.41 " "$9,875.41 " "$10,764.20 " N/A N/A N/A N/A N/A N/A N/A "$37,852.34 " "$30,600.90 " "$30,600.90 " "$30,600.90 " "$30,600.90 " "$18,441.16 " "$10,862.95 " "$9,875.41 " "$19,888.64 " N/A N/A N/A N/A "$9,875.41 " "$9,776.66 " "$67,022.99 " 330104 730 OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC I N/A N/A "$6,157.25 " N/A "$9,956.36 " "$10,477.06 " "$9,543.20 " "$6,095.68 " N/A "$11,698.77 " N/A "$6,157.25 " "$19,834.67 " "$6,772.97 " "$24,477.60 " "$20,257.66 " N/A N/A N/A "$40,780.92 " "$28,283.34 " "$38,356.43 " N/A "$6,341.97 " "$7,634.99 " N/A N/A N/A N/A N/A "$8,620.15 " N/A "$6,157.25 " "$6,157.25 " "$6,711.40 " N/A N/A N/A N/A N/A N/A N/A "$23,031.70 " "$18,619.47 " "$18,619.47 " "$18,619.47 " "$18,619.47 " "$11,220.74 " "$6,772.97 " "$6,157.25 " "$12,101.48 " N/A N/A N/A N/A "$6,157.25 " "$6,095.68 " "$40,780.92 " 330104 734 "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC" I N/A N/A "$19,632.50 " N/A "$33,175.71 " "$34,910.76 " "$31,799.03 " "$19,436.18 " N/A "$37,301.76 " N/A "$19,632.50 " "$66,091.37 " "$21,595.75 " "$81,562.15 " "$67,500.83 " N/A N/A N/A "$135,886.66 " "$94,243.31 " "$127,807.98 " N/A "$20,221.48 " "$24,344.31 " N/A N/A N/A N/A N/A "$27,485.51 " N/A "$19,632.50 " "$19,632.50 " "$21,399.43 " N/A N/A N/A N/A N/A N/A N/A "$76,744.22 " "$62,042.20 " "$62,042.20 " "$62,042.20 " "$62,042.20 " "$37,388.77 " "$21,595.75 " "$19,632.50 " "$40,323.50 " N/A N/A N/A N/A "$19,632.50 " "$19,436.18 " "$135,886.66 " 330104 735 "PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC" I N/A N/A "$11,588.23 " N/A "$19,314.54 " "$20,324.67 " "$18,513.05 " "$11,472.35 " N/A "$22,017.64 " N/A "$11,588.23 " "$38,477.69 " "$12,747.06 " "$47,484.61 " "$39,298.26 " N/A N/A N/A "$79,111.76 " "$54,867.44 " "$74,408.43 " N/A "$11,935.88 " "$14,369.41 " N/A N/A N/A N/A N/A "$16,223.53 " N/A "$11,588.23 " "$11,588.23 " "$12,631.17 " N/A N/A N/A N/A N/A N/A N/A "$44,679.66 " "$36,120.30 " "$36,120.30 " "$36,120.30 " "$36,120.30 " "$21,767.34 " "$12,747.06 " "$11,588.23 " "$23,475.91 " N/A N/A N/A N/A "$11,588.23 " "$11,472.35 " "$79,111.76 " 330104 736 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC I N/A N/A "$37,958.99 " N/A "$64,754.27 " "$68,140.84 " "$62,067.19 " "$37,579.40 " N/A "$72,122.08 " N/A "$37,958.99 " "$129,000.97 " "$41,754.89 " "$159,197.74 " "$131,752.03 " N/A N/A N/A "$265,231.46 " "$183,949.55 " "$249,463.02 " N/A "$39,097.76 " "$47,069.15 " N/A N/A N/A N/A N/A "$53,142.59 " N/A "$37,958.99 " "$37,958.99 " "$41,375.30 " N/A N/A N/A N/A N/A N/A N/A "$149,793.82 " "$121,097.56 " "$121,097.56 " "$121,097.56 " "$121,097.56 " "$72,977.57 " "$41,754.89 " "$37,958.99 " "$78,705.74 " N/A N/A N/A N/A "$37,958.99 " "$37,579.40 " "$265,231.46 " 330104 737 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC I N/A N/A "$18,207.80 " N/A "$30,720.78 " "$32,327.44 " "$29,445.97 " "$18,025.72 " N/A "$34,594.81 " N/A "$18,207.80 " "$61,200.76 " "$20,028.58 " "$75,526.73 " "$62,505.91 " N/A N/A N/A "$125,831.35 " "$87,269.51 " "$118,350.47 " N/A "$18,754.03 " "$22,577.67 " N/A N/A N/A N/A N/A "$25,490.91 " N/A "$18,207.80 " "$18,207.80 " "$19,846.50 " N/A N/A N/A N/A N/A N/A N/A "$71,065.32 " "$57,451.21 " "$57,451.21 " "$57,451.21 " "$57,451.21 " "$34,622.08 " "$20,028.58 " "$18,207.80 " "$37,339.65 " N/A N/A N/A N/A "$18,207.80 " "$18,025.72 " "$125,831.35 " 330104 738 UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC I N/A N/A "$12,747.74 " N/A "$21,312.49 " "$22,427.11 " "$20,428.10 " "$12,620.26 " N/A "$24,220.70 " N/A "$12,747.74 " "$42,457.93 " "$14,022.51 " "$52,396.55 " "$43,363.38 " N/A N/A N/A "$87,295.30 " "$60,543.09 " "$82,105.45 " N/A "$13,130.17 " "$15,807.19 " N/A N/A N/A N/A N/A "$17,846.83 " N/A "$12,747.74 " "$12,747.74 " "$13,895.03 " N/A N/A N/A N/A N/A N/A N/A "$49,301.46 " "$39,856.69 " "$39,856.69 " "$39,856.69 " "$39,856.69 " "$24,019.02 " "$14,022.51 " "$12,747.74 " "$25,904.32 " N/A N/A N/A N/A "$12,747.74 " "$12,620.26 " "$87,295.30 " 330104 739 UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC I N/A N/A "$34,761.55 " N/A "$59,244.72 " "$62,343.14 " "$56,786.27 " "$34,413.93 " N/A "$66,046.94 " N/A "$34,761.55 " "$118,025.06 " "$38,237.70 " "$145,652.57 " "$120,542.05 " N/A N/A N/A "$242,664.53 " "$168,298.39 " "$228,237.72 " N/A "$35,804.39 " "$43,104.32 " N/A N/A N/A N/A N/A "$48,666.17 " N/A "$34,761.55 " "$34,761.55 " "$37,890.09 " N/A N/A N/A N/A N/A N/A N/A "$137,048.78 " "$110,794.10 " "$110,794.10 " "$110,794.10 " "$110,794.10 " "$66,768.35 " "$38,237.70 " "$34,761.55 " "$72,009.14 " N/A N/A N/A N/A "$34,761.55 " "$34,413.93 " "$242,664.53 " 330104 740 UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC I N/A N/A "$16,259.73 " N/A "$27,364.04 " "$28,795.14 " "$26,228.52 " "$16,097.13 " N/A "$30,893.48 " N/A "$16,259.73 " "$54,513.59 " "$17,885.70 " "$67,274.22 " "$55,676.14 " N/A N/A N/A "$112,082.24 " "$77,733.91 " "$105,418.77 " N/A "$16,747.52 " "$20,162.06 " N/A N/A N/A N/A N/A "$22,763.62 " N/A "$16,259.73 " "$16,259.73 " "$17,723.10 " N/A N/A N/A N/A N/A N/A N/A "$63,300.29 " "$51,173.74 " "$51,173.74 " "$51,173.74 " "$51,173.74 " "$30,839.06 " "$17,885.70 " "$16,259.73 " "$33,259.69 " N/A N/A N/A N/A "$16,259.73 " "$16,097.13 " "$112,082.24 " 330104 741 UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC I N/A N/A "$11,946.83 " N/A "$19,932.45 " "$20,974.89 " "$19,105.32 " "$11,827.37 " N/A "$22,698.98 " N/A "$11,946.83 " "$39,708.66 " "$13,141.52 " "$49,003.73 " "$40,555.48 " N/A N/A N/A "$81,642.69 " "$56,622.75 " "$76,788.90 " N/A "$12,305.24 " "$14,814.07 " N/A N/A N/A N/A N/A "$16,725.57 " N/A "$11,946.83 " "$11,946.83 " "$13,022.05 " N/A N/A N/A N/A N/A N/A N/A "$46,109.05 " "$37,275.86 " "$37,275.86 " "$37,275.86 " "$37,275.86 " "$22,463.72 " "$13,141.52 " "$11,946.83 " "$24,226.94 " N/A N/A N/A N/A "$11,946.83 " "$11,827.37 " "$81,642.69 " 330104 742 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC I N/A N/A "$16,257.08 " N/A "$27,359.48 " "$28,790.35 " "$26,224.16 " "$16,094.51 " N/A "$30,888.46 " N/A "$16,257.08 " "$54,504.51 " "$17,882.79 " "$67,263.02 " "$55,666.87 " N/A N/A N/A "$112,063.59 " "$77,720.97 " "$105,401.22 " N/A "$16,744.80 " "$20,158.78 " N/A N/A N/A N/A N/A "$22,759.92 " N/A "$16,257.08 " "$16,257.08 " "$17,720.22 " N/A N/A N/A N/A N/A N/A N/A "$63,289.75 " "$51,165.22 " "$51,165.22 " "$51,165.22 " "$51,165.22 " "$30,833.93 " "$17,882.79 " "$16,257.08 " "$33,254.15 " N/A N/A N/A N/A "$16,257.08 " "$16,094.51 " "$112,063.59 " 330104 743 UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC I N/A N/A "$10,693.06 " N/A "$17,772.05 " "$18,701.51 " "$17,034.57 " "$10,586.12 " N/A "$20,316.81 " N/A "$10,693.06 " "$35,404.80 " "$11,762.36 " "$43,692.41 " "$36,159.83 " N/A N/A N/A "$72,793.76 " "$50,485.64 " "$68,466.05 " N/A "$11,013.85 " "$13,259.39 " N/A N/A N/A N/A N/A "$14,970.28 " N/A "$10,693.06 " "$10,693.06 " "$11,655.43 " N/A N/A N/A N/A N/A N/A N/A "$41,111.47 " "$33,235.68 " "$33,235.68 " "$33,235.68 " "$33,235.68 " "$20,028.97 " "$11,762.36 " "$10,693.06 " "$21,601.08 " N/A N/A N/A N/A "$10,693.06 " "$10,586.12 " "$72,793.76 " 330104 744 "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC" I N/A N/A "$17,104.68 " N/A "$28,819.99 " "$30,327.24 " "$27,624.06 " "$16,933.64 " N/A "$32,498.90 " N/A "$17,104.68 " "$57,414.08 " "$18,815.15 " "$70,853.67 " "$58,638.49 " N/A N/A N/A "$118,045.79 " "$81,869.88 " "$111,027.77 " N/A "$17,617.82 " "$21,209.81 " N/A N/A N/A N/A N/A "$23,946.56 " N/A "$17,104.68 " "$17,104.68 " "$18,644.10 " N/A N/A N/A N/A N/A N/A N/A "$66,668.30 " "$53,896.53 " "$53,896.53 " "$53,896.53 " "$53,896.53 " "$32,479.91 " "$18,815.15 " "$17,104.68 " "$35,029.33 " N/A N/A N/A N/A "$17,104.68 " "$16,933.64 " "$118,045.79 " 330104 745 "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC" I N/A N/A "$10,518.60 " N/A "$17,471.45 " "$18,385.18 " "$16,746.44 " "$10,413.42 " N/A "$19,985.34 " N/A "$10,518.60 " "$34,805.95 " "$11,570.46 " "$42,953.38 " "$35,548.21 " N/A N/A N/A "$71,562.50 " "$49,631.70 " "$67,307.99 " N/A "$10,834.16 " "$13,043.07 " N/A N/A N/A N/A N/A "$14,726.04 " N/A "$10,518.60 " "$10,518.60 " "$11,465.28 " N/A N/A N/A N/A N/A N/A N/A "$40,416.10 " "$32,673.51 " "$32,673.51 " "$32,673.51 " "$32,673.51 " "$19,690.19 " "$11,570.46 " "$10,518.60 " "$21,235.71 " N/A N/A N/A N/A "$10,518.60 " "$10,413.42 " "$71,562.50 " 330104 746 "VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC" I N/A N/A "$14,153.94 " N/A "$23,735.54 " "$24,976.88 " "$22,750.60 " "$14,012.40 " N/A "$26,892.49 " N/A "$14,153.94 " "$47,285.03 " "$15,569.34 " "$58,353.59 " "$48,293.43 " N/A N/A N/A "$97,220.03 " "$67,426.32 " "$91,440.14 " N/A "$14,578.56 " "$17,550.89 " N/A N/A N/A N/A N/A "$19,815.52 " N/A "$14,153.94 " "$14,153.94 " "$15,427.80 " N/A N/A N/A N/A N/A N/A N/A "$54,906.61 " "$44,388.05 " "$44,388.05 " "$44,388.05 " "$44,388.05 " "$26,749.77 " "$15,569.34 " "$14,153.94 " "$28,849.42 " N/A N/A N/A N/A "$14,153.94 " "$14,012.40 " "$97,220.03 " 330104 747 "VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC" I N/A N/A "$9,001.38 " N/A "$14,857.11 " "$15,634.11 " "$14,240.59 " "$8,911.37 " N/A "$17,102.62 " N/A "$9,001.38 " "$29,597.76 " "$9,901.52 " "$36,526.05 " "$30,228.95 " N/A N/A N/A "$60,854.24 " "$42,205.06 " "$57,236.36 " N/A "$9,271.42 " "$11,161.71 " N/A N/A N/A N/A N/A "$12,601.93 " N/A "$9,001.38 " "$9,001.38 " "$9,811.50 " N/A N/A N/A N/A N/A N/A N/A "$34,368.43 " "$27,784.41 " "$27,784.41 " "$27,784.41 " "$27,784.41 " "$16,743.85 " "$9,901.52 " "$9,001.38 " "$18,058.11 " N/A N/A N/A N/A "$9,001.38 " "$8,911.37 " "$60,854.24 " 330104 748 FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES I N/A N/A "$12,865.80 " N/A "$21,515.93 " "$22,641.19 " "$20,623.09 " "$12,737.14 " N/A "$24,445.02 " N/A "$12,865.80 " "$42,863.21 " "$14,152.38 " "$52,896.71 " "$43,777.31 " N/A N/A N/A "$88,128.58 " "$61,121.00 " "$82,889.19 " N/A "$13,251.78 " "$15,953.59 " N/A N/A N/A N/A N/A "$18,012.12 " N/A "$12,865.80 " "$12,865.80 " "$14,023.72 " N/A N/A N/A N/A N/A N/A N/A "$49,772.06 " "$40,237.14 " "$40,237.14 " "$40,237.14 " "$40,237.14 " "$24,248.29 " "$14,152.38 " "$12,865.80 " "$26,151.59 " N/A N/A N/A N/A "$12,865.80 " "$12,737.14 " "$88,128.58 " 330104 749 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC I N/A N/A "$22,636.99 " N/A "$38,352.77 " "$40,358.57 " "$36,761.26 " "$22,410.62 " N/A "$43,010.28 " N/A "$22,636.99 " "$76,404.92 " "$24,900.69 " "$94,289.91 " "$78,034.32 " N/A N/A N/A "$157,091.75 " "$108,949.95 " "$147,752.39 " N/A "$23,316.10 " "$28,069.87 " N/A N/A N/A N/A N/A "$31,691.79 " N/A "$22,636.99 " "$22,636.99 " "$24,674.32 " N/A N/A N/A N/A N/A N/A N/A "$88,720.14 " "$71,723.87 " "$71,723.87 " "$71,723.87 " "$71,723.87 " "$43,223.28 " "$24,900.69 " "$22,636.99 " "$46,615.97 " N/A N/A N/A N/A "$22,636.99 " "$22,410.62 " "$157,091.75 " 330104 750 OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$12,952.15 " N/A "$21,664.71 " "$22,797.75 " "$20,765.70 " "$12,822.63 " N/A "$24,609.08 " N/A "$12,952.15 " "$43,159.61 " "$14,247.36 " "$53,262.49 " "$44,080.03 " N/A N/A N/A "$88,737.99 " "$61,543.66 " "$83,462.38 " N/A "$13,340.71 " "$16,060.66 " N/A N/A N/A N/A N/A "$18,133.01 " N/A "$12,952.15 " "$12,952.15 " "$14,117.84 " N/A N/A N/A N/A N/A N/A N/A "$50,116.24 " "$40,515.38 " "$40,515.38 " "$40,515.38 " "$40,515.38 " "$24,415.97 " "$14,247.36 " "$12,952.15 " "$26,332.43 " N/A N/A N/A N/A "$12,952.15 " "$12,822.63 " "$88,737.99 " 330104 754 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC" I N/A N/A "$15,682.62 " N/A "$26,369.62 " "$27,748.71 " "$25,275.37 " "$15,525.79 " N/A "$29,796.97 " N/A "$15,682.62 " "$52,532.54 " "$17,250.88 " "$64,829.45 " "$53,652.84 " N/A N/A N/A "$108,009.13 " "$74,909.02 " "$101,587.81 " N/A "$16,153.10 " "$19,446.45 " N/A N/A N/A N/A N/A "$21,955.66 " N/A "$15,682.62 " "$15,682.62 " "$17,094.05 " N/A N/A N/A N/A N/A N/A N/A "$60,999.93 " "$49,314.06 " "$49,314.06 " "$49,314.06 " "$49,314.06 " "$29,718.36 " "$17,250.88 " "$15,682.62 " "$32,051.02 " N/A N/A N/A N/A "$15,682.62 " "$15,525.79 " "$108,009.13 " 330104 755 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC" I N/A N/A "$9,904.49 " N/A "$16,413.26 " "$17,271.65 " "$15,732.17 " "$9,805.44 " N/A "$18,818.53 " N/A "$9,904.49 " "$32,697.87 " "$10,894.94 " "$40,351.84 " "$33,395.18 " N/A N/A N/A "$67,228.20 " "$46,625.68 " "$63,231.38 " N/A "$10,201.62 " "$12,281.56 " N/A N/A N/A N/A N/A "$13,866.28 " N/A "$9,904.49 " "$9,904.49 " "$10,795.89 " N/A N/A N/A N/A N/A N/A N/A "$37,968.23 " "$30,694.59 " "$30,694.59 " "$30,694.59 " "$30,694.59 " "$18,497.62 " "$10,894.94 " "$9,904.49 " "$19,949.54 " N/A N/A N/A N/A "$9,904.49 " "$9,805.44 " "$67,228.20 " 330104 756 "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC" I N/A N/A "$9,161.74 " N/A "$15,133.42 " "$15,924.88 " "$14,505.43 " "$9,070.12 " N/A "$17,407.30 " N/A "$9,161.74 " "$30,148.22 " "$10,077.91 " "$37,205.36 " "$30,791.15 " N/A N/A N/A "$61,986.01 " "$42,989.99 " "$58,300.84 " N/A "$9,436.59 " "$11,360.55 " N/A N/A N/A N/A N/A "$12,826.43 " N/A "$9,161.74 " "$9,161.74 " "$9,986.29 " N/A N/A N/A N/A N/A N/A N/A "$35,007.62 " "$28,301.15 " "$28,301.15 " "$28,301.15 " "$28,301.15 " "$17,055.25 " "$10,077.91 " "$9,161.74 " "$18,393.95 " N/A N/A N/A N/A "$9,161.74 " "$9,070.12 " "$61,986.01 " 330104 757 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC" I N/A N/A "$12,469.31 " N/A "$20,832.74 " "$21,922.27 " "$19,968.25 " "$12,344.62 " N/A "$23,691.70 " N/A "$12,469.31 " "$41,502.19 " "$13,716.25 " "$51,217.09 " "$42,387.26 " N/A N/A N/A "$85,330.26 " "$59,180.24 " "$80,257.23 " N/A "$12,843.39 " "$15,461.95 " N/A N/A N/A N/A N/A "$17,457.04 " N/A "$12,469.31 " "$12,469.31 " "$13,591.55 " N/A N/A N/A N/A N/A N/A N/A "$48,191.66 " "$38,959.50 " "$38,959.50 " "$38,959.50 " "$38,959.50 " "$23,478.34 " "$13,716.25 " "$12,469.31 " "$25,321.21 " N/A N/A N/A N/A "$12,469.31 " "$12,344.62 " "$85,330.26 " 330104 758 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC" I N/A N/A "$8,797.85 " N/A "$14,506.40 " "$15,265.07 " "$13,904.44 " "$8,709.87 " N/A "$16,715.91 " N/A "$8,797.85 " "$28,899.10 " "$9,677.63 " "$35,663.85 " "$29,515.40 " N/A N/A N/A "$59,417.77 " "$41,208.80 " "$55,885.28 " N/A "$9,061.79 " "$10,909.33 " N/A N/A N/A N/A N/A "$12,316.99 " N/A "$8,797.85 " "$8,797.85 " "$9,589.66 " N/A N/A N/A N/A N/A N/A N/A "$33,557.16 " "$27,128.56 " "$27,128.56 " "$27,128.56 " "$27,128.56 " "$16,348.60 " "$9,677.63 " "$8,797.85 " "$17,631.84 " N/A N/A N/A N/A "$8,797.85 " "$8,709.87 " "$59,417.77 " 330104 759 "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC" I N/A N/A "$5,845.35 " N/A "$9,418.91 " "$9,911.51 " "$9,028.06 " "$5,786.89 " N/A "$11,106.16 " N/A "$5,845.35 " "$18,764.00 " "$6,429.88 " "$23,156.31 " "$19,164.16 " N/A N/A N/A "$38,579.57 " "$26,756.61 " "$36,285.96 " N/A "$6,020.71 " "$7,248.23 " N/A N/A N/A N/A N/A "$8,183.49 " N/A "$5,845.35 " "$5,845.35 " "$6,371.43 " N/A N/A N/A N/A N/A N/A N/A "$21,788.45 " "$17,614.40 " "$17,614.40 " "$17,614.40 " "$17,614.40 " "$10,615.04 " "$6,429.88 " "$5,845.35 " "$11,448.24 " N/A N/A N/A N/A "$5,845.35 " "$5,786.89 " "$38,579.57 " 330104 760 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC I N/A N/A "$8,895.65 " N/A "$14,674.92 " "$15,442.40 " "$14,065.96 " "$8,806.69 " N/A "$16,901.73 " N/A "$8,895.65 " "$29,234.82 " "$9,785.21 " "$36,078.15 " "$29,858.27 " N/A N/A N/A "$60,108.02 " "$41,687.52 " "$56,534.50 " N/A "$9,162.52 " "$11,030.61 " N/A N/A N/A N/A N/A "$12,453.91 " N/A "$8,895.65 " "$8,895.65 " "$9,696.26 " N/A N/A N/A N/A N/A N/A N/A "$33,946.99 " "$27,443.71 " "$27,443.71 " "$27,443.71 " "$27,443.71 " "$16,538.53 " "$9,785.21 " "$8,895.65 " "$17,836.67 " N/A N/A N/A N/A "$8,895.65 " "$8,806.69 " "$60,108.02 " 330104 761 MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC I N/A N/A "$5,363.40 " N/A "$8,588.46 " "$9,037.62 " "$8,232.07 " "$5,309.76 " N/A "$10,190.45 " N/A "$5,363.40 " "$17,109.60 " "$5,899.74 " "$21,114.64 " "$17,474.47 " N/A N/A N/A "$35,178.05 " "$24,397.51 " "$33,086.66 " N/A "$5,524.30 " "$6,650.61 " N/A N/A N/A N/A N/A "$7,508.75 " N/A "$5,363.40 " "$5,363.40 " "$5,846.10 " N/A N/A N/A N/A N/A N/A N/A "$19,867.38 " "$16,061.35 " "$16,061.35 " "$16,061.35 " "$16,061.35 " "$9,679.13 " "$5,899.74 " "$5,363.40 " "$10,438.86 " N/A N/A N/A N/A "$5,363.40 " "$5,309.76 " "$35,178.05 " 330104 768 VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C I N/A "$4,361.45 " "$10,483.36 " "$4,361.45 " "$17,410.72 " "$18,321.28 " "$16,688.23 " "$10,378.52 " N/A "$19,918.38 " N/A "$10,483.36 " "$16,850.00 " "$11,531.69 " "$4,963.03 " "$35,424.65 " N/A N/A N/A "$13,728.00 " "$14,266.00 " "$12,509.00 " N/A "$10,797.86 " "$12,999.36 " N/A N/A N/A N/A N/A "$14,676.70 " N/A "$10,483.36 " "$10,483.36 " "$11,426.86 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$19,621.75 " "$11,531.69 " "$10,483.36 " "$21,161.90 " N/A N/A N/A N/A "$10,483.36 " "$4,670.00 " "$35,424.65 " 330104 769 POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES I N/A N/A "$15,016.52 " N/A "$25,221.86 " "$26,540.93 " "$24,175.24 " "$14,866.36 " N/A "$28,531.39 " N/A "$15,016.52 " "$50,246.02 " "$16,518.17 " "$62,007.69 " "$51,317.56 " N/A N/A N/A "$103,307.94 " "$71,648.55 " "$97,166.11 " N/A "$15,467.02 " "$18,620.49 " N/A N/A N/A N/A N/A "$21,023.13 " N/A "$15,016.52 " "$15,016.52 " "$16,368.01 " N/A N/A N/A N/A N/A N/A N/A "$58,344.86 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$28,424.84 " "$16,518.17 " "$15,016.52 " "$30,655.97 " N/A N/A N/A N/A "$15,016.52 " "$14,866.36 " "$103,307.94 " 330104 770 "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY" I N/A N/A "$8,007.52 " N/A "$13,144.58 " "$13,832.02 " "$12,599.12 " "$7,927.45 " N/A "$15,214.29 " N/A "$8,007.52 " "$26,186.12 " "$8,808.27 " "$32,315.81 " "$26,744.56 " N/A N/A N/A "$53,839.77 " "$37,340.22 " "$50,638.91 " N/A "$8,247.75 " "$9,929.33 " N/A N/A N/A N/A N/A "$11,210.53 " N/A "$8,007.52 " "$8,007.52 " "$8,728.20 " N/A N/A N/A N/A N/A N/A N/A "$30,406.90 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$14,813.84 " "$8,808.27 " "$8,007.52 " "$15,976.61 " N/A N/A N/A N/A "$8,007.52 " "$7,927.45 " "$53,839.77 " 330104 776 POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES I N/A N/A "$6,521.14 " N/A "$10,583.37 " "$11,136.87 " "$10,144.20 " "$6,455.93 " N/A "$12,390.16 " N/A "$6,521.14 " "$21,083.79 " "$7,173.25 " "$26,019.12 " "$21,533.42 " N/A N/A N/A "$43,349.16 " "$30,064.53 " "$40,771.98 " N/A "$6,716.77 " "$8,086.21 " N/A N/A N/A N/A N/A "$9,129.59 " N/A "$6,521.14 " "$6,521.14 " "$7,108.04 " N/A N/A N/A N/A N/A N/A N/A "$24,482.15 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$11,927.38 " "$7,173.25 " "$6,521.14 " "$12,863.59 " N/A N/A N/A N/A "$6,521.14 " "$6,455.93 " "$43,349.16 " 330104 779 ABORTION WITHOUT D&C I N/A N/A "$9,353.81 " N/A "$15,464.39 " "$16,273.15 " "$14,822.67 " "$9,260.27 " N/A "$17,772.24 " N/A "$9,353.81 " "$30,807.56 " "$10,289.19 " "$38,019.04 " "$31,464.55 " N/A N/A N/A "$63,341.64 " "$43,930.18 " "$59,575.88 " N/A "$9,634.43 " "$11,598.73 " N/A N/A N/A N/A N/A "$13,095.34 " N/A "$9,353.81 " "$9,353.81 " "$10,195.66 " N/A N/A N/A N/A N/A N/A N/A "$35,773.23 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$15,083.00 " "$17,428.25 " "$10,289.19 " "$9,353.81 " "$18,796.23 " N/A N/A N/A N/A "$9,353.81 " "$9,260.27 " "$63,341.64 " 330104 783 CESAREAN SECTION WITH STERILIZATION WITH MCC I N/A "$8,321.12 " "$17,381.34 " "$8,321.12 " "$29,296.71 " "$30,828.89 " "$28,080.99 " "$17,207.53 " N/A "$33,024.55 " N/A "$17,381.34 " "$26,807.00 " "$19,119.48 " "$4,963.03 " "$59,608.43 " N/A N/A N/A "$23,709.00 " "$24,638.00 " "$21,603.00 " N/A "$17,902.78 " "$21,552.86 " N/A N/A N/A N/A N/A "$24,333.88 " N/A "$17,381.34 " "$17,381.34 " "$18,945.66 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$54,788.04 " "$54,788.04 " "$54,788.04 " "$54,788.04 " "$33,017.17 " "$19,119.48 " "$17,381.34 " "$35,608.75 " N/A N/A N/A N/A "$17,381.34 " "$4,670.00 " "$59,608.43 " 330104 784 CESAREAN SECTION WITH STERILIZATION WITH CC I N/A "$6,565.73 " "$9,577.61 " "$6,565.73 " "$15,850.01 " "$16,678.94 " "$15,192.29 " "$9,481.83 " N/A "$18,197.45 " N/A "$9,577.61 " "$26,807.00 " "$10,535.37 " "$4,963.03 " "$32,249.16 " N/A N/A N/A "$23,709.00 " "$24,638.00 " "$21,603.00 " N/A "$9,864.93 " "$11,876.23 " N/A N/A N/A N/A N/A "$13,408.65 " N/A "$9,577.61 " "$9,577.61 " "$10,439.59 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$29,641.25 " "$29,641.25 " "$29,641.25 " "$29,641.25 " "$17,862.84 " "$10,535.37 " "$9,577.61 " "$19,264.93 " N/A N/A N/A N/A "$9,577.61 " "$4,670.00 " "$32,249.16 " 330104 785 CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC I N/A "$5,764.67 " "$8,415.46 " "$5,764.67 " "$13,847.50 " "$14,571.71 " "$13,272.88 " "$8,331.31 " N/A "$15,989.38 " N/A "$8,415.46 " "$26,807.00 " "$9,257.01 " "$4,963.03 " "$28,174.77 " N/A N/A N/A "$23,709.00 " "$24,638.00 " "$21,603.00 " N/A "$8,667.92 " "$10,435.17 " N/A N/A N/A N/A N/A "$11,781.65 " N/A "$8,415.46 " "$8,415.46 " "$9,172.85 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$25,896.34 " "$25,896.34 " "$25,896.34 " "$25,896.34 " "$15,606.03 " "$9,257.01 " "$8,415.46 " "$16,830.98 " N/A N/A N/A N/A "$8,415.46 " "$4,670.00 " "$28,174.77 " 330104 786 CESAREAN SECTION WITHOUT STERILIZATION WITH MCC I N/A N/A "$14,608.58 " N/A "$24,518.93 " "$25,801.24 " "$23,501.48 " "$14,462.49 " N/A "$27,756.30 " N/A "$14,608.58 " "$26,807.00 " "$16,069.44 " "$4,963.03 " "$49,887.35 " N/A N/A N/A "$23,709.00 " "$24,638.00 " "$21,603.00 " N/A "$15,046.84 " "$18,114.64 " N/A N/A N/A N/A N/A "$20,452.01 " N/A "$14,608.58 " "$14,608.58 " "$15,923.35 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$45,853.08 " "$45,853.08 " "$45,853.08 " "$45,853.08 " "$27,632.65 " "$16,069.44 " "$14,608.58 " "$29,801.60 " N/A N/A N/A N/A "$14,608.58 " "$4,670.00 " "$49,887.35 " 330104 787 CESAREAN SECTION WITHOUT STERILIZATION WITH CC I N/A N/A "$9,765.28 " N/A "$16,173.38 " "$17,019.23 " "$15,502.25 " "$9,667.62 " N/A "$18,554.03 " N/A "$9,765.28 " "$26,807.00 " "$10,741.80 " "$4,963.03 " "$32,907.12 " N/A N/A N/A "$23,709.00 " "$24,638.00 " "$21,603.00 " N/A "$10,058.24 " "$12,108.94 " N/A N/A N/A N/A N/A "$13,671.39 " N/A "$9,765.28 " "$9,765.28 " "$10,644.15 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$30,246.00 " "$30,246.00 " "$30,246.00 " "$30,246.00 " "$18,227.28 " "$10,741.80 " "$9,765.28 " "$19,657.98 " N/A N/A N/A N/A "$9,765.28 " "$4,670.00 " "$32,907.12 " 330104 788 CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC I N/A N/A "$8,065.67 " N/A "$13,244.78 " "$13,937.46 " "$12,695.16 " "$7,985.01 " N/A "$15,324.78 " N/A "$8,065.67 " "$26,807.00 " "$8,872.24 " "$4,963.03 " "$26,948.44 " N/A N/A N/A "$23,709.00 " "$24,638.00 " "$21,603.00 " N/A "$8,307.64 " "$10,001.43 " N/A N/A N/A N/A N/A "$11,291.94 " N/A "$8,065.67 " "$8,065.67 " "$8,791.58 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$24,769.18 " "$24,769.18 " "$24,769.18 " "$24,769.18 " "$14,926.76 " "$8,872.24 " "$8,065.67 " "$16,098.40 " N/A N/A N/A N/A "$8,065.67 " "$4,670.00 " "$26,948.44 " 330104 789 "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY" I N/A N/A "$16,465.90 " N/A "$27,719.30 " "$29,168.98 " "$26,569.04 " "$16,301.24 " N/A "$31,285.21 " N/A "$16,465.90 " "$37,135.00 " "$18,112.49 " "$5,633.71 " "$56,398.96 " N/A N/A N/A "$6,736.00 " "$7,000.00 " "$6,138.00 " N/A "$16,959.88 " "$20,417.71 " N/A N/A N/A N/A N/A "$23,052.26 " N/A "$16,465.90 " "$16,465.90 " "$17,947.83 " N/A N/A N/A N/A N/A N/A N/A "$5,301.00 " "$51,838.11 " "$51,838.11 " "$51,838.11 " "$51,838.11 " "$31,239.44 " "$18,112.49 " "$16,465.90 " "$33,691.49 " N/A N/A N/A N/A "$16,465.90 " "$5,301.00 " "$56,398.96 " 330104 790 "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE" I N/A N/A "$53,429.89 " N/A "$91,412.34 " "$96,193.09 " "$87,619.05 " "$52,895.60 " N/A "$101,516.80 " N/A "$53,429.89 " "$102,995.00 " "$58,772.88 " "$5,633.71 " "$185,991.78 " N/A N/A N/A "$6,736.00 " "$7,000.00 " "$6,138.00 " N/A "$55,032.79 " "$66,253.07 " N/A N/A N/A N/A N/A "$74,801.85 " N/A "$53,429.89 " "$53,429.89 " "$58,238.59 " N/A N/A N/A N/A N/A N/A N/A "$5,301.00 " "$9,340.00 " "$9,340.00 " "$9,340.00 " "$9,340.00 " "$103,021.02 " "$58,772.88 " "$53,429.89 " "$111,107.36 " N/A N/A N/A N/A "$53,429.89 " "$5,301.00 " "$185,991.78 " 330104 791 PREMATURITY WITH MAJOR PROBLEMS I N/A N/A "$36,610.06 " N/A "$62,429.90 " "$65,694.91 " "$59,839.28 " "$36,243.96 " N/A "$69,559.11 " N/A "$36,610.06 " "$71,480.00 " "$40,271.06 " "$5,633.71 " "$127,022.77 " N/A N/A N/A "$6,736.00 " "$7,000.00 " "$6,138.00 " N/A "$37,708.36 " "$45,396.47 " N/A N/A N/A N/A N/A "$51,254.08 " N/A "$36,610.06 " "$36,610.06 " "$39,904.96 " N/A N/A N/A N/A N/A N/A N/A "$5,301.00 " "$9,340.00 " "$9,340.00 " "$9,340.00 " "$9,340.00 " "$70,358.03 " "$40,271.06 " "$36,610.06 " "$75,880.58 " N/A N/A N/A N/A "$36,610.06 " "$5,301.00 " "$127,022.77 " 330104 792 PREMATURITY WITHOUT MAJOR PROBLEMS I N/A N/A "$22,240.50 " N/A "$37,669.58 " "$39,639.65 " "$36,106.42 " "$22,018.10 " N/A "$42,256.96 " N/A "$22,240.50 " "$44,529.00 " "$24,464.55 " "$5,633.71 " "$76,644.27 " N/A N/A N/A "$6,736.00 " "$7,000.00 " "$6,138.00 " N/A "$22,907.72 " "$27,578.23 " N/A N/A N/A N/A N/A "$31,136.71 " N/A "$22,240.50 " "$22,240.50 " "$24,242.15 " N/A N/A N/A N/A N/A N/A N/A "$5,301.00 " "$70,446.23 " "$70,446.23 " "$70,446.23 " "$70,446.23 " "$42,453.33 " "$24,464.55 " "$22,240.50 " "$45,785.58 " N/A N/A N/A N/A "$22,240.50 " "$5,301.00 " "$76,644.27 " 330104 793 FULL TERM NEONATE WITH MAJOR PROBLEMS I N/A N/A "$37,595.99 " N/A "$64,128.77 " "$67,482.62 " "$61,467.65 " "$37,220.03 " N/A "$71,432.37 " N/A "$37,595.99 " "$73,298.00 " "$41,355.58 " "$5,633.71 " "$130,479.36 " N/A N/A N/A "$6,736.00 " "$7,000.00 " "$6,138.00 " N/A "$38,723.87 " "$46,619.02 " N/A N/A N/A N/A N/A "$52,634.38 " N/A "$37,595.99 " "$37,595.99 " "$40,979.62 " N/A N/A N/A N/A N/A N/A N/A "$5,301.00 " "$119,927.81 " "$119,927.81 " "$119,927.81 " "$119,927.81 " "$72,272.64 " "$41,355.58 " "$37,595.99 " "$77,945.47 " N/A N/A N/A N/A "$37,595.99 " "$5,301.00 " "$130,479.36 " 330104 794 NEONATE WITH OTHER SIGNIFICANT PROBLEMS I N/A N/A "$13,552.16 " N/A "$22,698.61 " "$23,885.72 " "$21,756.70 " "$13,416.64 " N/A "$25,749.11 " N/A "$13,552.16 " "$28,256.00 " "$14,907.38 " "$5,633.71 " "$46,183.64 " N/A N/A N/A "$6,736.00 " "$7,000.00 " "$6,138.00 " N/A "$13,958.73 " "$16,804.68 " N/A N/A N/A N/A N/A "$18,973.03 " N/A "$13,552.16 " "$13,552.16 " "$14,771.86 " N/A N/A N/A N/A N/A N/A N/A "$5,301.00 " "$42,448.88 " "$42,448.88 " "$42,448.88 " "$42,448.88 " "$25,581.16 " "$14,907.38 " "$13,552.16 " "$27,589.08 " N/A N/A N/A N/A "$13,552.16 " "$5,301.00 " "$46,183.64 " 330104 795 NORMAL NEWBORN I N/A "$1,726.67 " "$2,162.43 " "$1,726.67 " "$3,072.84 " "$3,233.54 " "$2,945.32 " "$2,140.80 " N/A "$4,108.61 " N/A "$2,162.43 " "$6,121.59 " "$2,378.67 " "$4,964.76 " "$6,252.14 " N/A N/A N/A "$5,883.00 " "$6,113.00 " "$5,360.00 " N/A "$2,227.30 " "$2,681.41 " N/A N/A N/A N/A N/A "$3,027.40 " N/A "$2,162.43 " "$2,162.43 " "$2,357.05 " N/A N/A N/A N/A N/A N/A N/A "$4,417.00 " "$3,549.00 " "$3,549.00 " "$3,549.00 " "$3,549.00 " "$3,463.06 " "$2,378.67 " "$2,162.43 " "$3,734.89 " N/A N/A N/A N/A "$2,162.43 " "$2,140.80 " "$6,252.14 " 330104 796 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC I N/A "$7,090.92 " "$11,947.71 " "$7,090.92 " "$19,933.97 " "$20,976.49 " "$19,106.78 " "$11,828.24 " N/A "$22,700.66 " N/A "$11,947.71 " "$16,850.00 " "$13,142.49 " "$4,963.03 " "$40,558.57 " N/A N/A N/A "$13,728.00 " "$14,266.00 " "$12,509.00 " N/A "$12,306.15 " "$14,815.17 " N/A N/A N/A N/A N/A "$16,726.80 " N/A "$11,947.71 " "$11,947.71 " "$13,023.01 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$37,278.70 " "$37,278.70 " "$37,278.70 " "$37,278.70 " "$22,465.43 " "$13,142.49 " "$11,947.71 " "$24,228.79 " N/A N/A N/A N/A "$11,947.71 " "$4,670.00 " "$40,558.57 " 330104 797 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC I N/A "$5,485.39 " "$8,554.67 " "$5,485.39 " "$14,087.38 " "$14,824.13 " "$13,502.80 " "$8,469.12 " N/A "$16,253.88 " N/A "$8,554.67 " "$16,850.00 " "$9,410.14 " "$4,963.03 " "$28,662.83 " N/A N/A N/A "$13,728.00 " "$14,266.00 " "$12,509.00 " N/A "$8,811.31 " "$10,607.79 " N/A N/A N/A N/A N/A "$11,976.54 " N/A "$8,554.67 " "$8,554.67 " "$9,324.59 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$26,344.94 " "$26,344.94 " "$26,344.94 " "$26,344.94 " "$15,876.37 " "$9,410.14 " "$8,554.67 " "$17,122.54 " N/A N/A N/A N/A "$8,554.67 " "$4,670.00 " "$28,662.83 " 330104 798 VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC I N/A "$4,975.28 " "$8,554.67 " N/A "$14,087.38 " "$14,824.13 " "$13,502.80 " "$8,469.12 " N/A "$16,253.88 " N/A "$8,554.67 " "$16,850.00 " "$9,410.14 " "$4,963.03 " "$28,662.83 " N/A N/A N/A "$13,728.00 " "$14,266.00 " "$12,509.00 " N/A "$8,811.31 " "$10,607.79 " N/A N/A N/A N/A N/A "$11,976.54 " N/A "$8,554.67 " "$8,554.67 " "$9,324.59 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$26,344.94 " "$26,344.94 " "$26,344.94 " "$26,344.94 " "$15,876.37 " "$9,410.14 " "$8,554.67 " "$17,122.54 " N/A N/A N/A N/A "$8,554.67 " "$4,670.00 " "$28,662.83 " 330104 799 SPLENECTOMY WITH MCC I N/A N/A "$46,263.18 " N/A "$79,063.30 " "$83,198.22 " "$75,782.45 " "$45,800.55 " N/A "$87,900.04 " N/A "$46,263.18 " "$157,506.89 " "$50,889.50 " "$194,376.36 " "$160,865.85 " N/A N/A N/A "$323,840.82 " "$224,597.69 " "$304,587.96 " N/A "$47,651.08 " "$57,366.34 " N/A N/A N/A N/A N/A "$64,768.45 " N/A "$46,263.18 " "$46,263.18 " "$50,426.87 " N/A N/A N/A N/A N/A N/A N/A "$182,894.42 " "$147,857.02 " "$147,857.02 " "$147,857.02 " "$147,857.02 " "$89,103.75 " "$50,889.50 " "$46,263.18 " "$96,097.69 " N/A N/A N/A N/A "$46,263.18 " "$45,800.55 " "$323,840.82 " 330104 800 SPLENECTOMY WITH CC I N/A N/A "$23,802.66 " N/A "$40,361.35 " "$42,472.20 " "$38,686.49 " "$23,564.63 " N/A "$45,225.06 " N/A "$23,802.66 " "$80,406.33 " "$26,182.93 " "$99,227.98 " "$82,121.07 " N/A N/A N/A "$165,318.82 " "$114,655.79 " "$155,490.35 " N/A "$24,516.74 " "$29,515.30 " N/A N/A N/A N/A N/A "$33,323.73 " N/A "$23,802.66 " "$23,802.66 " "$25,944.90 " N/A N/A N/A N/A N/A N/A N/A "$93,366.52 " "$75,480.13 " "$75,480.13 " "$75,480.13 " "$75,480.13 " "$45,486.94 " "$26,182.93 " "$23,802.66 " "$49,057.30 " N/A N/A N/A N/A "$23,802.66 " "$23,564.63 " "$165,318.82 " 330104 801 SPLENECTOMY WITHOUT CC/MCC I N/A N/A "$16,203.34 " N/A "$27,266.87 " "$28,692.90 " "$26,135.39 " "$16,041.30 " N/A "$30,786.34 " N/A "$16,203.34 " "$54,320.02 " "$17,823.67 " "$67,035.34 " "$55,478.44 " N/A N/A N/A "$111,684.26 " "$77,457.89 " "$105,044.45 " N/A "$16,689.44 " "$20,092.14 " N/A N/A N/A N/A N/A "$22,684.67 " N/A "$16,203.34 " "$16,203.34 " "$17,661.64 " N/A N/A N/A N/A N/A N/A N/A "$63,075.52 " "$50,992.03 " "$50,992.03 " "$50,992.03 " "$50,992.03 " "$30,729.56 " "$17,823.67 " "$16,203.34 " "$33,141.59 " N/A N/A N/A N/A "$16,203.34 " "$16,041.30 " "$111,684.26 " 330104 802 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC I N/A N/A "$33,965.93 " N/A "$57,873.78 " "$60,900.51 " "$55,472.22 " "$33,626.27 " N/A "$64,535.27 " N/A "$33,965.93 " "$115,293.94 " "$37,362.52 " "$142,282.14 " "$117,752.68 " N/A N/A N/A "$237,049.22 " "$164,403.94 " "$222,956.26 " N/A "$34,984.91 " "$42,117.76 " N/A N/A N/A N/A N/A "$47,552.30 " N/A "$33,965.93 " "$33,965.93 " "$37,022.87 " N/A N/A N/A N/A N/A N/A N/A "$133,877.44 " "$108,230.30 " "$108,230.30 " "$108,230.30 " "$108,230.30 " "$65,223.32 " "$37,362.52 " "$33,965.93 " "$70,342.84 " N/A N/A N/A N/A "$33,965.93 " "$33,626.27 " "$237,049.22 " 330104 803 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC I N/A N/A "$18,470.36 " N/A "$31,173.20 " "$32,803.52 " "$29,879.62 " "$18,285.65 " N/A "$35,093.68 " N/A "$18,470.36 " "$62,102.06 " "$20,317.39 " "$76,639.01 " "$63,426.44 " N/A N/A N/A "$127,684.46 " "$88,554.72 " "$120,093.41 " N/A "$19,024.47 " "$22,903.24 " N/A N/A N/A N/A N/A "$25,858.50 " N/A "$18,470.36 " "$18,470.36 " "$20,132.69 " N/A N/A N/A N/A N/A N/A N/A "$72,111.90 " "$58,297.29 " "$58,297.29 " "$58,297.29 " "$58,297.29 " "$35,131.96 " "$20,317.39 " "$18,470.36 " "$37,889.54 " N/A N/A N/A N/A "$18,470.36 " "$18,285.65 " "$127,684.46 " 330104 804 OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC I N/A N/A "$11,496.60 " N/A "$19,156.65 " "$20,158.52 " "$18,361.71 " "$11,381.64 " N/A "$21,843.54 " N/A "$11,496.60 " "$38,163.14 " "$12,646.26 " "$47,096.43 " "$38,977.00 " N/A N/A N/A "$78,465.03 " "$54,418.91 " "$73,800.16 " N/A "$11,841.50 " "$14,255.79 " N/A N/A N/A N/A N/A "$16,095.24 " N/A "$11,496.60 " "$11,496.60 " "$12,531.30 " N/A N/A N/A N/A N/A N/A N/A "$44,314.42 " "$35,825.03 " "$35,825.03 " "$35,825.03 " "$35,825.03 " "$21,589.40 " "$12,646.26 " "$11,496.60 " "$23,284.00 " N/A N/A N/A N/A "$11,496.60 " "$11,381.64 " "$78,465.03 " 330104 805 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC I N/A "$5,255.84 " "$9,239.27 " "$5,255.84 " "$15,267.02 " "$16,065.47 " "$14,633.49 " "$9,146.88 " N/A "$17,554.62 " N/A "$9,239.27 " "$16,850.00 " "$10,163.20 " "$4,963.03 " "$31,062.98 " N/A N/A N/A "$13,728.00 " "$14,266.00 " "$12,509.00 " N/A "$9,516.45 " "$11,456.70 " N/A N/A N/A N/A N/A "$12,934.98 " N/A "$9,239.27 " "$9,239.27 " "$10,070.81 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$28,551.00 " "$28,551.00 " "$28,551.00 " "$28,551.00 " "$17,205.82 " "$10,163.20 " "$9,239.27 " "$18,556.34 " N/A N/A N/A N/A "$9,239.27 " "$4,670.00 " "$31,062.98 " 330104 806 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC I N/A "$4,294.02 " "$6,527.30 " "$4,294.02 " "$10,594.00 " "$11,148.05 " "$10,154.39 " "$6,462.03 " N/A "$12,401.88 " N/A "$6,527.30 " "$16,850.00 " "$7,180.03 " "$4,963.03 " "$21,555.04 " N/A N/A N/A "$13,728.00 " "$14,266.00 " "$12,509.00 " N/A "$6,723.12 " "$8,093.86 " N/A N/A N/A N/A N/A "$9,138.23 " N/A "$6,527.30 " "$6,527.30 " "$7,114.76 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$19,811.94 " "$19,811.94 " "$19,811.94 " "$19,811.94 " "$11,939.36 " "$7,180.03 " "$6,527.30 " "$12,876.50 " N/A N/A N/A N/A "$6,527.30 " "$4,670.00 " "$21,555.04 " 330104 807 VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC I N/A "$3,914.60 " "$5,942.27 " "$3,914.60 " "$9,585.91 " "$10,087.25 " "$9,188.13 " "$5,882.84 " N/A "$11,290.31 " N/A "$5,942.27 " "$16,850.00 " "$6,536.49 " "$4,963.03 " "$19,503.95 " N/A N/A N/A "$13,728.00 " "$14,266.00 " "$12,509.00 " N/A "$6,120.53 " "$7,368.41 " N/A N/A N/A N/A N/A "$8,319.17 " N/A "$5,942.27 " "$5,942.27 " "$6,477.07 " N/A N/A N/A N/A N/A N/A N/A "$4,670.00 " "$17,926.71 " "$17,926.71 " "$17,926.71 " "$17,926.71 " "$10,803.25 " "$6,536.49 " "$5,942.27 " "$11,651.22 " N/A N/A N/A N/A "$5,942.27 " "$4,670.00 " "$19,503.95 " 330104 808 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC I N/A N/A "$19,243.07 " N/A "$32,504.66 " "$34,204.62 " "$31,155.83 " "$19,050.64 " N/A "$36,561.83 " N/A "$19,243.07 " "$64,754.54 " "$21,167.37 " "$79,912.40 " "$66,135.49 " N/A N/A N/A "$133,138.08 " "$92,337.05 " "$125,222.81 " N/A "$19,820.36 " "$23,861.40 " N/A N/A N/A N/A N/A "$26,940.29 " N/A "$19,243.07 " "$19,243.07 " "$20,974.94 " N/A N/A N/A N/A N/A N/A N/A "$75,191.92 " "$60,787.27 " "$60,787.27 " "$60,787.27 " "$60,787.27 " "$36,632.51 " "$21,167.37 " "$19,243.07 " "$39,507.87 " N/A N/A N/A N/A "$19,243.07 " "$19,050.64 " "$133,138.08 " 330104 809 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC I N/A N/A "$11,090.42 " N/A "$18,456.76 " "$19,422.02 " "$17,690.87 " "$10,979.52 " N/A "$21,071.80 " N/A "$11,090.42 " "$36,768.85 " "$12,199.47 " "$45,375.76 " "$37,552.97 " N/A N/A N/A "$75,598.30 " "$52,430.71 " "$71,103.86 " N/A "$11,423.14 " "$13,752.12 " N/A N/A N/A N/A N/A "$15,526.59 " N/A "$11,090.42 " "$11,090.42 " "$12,088.56 " N/A N/A N/A N/A N/A N/A N/A "$42,695.38 " "$34,516.15 " "$34,516.15 " "$34,516.15 " "$34,516.15 " "$20,800.63 " "$12,199.47 " "$11,090.42 " "$22,433.31 " N/A N/A N/A N/A "$11,090.42 " "$10,979.52 " "$75,598.30 " 330104 810 MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC I N/A N/A "$8,650.71 " N/A "$14,252.86 " "$14,998.27 " "$13,661.42 " "$8,564.20 " N/A "$16,436.35 " N/A "$8,650.71 " "$28,394.01 " "$9,515.78 " "$35,040.52 " "$28,999.53 " N/A N/A N/A "$58,379.28 " "$40,488.57 " "$54,908.53 " N/A "$8,910.23 " "$10,726.88 " N/A N/A N/A N/A N/A "$12,110.99 " N/A "$8,650.71 " "$8,650.71 " "$9,429.27 " N/A N/A N/A N/A N/A N/A N/A "$32,970.66 " "$26,654.41 " "$26,654.41 " "$26,654.41 " "$26,654.41 " "$16,062.87 " "$9,515.78 " "$8,650.71 " "$17,323.68 " N/A N/A N/A N/A "$8,650.71 " "$8,564.20 " "$58,379.28 " 330104 811 RED BLOOD CELL DISORDERS WITH MCC I N/A N/A "$12,628.79 " N/A "$21,107.53 " "$22,211.43 " "$20,231.65 " "$12,502.50 " N/A "$23,994.70 " N/A "$12,628.79 " "$42,049.62 " "$13,891.67 " "$51,892.67 " "$42,946.37 " N/A N/A N/A "$86,455.81 " "$59,960.86 " "$81,315.87 " N/A "$13,007.65 " "$15,659.70 " N/A N/A N/A N/A N/A "$17,680.31 " N/A "$12,628.79 " "$12,628.79 " "$13,765.38 " N/A N/A N/A N/A N/A N/A N/A "$48,827.34 " "$39,473.40 " "$39,473.40 " "$39,473.40 " "$39,473.40 " "$23,788.03 " "$13,891.67 " "$12,628.79 " "$25,655.21 " N/A N/A N/A N/A "$12,628.79 " "$12,502.50 " "$86,455.81 " 330104 812 RED BLOOD CELL DISORDERS WITHOUT MCC I N/A N/A "$8,291.23 " N/A "$13,633.44 " "$14,346.45 " "$13,067.70 " "$8,208.32 " N/A "$15,753.33 " N/A "$8,291.23 " "$27,160.01 " "$9,120.35 " "$33,517.67 " "$27,739.22 " N/A N/A N/A "$55,842.13 " "$38,728.94 " "$52,522.22 " N/A "$8,539.97 " "$10,281.12 " N/A N/A N/A N/A N/A "$11,607.72 " N/A "$8,291.23 " "$8,291.23 " "$9,037.44 " N/A N/A N/A N/A N/A N/A N/A "$31,537.76 " "$25,496.02 " "$25,496.02 " "$25,496.02 " "$25,496.02 " "$15,364.78 " "$9,120.35 " "$8,291.23 " "$16,570.79 " N/A N/A N/A N/A "$8,291.23 " "$8,208.32 " "$55,842.13 " 330104 813 COAGULATION DISORDERS I N/A N/A "$14,168.92 " N/A "$23,761.35 " "$25,004.04 " "$22,775.34 " "$14,027.23 " N/A "$26,920.95 " N/A "$14,168.92 " "$47,336.45 " "$15,585.81 " "$58,417.04 " "$48,345.94 " N/A N/A N/A "$97,325.74 " "$67,499.63 " "$91,539.57 " N/A "$14,593.99 " "$17,569.46 " N/A N/A N/A N/A N/A "$19,836.49 " N/A "$14,168.92 " "$14,168.92 " "$15,444.12 " N/A N/A N/A N/A N/A N/A N/A "$54,966.31 " "$44,436.32 " "$44,436.32 " "$44,436.32 " "$44,436.32 " "$26,778.86 " "$15,585.81 " "$14,168.92 " "$28,880.79 " N/A N/A N/A N/A "$14,168.92 " "$14,027.23 " "$97,325.74 " 330104 814 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC I N/A N/A "$16,935.52 " N/A "$28,528.50 " "$30,020.50 " "$27,344.66 " "$16,766.16 " N/A "$32,177.48 " N/A "$16,935.52 " "$56,833.38 " "$18,629.07 " "$70,137.03 " "$58,045.40 " N/A N/A N/A "$116,851.83 " "$81,041.82 " "$109,904.80 " N/A "$17,443.58 " "$21,000.04 " N/A N/A N/A N/A N/A "$23,709.72 " N/A "$16,935.52 " "$16,935.52 " "$18,459.71 " N/A N/A N/A N/A N/A N/A N/A "$65,993.99 " "$53,351.41 " "$53,351.41 " "$53,351.41 " "$53,351.41 " "$32,151.40 " "$18,629.07 " "$16,935.52 " "$34,675.03 " N/A N/A N/A N/A "$16,935.52 " "$16,766.16 " "$116,851.83 " 330104 815 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC I N/A N/A "$9,463.95 " N/A "$15,654.16 " "$16,472.85 " "$15,004.57 " "$9,369.31 " N/A "$17,981.50 " N/A "$9,463.95 " "$31,185.62 " "$10,410.34 " "$38,485.60 " "$31,850.68 " N/A N/A N/A "$64,118.95 " "$44,469.28 " "$60,306.98 " N/A "$9,747.87 " "$11,735.29 " N/A N/A N/A N/A N/A "$13,249.53 " N/A "$9,463.95 " "$9,463.95 " "$10,315.70 " N/A N/A N/A N/A N/A N/A N/A "$36,212.23 " "$29,274.99 " "$29,274.99 " "$29,274.99 " "$29,274.99 " "$17,642.12 " "$10,410.34 " "$9,463.95 " "$19,026.89 " N/A N/A N/A N/A "$9,463.95 " "$9,369.31 " "$64,118.95 " 330104 816 RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC I N/A N/A "$6,802.20 " N/A "$11,067.68 " "$11,646.50 " "$10,608.41 " "$6,734.18 " N/A "$12,924.18 " N/A "$6,802.20 " "$22,048.61 " "$7,482.42 " "$27,209.78 " "$22,518.81 " N/A N/A N/A "$45,332.87 " "$31,440.31 " "$42,637.75 " N/A "$7,006.27 " "$8,434.73 " N/A N/A N/A N/A N/A "$9,523.08 " N/A "$6,802.20 " "$6,802.20 " "$7,414.40 " N/A N/A N/A N/A N/A N/A N/A "$25,602.48 " "$20,697.77 " "$20,697.77 " "$20,697.77 " "$20,697.77 " "$12,473.19 " "$7,482.42 " "$6,802.20 " "$13,452.24 " N/A N/A N/A N/A "$6,802.20 " "$6,734.18 " "$45,332.87 " 330104 817 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC I N/A N/A "$27,955.20 " N/A "$47,516.62 " "$50,001.68 " "$45,544.85 " "$27,675.64 " N/A "$53,114.87 " N/A "$27,955.20 " "$94,660.80 " "$30,750.72 " "$116,819.16 " "$96,679.52 " N/A N/A N/A "$194,626.61 " "$134,982.01 " "$183,055.74 " N/A "$28,793.85 " "$34,664.44 " N/A N/A N/A N/A N/A "$39,137.28 " N/A "$27,955.20 " "$27,955.20 " "$30,471.16 " N/A N/A N/A N/A N/A N/A N/A "$109,918.58 " "$88,861.28 " "$88,861.28 " "$88,861.28 " "$88,861.28 " "$53,550.88 " "$30,750.72 " "$27,955.20 " "$57,754.20 " N/A N/A N/A N/A "$27,955.20 " "$27,675.64 " "$194,626.61 " 330104 818 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC I N/A N/A "$14,389.19 " N/A "$24,140.90 " "$25,403.44 " "$23,139.14 " "$14,245.30 " N/A "$27,339.46 " N/A "$14,389.19 " "$48,092.57 " "$15,828.11 " "$59,350.16 " "$49,118.19 " N/A N/A N/A "$98,880.37 " "$68,577.83 " "$93,001.77 " N/A "$14,820.87 " "$17,842.60 " N/A N/A N/A N/A N/A "$20,144.87 " N/A "$14,389.19 " "$14,389.19 " "$15,684.22 " N/A N/A N/A N/A N/A N/A N/A "$55,844.31 " "$45,146.12 " "$45,146.12 " "$45,146.12 " "$45,146.12 " "$27,206.61 " "$15,828.11 " "$14,389.19 " "$29,342.12 " N/A N/A N/A N/A "$14,389.19 " "$14,245.30 " "$98,880.37 " 330104 819 OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$8,207.53 " N/A "$13,489.21 " "$14,194.68 " "$12,929.45 " "$8,125.45 " N/A "$15,594.30 " N/A "$8,207.53 " "$26,872.68 " "$9,028.28 " "$33,163.08 " "$27,445.76 " N/A N/A N/A "$55,251.37 " "$38,319.23 " "$51,966.59 " N/A "$8,453.75 " "$10,177.33 " N/A N/A N/A N/A N/A "$11,490.54 " N/A "$8,207.53 " "$8,207.53 " "$8,946.20 " N/A N/A N/A N/A N/A N/A N/A "$31,204.12 " "$25,226.29 " "$25,226.29 " "$25,226.29 " "$25,226.29 " "$15,202.23 " "$9,028.28 " "$8,207.53 " "$16,395.49 " N/A N/A N/A N/A "$8,207.53 " "$8,125.45 " "$55,251.37 " 330104 820 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC I N/A N/A "$47,231.49 " N/A "$80,731.80 " "$84,953.98 " "$77,381.72 " "$46,759.17 " N/A "$89,739.83 " N/A "$47,231.49 " "$160,830.81 " "$51,954.64 " "$198,478.36 " "$164,260.66 " N/A N/A N/A "$330,674.96 " "$229,337.45 " "$311,015.79 " N/A "$48,648.43 " "$58,567.05 " N/A N/A N/A N/A N/A "$66,124.08 " N/A "$47,231.49 " "$47,231.49 " "$51,482.32 " N/A N/A N/A N/A N/A N/A N/A "$186,754.11 " "$150,977.30 " "$150,977.30 " "$150,977.30 " "$150,977.30 " "$90,984.14 " "$51,954.64 " "$47,231.49 " "$98,125.67 " N/A N/A N/A N/A "$47,231.49 " "$46,759.17 " "$330,674.96 " 330104 821 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC I N/A N/A "$19,431.62 " N/A "$32,829.56 " "$34,546.50 " "$31,467.24 " "$19,237.30 " N/A "$36,920.07 " N/A "$19,431.62 " "$65,401.79 " "$21,374.78 " "$80,711.15 " "$66,796.54 " N/A N/A N/A "$134,468.84 " "$93,259.99 " "$126,474.45 " N/A "$20,014.57 " "$24,095.21 " N/A N/A N/A N/A N/A "$27,204.27 " N/A "$19,431.62 " "$19,431.62 " "$21,180.46 " N/A N/A N/A N/A N/A N/A N/A "$75,943.49 " "$61,394.86 " "$61,394.86 " "$61,394.86 " "$61,394.86 " "$36,998.66 " "$21,374.78 " "$19,431.62 " "$39,902.77 " N/A N/A N/A N/A "$19,431.62 " "$19,237.30 " "$134,468.84 " 330104 822 LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$10,996.15 " N/A "$18,294.31 " "$19,251.08 " "$17,535.16 " "$10,886.19 " N/A "$20,892.68 " N/A "$10,996.15 " "$36,445.22 " "$12,095.76 " "$44,976.38 " "$37,222.45 " N/A N/A N/A "$74,932.93 " "$51,969.24 " "$70,478.04 " N/A "$11,326.03 " "$13,635.22 " N/A N/A N/A N/A N/A "$15,394.61 " N/A "$10,996.15 " "$10,996.15 " "$11,985.80 " N/A N/A N/A N/A N/A N/A N/A "$42,319.60 " "$34,212.36 " "$34,212.36 " "$34,212.36 " "$34,212.36 " "$20,617.55 " "$12,095.76 " "$10,996.15 " "$22,235.87 " N/A N/A N/A N/A "$10,996.15 " "$10,886.19 " "$74,932.93 " 330104 823 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC I N/A N/A "$38,498.21 " N/A "$65,683.40 " "$69,118.57 " "$62,957.77 " "$38,113.23 " N/A "$73,146.60 " N/A "$38,498.21 " "$130,851.97 " "$42,348.03 " "$161,482.01 " "$133,642.50 " N/A N/A N/A "$269,037.18 " "$186,588.98 " "$253,042.48 " N/A "$39,653.16 " "$47,737.78 " N/A N/A N/A N/A N/A "$53,897.50 " N/A "$38,498.21 " "$38,498.21 " "$41,963.05 " N/A N/A N/A N/A N/A N/A N/A "$151,943.17 " "$122,835.15 " "$122,835.15 " "$122,835.15 " "$122,835.15 " "$74,024.70 " "$42,348.03 " "$38,498.21 " "$79,835.06 " N/A N/A N/A N/A "$38,498.21 " "$38,113.23 " "$269,037.18 " 330104 824 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC I N/A N/A "$20,558.52 " N/A "$34,771.33 " "$36,589.83 " "$33,328.45 " "$20,352.94 " N/A "$39,061.19 " N/A "$20,558.52 " "$69,270.12 " "$22,614.37 " "$85,484.99 " "$70,747.37 " N/A N/A N/A "$142,422.31 " "$98,776.06 " "$133,955.07 " N/A "$21,175.28 " "$25,492.57 " N/A N/A N/A N/A N/A "$28,781.93 " N/A "$20,558.52 " "$20,558.52 " "$22,408.79 " N/A N/A N/A N/A N/A N/A N/A "$80,435.34 " "$65,026.20 " "$65,026.20 " "$65,026.20 " "$65,026.20 " "$39,187.03 " "$22,614.37 " "$20,558.52 " "$42,262.91 " N/A N/A N/A N/A "$20,558.52 " "$20,352.94 " "$142,422.31 " 330104 825 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC I N/A N/A "$11,979.43 " N/A "$19,988.62 " "$21,034.00 " "$19,159.16 " "$11,859.64 " N/A "$22,760.92 " N/A "$11,979.43 " "$39,820.57 " "$13,177.38 " "$49,141.83 " "$40,669.77 " N/A N/A N/A "$81,872.77 " "$56,782.32 " "$77,005.30 " N/A "$12,338.82 " "$14,854.50 " N/A N/A N/A N/A N/A "$16,771.21 " N/A "$11,979.43 " "$11,979.43 " "$13,057.58 " N/A N/A N/A N/A N/A N/A N/A "$46,238.99 " "$37,380.91 " "$37,380.91 " "$37,380.91 " "$37,380.91 " "$22,527.03 " "$13,177.38 " "$11,979.43 " "$24,295.22 " N/A N/A N/A N/A "$11,979.43 " "$11,859.64 " "$81,872.77 " 330104 826 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC I N/A N/A "$45,683.43 " N/A "$78,064.33 " "$82,146.99 " "$74,824.93 " "$45,226.60 " N/A "$86,798.52 " N/A "$45,683.43 " "$155,516.77 " "$50,251.77 " "$191,920.39 " "$158,833.29 " N/A N/A N/A "$319,749.05 " "$221,759.86 " "$300,739.45 " N/A "$47,053.93 " "$56,647.45 " N/A N/A N/A N/A N/A "$63,956.80 " N/A "$45,683.43 " "$45,683.43 " "$49,794.94 " N/A N/A N/A N/A N/A N/A N/A "$180,583.53 " "$145,988.82 " "$145,988.82 " "$145,988.82 " "$145,988.82 " "$87,977.91 " "$50,251.77 " "$45,683.43 " "$94,883.48 " N/A N/A N/A N/A "$45,683.43 " "$45,226.60 " "$319,749.05 " 330104 827 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC I N/A N/A "$21,830.80 " N/A "$36,963.62 " "$38,896.77 " "$35,429.75 " "$21,612.49 " N/A "$41,478.52 " N/A "$21,830.80 " "$73,637.50 " "$24,013.88 " "$90,874.69 " "$75,207.88 " N/A N/A N/A "$151,401.82 " "$105,003.74 " "$142,400.73 " N/A "$22,485.73 " "$27,070.19 " N/A N/A N/A N/A N/A "$30,563.12 " N/A "$21,830.80 " "$21,830.80 " "$23,795.57 " N/A N/A N/A N/A N/A N/A N/A "$85,506.66 " "$69,126.00 " "$69,126.00 " "$69,126.00 " "$69,126.00 " "$41,657.72 " "$24,013.88 " "$21,830.80 " "$44,927.52 " N/A N/A N/A N/A "$21,830.80 " "$21,612.49 " "$151,401.82 " 330104 828 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$15,702.00 " N/A "$26,403.02 " "$27,783.86 " "$25,307.38 " "$15,544.98 " N/A "$29,833.80 " N/A "$15,702.00 " "$52,599.08 " "$17,272.20 " "$64,911.56 " "$53,720.80 " N/A N/A N/A "$108,145.93 " "$75,003.90 " "$101,716.48 " N/A "$16,173.06 " "$19,470.48 " N/A N/A N/A N/A N/A "$21,982.80 " N/A "$15,702.00 " "$15,702.00 " "$17,115.18 " N/A N/A N/A N/A N/A N/A N/A "$61,077.19 " "$49,376.53 " "$49,376.53 " "$49,376.53 " "$49,376.53 " "$29,756.00 " "$17,272.20 " "$15,702.00 " "$32,091.61 " N/A N/A N/A N/A "$15,702.00 " "$15,544.98 " "$108,145.93 " 330104 829 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC I N/A N/A "$28,262.69 " N/A "$48,046.48 " "$50,559.25 " "$46,052.71 " "$27,980.07 " N/A "$53,699.12 " N/A "$28,262.69 " "$95,716.35 " "$31,088.96 " "$118,121.79 " "$97,757.58 " N/A N/A N/A "$196,796.87 " "$136,487.18 " "$185,096.97 " N/A "$29,110.57 " "$35,045.74 " N/A N/A N/A N/A N/A "$39,567.77 " N/A "$28,262.69 " "$28,262.69 " "$30,806.34 " N/A N/A N/A N/A N/A N/A N/A "$111,144.26 " "$89,852.16 " "$89,852.16 " "$89,852.16 " "$89,852.16 " "$54,148.02 " "$31,088.96 " "$28,262.69 " "$58,398.21 " N/A N/A N/A N/A "$28,262.69 " "$27,980.07 " "$196,796.87 " 330104 830 MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC I N/A N/A "$13,335.42 " N/A "$22,325.13 " "$23,492.71 " "$21,398.72 " "$13,202.06 " N/A "$25,337.29 " N/A "$13,335.42 " "$44,475.27 " "$14,668.96 " "$54,886.12 " "$45,423.74 " N/A N/A N/A "$91,443.04 " "$63,419.72 " "$86,006.60 " N/A "$13,735.48 " "$16,535.92 " N/A N/A N/A N/A N/A "$18,669.58 " N/A "$13,335.42 " "$13,335.42 " "$14,535.61 " N/A N/A N/A N/A N/A N/A N/A "$51,643.96 " "$41,750.44 " "$41,750.44 " "$41,750.44 " "$41,750.44 " "$25,160.25 " "$14,668.96 " "$13,335.42 " "$27,135.14 " N/A N/A N/A N/A "$13,335.42 " "$13,202.06 " "$91,443.04 " 330104 831 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC I N/A N/A "$10,906.28 " N/A "$18,139.45 " "$19,088.12 " "$17,386.73 " "$10,797.21 " N/A "$20,721.93 " N/A "$10,906.28 " "$36,136.73 " "$11,996.90 " "$44,595.67 " "$36,907.37 " N/A N/A N/A "$74,298.64 " "$51,529.33 " "$69,881.46 " N/A "$11,233.47 " "$13,523.78 " N/A N/A N/A N/A N/A "$15,268.79 " N/A "$10,906.28 " "$10,906.28 " "$11,887.84 " N/A N/A N/A N/A N/A N/A N/A "$41,961.38 " "$33,922.76 " "$33,922.76 " "$33,922.76 " "$33,922.76 " "$20,443.03 " "$11,996.90 " "$10,906.28 " "$22,047.64 " N/A N/A N/A N/A "$10,906.28 " "$10,797.21 " "$74,298.64 " 330104 832 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC I N/A N/A "$6,551.09 " N/A "$10,634.99 " "$11,191.19 " "$10,193.68 " "$6,485.58 " N/A "$12,447.08 " N/A "$6,551.09 " "$21,186.62 " "$7,206.20 " "$26,146.02 " "$21,638.44 " N/A N/A N/A "$43,560.59 " "$30,211.16 " "$40,970.84 " N/A "$6,747.63 " "$8,123.36 " N/A N/A N/A N/A N/A "$9,171.53 " N/A "$6,551.09 " "$6,551.09 " "$7,140.69 " N/A N/A N/A N/A N/A N/A N/A "$24,601.56 " "$19,888.60 " "$19,888.60 " "$19,888.60 " "$19,888.60 " "$11,985.56 " "$7,206.20 " "$6,551.09 " "$12,926.33 " N/A N/A N/A N/A "$6,551.09 " "$6,485.58 " "$43,560.59 " 330104 833 OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$4,819.77 " N/A "$7,651.73 " "$8,051.90 " "$7,334.21 " "$4,771.57 " N/A "$9,157.56 " N/A "$4,819.77 " "$15,243.48 " "$5,301.75 " "$18,811.70 " "$15,568.56 " N/A N/A N/A "$31,341.24 " "$21,736.51 " "$29,477.95 " N/A "$4,964.36 " "$5,976.51 " N/A N/A N/A N/A N/A "$6,747.68 " N/A "$4,819.77 " "$4,819.77 " "$5,253.55 " N/A N/A N/A N/A N/A N/A N/A "$17,700.48 " "$14,309.57 " "$14,309.57 " "$14,309.57 " "$14,309.57 " "$8,623.44 " "$5,301.75 " "$4,819.77 " "$9,300.31 " N/A N/A N/A N/A "$4,819.77 " "$4,771.57 " "$31,341.24 " 330104 834 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC I N/A N/A "$49,102.91 " N/A "$83,956.46 " "$88,347.28 " "$80,472.56 " "$48,611.88 " N/A "$93,295.52 " N/A "$49,102.91 " "$167,254.85 " "$54,013.20 " "$206,406.14 " "$170,821.70 " N/A N/A N/A "$343,883.05 " "$238,497.84 " "$323,438.64 " N/A "$50,575.99 " "$60,887.60 " N/A N/A N/A N/A N/A "$68,744.07 " N/A "$49,102.91 " "$49,102.91 " "$53,522.17 " N/A N/A N/A N/A N/A N/A N/A "$194,213.60 " "$157,007.76 " "$157,007.76 " "$157,007.76 " "$157,007.76 " "$94,618.30 " "$54,013.20 " "$49,102.91 " "$102,045.09 " N/A N/A N/A N/A "$49,102.91 " "$48,611.88 " "$343,883.05 " 330104 835 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC I N/A N/A "$18,856.27 " N/A "$31,838.17 " "$33,503.27 " "$30,517.00 " "$18,667.71 " N/A "$35,826.92 " N/A "$18,856.27 " "$63,426.79 " "$20,741.90 " "$78,273.84 " "$64,779.42 " N/A N/A N/A "$130,408.16 " "$90,443.73 " "$122,655.18 " N/A "$19,421.96 " "$23,381.78 " N/A N/A N/A N/A N/A "$26,398.78 " N/A "$18,856.27 " "$18,856.27 " "$20,553.34 " N/A N/A N/A N/A N/A N/A N/A "$73,650.15 " "$59,540.86 " "$59,540.86 " "$59,540.86 " "$59,540.86 " "$35,881.38 " "$20,741.90 " "$18,856.27 " "$38,697.79 " N/A N/A N/A N/A "$18,856.27 " "$18,667.71 " "$130,408.16 " 330104 836 ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$14,201.52 " N/A "$23,817.52 " "$25,063.15 " "$22,829.18 " "$14,059.51 " N/A "$26,982.89 " N/A "$14,201.52 " "$47,448.36 " "$15,621.67 " "$58,555.15 " "$48,460.23 " N/A N/A N/A "$97,555.83 " "$67,659.21 " "$91,755.97 " N/A "$14,627.57 " "$17,609.89 " N/A N/A N/A N/A N/A "$19,882.13 " N/A "$14,201.52 " "$14,201.52 " "$15,479.66 " N/A N/A N/A N/A N/A N/A N/A "$55,096.26 " "$44,541.37 " "$44,541.37 " "$44,541.37 " "$44,541.37 " "$26,842.17 " "$15,621.67 " "$14,201.52 " "$28,949.07 " N/A N/A N/A N/A "$14,201.52 " "$14,059.51 " "$97,555.83 " 330104 837 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC I N/A N/A "$47,800.67 " N/A "$81,712.56 " "$85,986.03 " "$78,321.77 " "$47,322.66 " N/A "$90,821.27 " N/A "$47,800.67 " "$162,784.64 " "$52,580.73 " "$200,889.54 " "$166,256.16 " N/A N/A N/A "$334,692.11 " "$232,123.52 " "$314,794.11 " N/A "$49,234.69 " "$59,272.83 " N/A N/A N/A N/A N/A "$66,920.93 " N/A "$47,800.67 " "$47,800.67 " "$52,102.73 " N/A N/A N/A N/A N/A N/A N/A "$189,022.86 " "$152,811.42 " "$152,811.42 " "$152,811.42 " "$152,811.42 " "$92,089.44 " "$52,580.73 " "$47,800.67 " "$99,317.74 " N/A N/A N/A N/A "$47,800.67 " "$47,322.66 " "$334,692.11 " 330104 838 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT I N/A N/A "$19,975.24 " N/A "$33,766.29 " "$35,532.22 " "$32,365.10 " "$19,775.49 " N/A "$37,952.97 " N/A "$19,975.24 " "$67,267.90 " "$21,972.77 " "$83,014.09 " "$68,702.45 " N/A N/A N/A "$138,305.66 " "$95,920.98 " "$130,083.16 " N/A "$20,574.50 " "$24,769.30 " N/A N/A N/A N/A N/A "$27,965.34 " N/A "$19,975.24 " "$19,975.24 " "$21,773.02 " N/A N/A N/A N/A N/A N/A N/A "$78,110.39 " "$63,146.65 " "$63,146.65 " "$63,146.65 " "$63,146.65 " "$38,054.35 " "$21,972.77 " "$19,975.24 " "$41,041.32 " N/A N/A N/A N/A "$19,975.24 " "$19,775.49 " "$138,305.66 " 330104 839 CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC I N/A N/A "$12,491.34 " N/A "$20,870.70 " "$21,962.21 " "$20,004.63 " "$12,366.43 " N/A "$23,733.55 " N/A "$12,491.34 " "$41,577.80 " "$13,740.48 " "$51,310.40 " "$42,464.48 " N/A N/A N/A "$85,485.72 " "$59,288.06 " "$80,403.45 " N/A "$12,866.08 " "$15,489.26 " N/A N/A N/A N/A N/A "$17,487.88 " N/A "$12,491.34 " "$12,491.34 " "$13,615.56 " N/A N/A N/A N/A N/A N/A N/A "$48,279.46 " "$39,030.48 " "$39,030.48 " "$39,030.48 " "$39,030.48 " "$23,521.12 " "$13,740.48 " "$12,491.34 " "$25,367.34 " N/A N/A N/A N/A "$12,491.34 " "$12,366.43 " "$85,485.72 " 330104 840 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC I N/A N/A "$27,754.31 " N/A "$47,170.47 " "$49,637.43 " "$45,213.06 " "$27,476.77 " N/A "$52,733.19 " N/A "$27,754.31 " "$93,971.21 " "$30,529.74 " "$115,968.15 " "$95,975.23 " N/A N/A N/A "$193,208.79 " "$133,998.70 " "$181,722.22 " N/A "$28,586.94 " "$34,415.34 " N/A N/A N/A N/A N/A "$38,856.03 " N/A "$27,754.31 " "$27,754.31 " "$30,252.20 " N/A N/A N/A N/A N/A N/A N/A "$109,117.84 " "$88,213.94 " "$88,213.94 " "$88,213.94 " "$88,213.94 " "$53,160.77 " "$30,529.74 " "$27,754.31 " "$57,333.47 " N/A N/A N/A N/A "$27,754.31 " "$27,476.77 " "$193,208.79 " 330104 841 LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC I N/A N/A "$14,430.60 " N/A "$24,212.25 " "$25,478.52 " "$23,207.53 " "$14,286.30 " N/A "$27,418.14 " N/A "$14,430.60 " "$48,234.73 " "$15,873.66 " "$59,525.59 " "$49,263.37 " N/A N/A N/A "$99,172.64 " "$68,780.53 " "$93,276.66 " N/A "$14,863.52 " "$17,893.95 " N/A N/A N/A N/A N/A "$20,202.84 " N/A "$14,430.60 " "$14,430.60 " "$15,729.36 " N/A N/A N/A N/A N/A N/A N/A "$56,009.38 " "$45,279.56 " "$45,279.56 " "$45,279.56 " "$45,279.56 " "$27,287.03 " "$15,873.66 " "$14,430.60 " "$29,428.84 " N/A N/A N/A N/A "$14,430.60 " "$14,286.30 " "$99,172.64 " 330104 842 LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC I N/A N/A "$10,103.61 " N/A "$16,756.37 " "$17,632.71 " "$16,061.04 " "$10,002.58 " N/A "$19,196.86 " N/A "$10,103.61 " "$33,381.41 " "$11,113.97 " "$41,195.38 " "$34,093.29 " N/A N/A N/A "$68,633.58 " "$47,600.37 " "$64,553.21 " N/A "$10,406.72 " "$12,528.48 " N/A N/A N/A N/A N/A "$14,145.06 " N/A "$10,103.61 " "$10,103.61 " "$11,012.94 " N/A N/A N/A N/A N/A N/A N/A "$38,761.94 " "$31,336.25 " "$31,336.25 " "$31,336.25 " "$31,336.25 " "$18,884.31 " "$11,113.97 " "$10,103.61 " "$20,366.58 " N/A N/A N/A N/A "$10,103.61 " "$10,002.58 " "$68,633.58 " 330104 843 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC I N/A N/A "$17,449.19 " N/A "$29,413.61 " "$30,951.90 " "$28,193.04 " "$17,274.69 " N/A "$33,153.45 " N/A "$17,449.19 " "$58,596.66 " "$19,194.10 " "$72,313.07 " "$59,846.29 " N/A N/A N/A "$120,477.22 " "$83,556.19 " "$113,314.65 " N/A "$17,972.66 " "$21,636.99 " N/A N/A N/A N/A N/A "$24,428.86 " N/A "$17,449.19 " "$17,449.19 " "$19,019.61 " N/A N/A N/A N/A N/A N/A N/A "$68,041.49 " "$55,006.66 " "$55,006.66 " "$55,006.66 " "$55,006.66 " "$33,148.91 " "$19,194.10 " "$17,449.19 " "$35,750.84 " N/A N/A N/A N/A "$17,449.19 " "$17,274.69 " "$120,477.22 " 330104 844 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC I N/A N/A "$10,428.73 " N/A "$17,316.59 " "$18,222.23 " "$16,598.01 " "$10,324.44 " N/A "$19,814.59 " N/A "$10,428.73 " "$34,497.45 " "$11,471.60 " "$42,572.67 " "$35,233.13 " N/A N/A N/A "$70,928.21 " "$49,191.80 " "$66,711.41 " N/A "$10,741.59 " "$12,931.63 " N/A N/A N/A N/A N/A "$14,600.22 " N/A "$10,428.73 " "$10,428.73 " "$11,367.32 " N/A N/A N/A N/A N/A N/A N/A "$40,057.87 " "$32,383.92 " "$32,383.92 " "$32,383.92 " "$32,383.92 " "$19,515.67 " "$11,471.60 " "$10,428.73 " "$21,047.49 " N/A N/A N/A N/A "$10,428.73 " "$10,324.44 " "$70,928.21 " 330104 845 OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC I N/A N/A "$7,828.66 " N/A "$12,836.38 " "$13,507.71 " "$12,303.72 " "$7,750.37 " N/A "$14,874.46 " N/A "$7,828.66 " "$25,572.15 " "$8,611.53 " "$31,558.12 " "$26,117.50 " N/A N/A N/A "$52,577.42 " "$36,464.72 " "$49,451.60 " N/A "$8,063.52 " "$9,707.54 " N/A N/A N/A N/A N/A "$10,960.13 " N/A "$7,828.66 " "$7,828.66 " "$8,533.24 " N/A N/A N/A N/A N/A N/A N/A "$29,693.96 " "$24,005.44 " "$24,005.44 " "$24,005.44 " "$24,005.44 " "$14,466.51 " "$8,611.53 " "$7,828.66 " "$15,602.01 " N/A N/A N/A N/A "$7,828.66 " "$7,750.37 " "$52,577.42 " 330104 846 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC I N/A N/A "$21,604.36 " N/A "$36,573.44 " "$38,486.18 " "$35,055.77 " "$21,388.32 " N/A "$41,048.29 " N/A "$21,604.36 " "$72,860.21 " "$23,764.80 " "$89,915.44 " "$74,414.01 " N/A N/A N/A "$149,803.67 " "$103,895.35 " "$140,897.59 " N/A "$22,252.49 " "$26,789.41 " N/A N/A N/A N/A N/A "$30,246.11 " N/A "$21,604.36 " "$21,604.36 " "$23,548.76 " N/A N/A N/A N/A N/A N/A N/A "$84,604.08 " "$68,396.33 " "$68,396.33 " "$68,396.33 " "$68,396.33 " "$41,217.99 " "$23,764.80 " "$21,604.36 " "$44,453.28 " N/A N/A N/A N/A "$21,604.36 " "$21,388.32 " "$149,803.67 " 330104 847 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC I N/A N/A "$11,111.57 " N/A "$18,493.19 " "$19,460.37 " "$17,725.79 " "$11,000.45 " N/A "$21,111.98 " N/A "$11,111.57 " "$36,841.43 " "$12,222.73 " "$45,465.34 " "$37,627.11 " N/A N/A N/A "$75,747.55 " "$52,534.22 " "$71,244.23 " N/A "$11,444.92 " "$13,778.35 " N/A N/A N/A N/A N/A "$15,556.20 " N/A "$11,111.57 " "$11,111.57 " "$12,111.61 " N/A N/A N/A N/A N/A N/A N/A "$42,779.67 " "$34,584.30 " "$34,584.30 " "$34,584.30 " "$34,584.30 " "$20,841.69 " "$12,222.73 " "$11,111.57 " "$22,477.60 " N/A N/A N/A N/A "$11,111.57 " "$11,000.45 " "$75,747.55 " 330104 848 CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC I N/A N/A "$8,565.24 " N/A "$14,105.60 " "$14,843.30 " "$13,520.26 " "$8,479.59 " N/A "$16,273.96 " N/A "$8,565.24 " "$28,100.63 " "$9,421.77 " "$34,678.47 " "$28,699.90 " N/A N/A N/A "$57,776.08 " "$40,070.22 " "$54,341.20 " N/A "$8,822.20 " "$10,620.90 " N/A N/A N/A N/A N/A "$11,991.34 " N/A "$8,565.24 " "$8,565.24 " "$9,336.12 " N/A N/A N/A N/A N/A N/A N/A "$32,629.99 " "$26,379.01 " "$26,379.01 " "$26,379.01 " "$26,379.01 " "$15,896.90 " "$9,421.77 " "$8,565.24 " "$17,144.68 " N/A N/A N/A N/A "$8,565.24 " "$8,479.59 " "$57,776.08 " 330104 849 RADIOTHERAPY I N/A N/A "$20,986.73 " N/A "$35,509.18 " "$37,366.27 " "$34,035.67 " "$20,776.86 " N/A "$39,874.78 " N/A "$20,986.73 " "$70,740.03 " "$23,085.40 " "$87,298.97 " "$72,248.62 " N/A N/A N/A "$145,444.50 " "$100,872.08 " "$136,797.58 " N/A "$21,616.33 " "$26,023.54 " N/A N/A N/A N/A N/A "$29,381.42 " N/A "$20,986.73 " "$20,986.73 " "$22,875.53 " N/A N/A N/A N/A N/A N/A N/A "$82,142.17 " "$66,406.05 " "$66,406.05 " "$66,406.05 " "$66,406.05 " "$40,018.58 " "$23,085.40 " "$20,986.73 " "$43,159.72 " N/A N/A N/A N/A "$20,986.73 " "$20,776.86 " "$145,444.50 " 330104 853 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC I N/A N/A "$43,560.91 " N/A "$74,406.98 " "$78,298.38 " "$71,319.35 " "$43,125.30 " N/A "$82,765.72 " N/A "$43,560.91 " "$148,230.74 " "$47,917.00 " "$182,928.84 " "$151,391.89 " N/A N/A N/A "$304,768.68 " "$211,370.33 " "$286,649.69 " N/A "$44,867.73 " "$54,015.52 " N/A N/A N/A N/A N/A "$60,985.27 " N/A "$43,560.91 " "$43,560.91 " "$47,481.39 " N/A N/A N/A N/A N/A N/A N/A "$172,123.12 " "$139,149.19 " "$139,149.19 " "$139,149.19 " "$139,149.19 " "$83,856.11 " "$47,917.00 " "$43,560.91 " "$90,438.15 " N/A N/A N/A N/A "$43,560.91 " "$43,125.30 " "$304,768.68 " 330104 854 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC I N/A N/A "$18,490.62 " N/A "$31,208.12 " "$32,840.27 " "$29,913.09 " "$18,305.72 " N/A "$35,132.18 " N/A "$18,490.62 " "$62,171.62 " "$20,339.69 " "$76,724.86 " "$63,497.48 " N/A N/A N/A "$127,827.49 " "$88,653.92 " "$120,227.93 " N/A "$19,045.34 " "$22,928.37 " N/A N/A N/A N/A N/A "$25,886.87 " N/A "$18,490.62 " "$18,490.62 " "$20,154.78 " N/A N/A N/A N/A N/A N/A N/A "$72,192.67 " "$58,362.60 " "$58,362.60 " "$58,362.60 " "$58,362.60 " "$35,171.32 " "$20,339.69 " "$18,490.62 " "$37,931.99 " N/A N/A N/A N/A "$18,490.62 " "$18,305.72 " "$127,827.49 " 330104 855 INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$13,839.40 " N/A "$23,193.54 " "$24,406.54 " "$22,231.09 " "$13,701.00 " N/A "$26,294.85 " N/A "$13,839.40 " "$46,205.29 " "$15,223.34 " "$57,021.10 " "$47,190.65 " N/A N/A N/A "$95,000.02 " "$65,886.65 " "$89,352.12 " N/A "$14,254.58 " "$17,160.85 " N/A N/A N/A N/A N/A "$19,375.15 " N/A "$13,839.40 " "$13,839.40 " "$15,084.94 " N/A N/A N/A N/A N/A N/A N/A "$53,652.82 " "$43,374.46 " "$43,374.46 " "$43,374.46 " "$43,374.46 " "$26,138.95 " "$15,223.34 " "$13,839.40 " "$28,190.65 " N/A N/A N/A N/A "$13,839.40 " "$13,701.00 " "$95,000.02 " 330104 856 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC I N/A N/A "$39,258.59 " N/A "$66,993.61 " "$70,497.30 " "$64,213.61 " "$38,866.00 " N/A "$74,591.31 " N/A "$39,258.59 " "$133,462.11 " "$43,184.44 " "$164,703.14 " "$136,308.30 " N/A N/A N/A "$274,403.75 " "$190,310.93 " "$258,090.00 " N/A "$40,436.34 " "$48,680.65 " N/A N/A N/A N/A N/A "$54,962.02 " N/A "$39,258.59 " "$39,258.59 " "$42,791.86 " N/A N/A N/A N/A N/A N/A N/A "$154,974.02 " "$125,285.38 " "$125,285.38 " "$125,285.38 " "$125,285.38 " "$75,501.30 " "$43,184.44 " "$39,258.59 " "$81,427.55 " N/A N/A N/A N/A "$39,258.59 " "$38,866.00 " "$274,403.75 " 330104 857 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC I N/A N/A "$18,961.12 " N/A "$32,018.84 " "$33,693.38 " "$30,690.17 " "$18,771.51 " N/A "$36,026.13 " N/A "$18,961.12 " "$63,786.71 " "$20,857.23 " "$78,718.00 " "$65,147.01 " N/A N/A N/A "$131,148.17 " "$90,956.95 " "$123,351.19 " N/A "$19,529.95 " "$23,511.79 " N/A N/A N/A N/A N/A "$26,545.57 " N/A "$18,961.12 " "$18,961.12 " "$20,667.62 " N/A N/A N/A N/A N/A N/A N/A "$74,068.08 " "$59,878.73 " "$59,878.73 " "$59,878.73 " "$59,878.73 " "$36,084.99 " "$20,857.23 " "$18,961.12 " "$38,917.38 " N/A N/A N/A N/A "$18,961.12 " "$18,771.51 " "$131,148.17 " 330104 858 POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC I N/A N/A "$12,842.89 " N/A "$21,476.46 " "$22,599.65 " "$20,585.26 " "$12,714.46 " N/A "$24,401.50 " N/A "$12,842.89 " "$42,784.58 " "$14,127.18 " "$52,799.66 " "$43,696.99 " N/A N/A N/A "$87,966.90 " "$61,008.87 " "$82,737.12 " N/A "$13,228.18 " "$15,925.19 " N/A N/A N/A N/A N/A "$17,980.05 " N/A "$12,842.89 " "$12,842.89 " "$13,998.75 " N/A N/A N/A N/A N/A N/A N/A "$49,680.75 " "$40,163.32 " "$40,163.32 " "$40,163.32 " "$40,163.32 " "$24,203.81 " "$14,127.18 " "$12,842.89 " "$26,103.61 " N/A N/A N/A N/A "$12,842.89 " "$12,714.46 " "$87,966.90 " 330104 862 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC I N/A N/A "$16,494.97 " N/A "$27,769.40 " "$29,221.70 " "$26,617.06 " "$16,330.02 " N/A "$31,340.45 " N/A "$16,494.97 " "$55,321.13 " "$18,144.47 " "$68,270.79 " "$56,500.90 " N/A N/A N/A "$113,742.58 " "$78,885.42 " "$106,980.40 " N/A "$16,989.82 " "$20,453.77 " N/A N/A N/A N/A N/A "$23,092.96 " N/A "$16,494.97 " "$16,494.97 " "$17,979.52 " N/A N/A N/A N/A N/A N/A N/A "$64,237.99 " "$51,931.81 " "$51,931.81 " "$51,931.81 " "$51,931.81 " "$31,295.90 " "$18,144.47 " "$16,494.97 " "$33,752.38 " N/A N/A N/A N/A "$16,494.97 " "$16,330.02 " "$113,742.58 " 330104 863 POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC I N/A N/A "$9,241.91 " N/A "$15,271.57 " "$16,070.26 " "$14,637.86 " "$9,149.50 " N/A "$17,559.64 " N/A "$9,241.91 " "$30,423.45 " "$10,166.11 " "$37,545.02 " "$31,072.25 " N/A N/A N/A "$62,551.89 " "$43,382.46 " "$58,833.08 " N/A "$9,519.17 " "$11,459.97 " N/A N/A N/A N/A N/A "$12,938.68 " N/A "$9,241.91 " "$9,241.91 " "$10,073.69 " N/A N/A N/A N/A N/A N/A N/A "$35,327.21 " "$28,559.51 " "$28,559.51 " "$28,559.51 " "$28,559.51 " "$17,210.95 " "$10,166.11 " "$9,241.91 " "$18,561.87 " N/A N/A N/A N/A "$9,241.91 " "$9,149.50 " "$62,551.89 " 330104 864 FEVER AND INFLAMMATORY CONDITIONS I N/A N/A "$7,852.45 " N/A "$12,877.37 " "$13,550.84 " "$12,343.01 " "$7,773.93 " N/A "$14,919.65 " N/A "$7,852.45 " "$25,653.81 " "$8,637.69 " "$31,658.90 " "$26,200.90 " N/A N/A N/A "$52,745.32 " "$36,581.17 " "$49,609.52 " N/A "$8,088.02 " "$9,737.04 " N/A N/A N/A N/A N/A "$10,993.43 " N/A "$7,852.45 " "$7,852.45 " "$8,559.17 " N/A N/A N/A N/A N/A N/A N/A "$29,788.78 " "$24,082.09 " "$24,082.09 " "$24,082.09 " "$24,082.09 " "$14,512.70 " "$8,637.69 " "$7,852.45 " "$15,651.83 " N/A N/A N/A N/A "$7,852.45 " "$7,773.93 " "$52,745.32 " 330104 865 VIRAL ILLNESS WITH MCC I N/A N/A "$15,117.84 " N/A "$25,396.45 " "$26,724.65 " "$24,342.59 " "$14,966.67 " N/A "$28,723.91 " N/A "$15,117.84 " "$50,593.84 " "$16,629.63 " "$62,436.93 " "$51,672.79 " N/A N/A N/A "$104,023.07 " "$72,144.52 " "$97,838.73 " N/A "$15,571.38 " "$18,746.13 " N/A N/A N/A N/A N/A "$21,164.98 " N/A "$15,117.84 " "$15,117.84 " "$16,478.45 " N/A N/A N/A N/A N/A N/A N/A "$58,748.74 " "$47,494.14 " "$47,494.14 " "$47,494.14 " "$47,494.14 " "$28,621.61 " "$16,629.63 " "$15,117.84 " "$30,868.18 " N/A N/A N/A N/A "$15,117.84 " "$14,966.67 " "$104,023.07 " 330104 866 VIRAL ILLNESS WITHOUT MCC I N/A N/A "$8,306.21 " N/A "$13,659.25 " "$14,373.61 " "$13,092.43 " "$8,223.14 " N/A "$15,781.79 " N/A "$8,306.21 " "$27,211.43 " "$9,136.83 " "$33,581.12 " "$27,791.73 " N/A N/A N/A "$55,947.84 " "$38,802.26 " "$52,621.65 " N/A "$8,555.39 " "$10,299.70 " N/A N/A N/A N/A N/A "$11,628.69 " N/A "$8,306.21 " "$8,306.21 " "$9,053.77 " N/A N/A N/A N/A N/A N/A N/A "$31,597.46 " "$25,544.28 " "$25,544.28 " "$25,544.28 " "$25,544.28 " "$15,393.87 " "$9,136.83 " "$8,306.21 " "$16,602.16 " N/A N/A N/A N/A "$8,306.21 " "$8,223.14 " "$55,947.84 " 330104 867 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC I N/A N/A "$18,999.89 " N/A "$32,085.64 " "$33,763.68 " "$30,754.20 " "$18,809.89 " N/A "$36,099.79 " N/A "$18,999.89 " "$63,919.78 " "$20,899.88 " "$78,882.23 " "$65,282.93 " N/A N/A N/A "$131,421.78 " "$91,146.72 " "$123,608.54 " N/A "$19,569.88 " "$23,559.86 " N/A N/A N/A N/A N/A "$26,599.84 " N/A "$18,999.89 " "$18,999.89 " "$20,709.88 " N/A N/A N/A N/A N/A N/A N/A "$74,222.61 " "$60,003.65 " "$60,003.65 " "$60,003.65 " "$60,003.65 " "$36,160.27 " "$20,899.88 " "$18,999.89 " "$38,998.57 " N/A N/A N/A N/A "$18,999.89 " "$18,809.89 " "$131,421.78 " 330104 868 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC I N/A N/A "$9,680.69 " N/A "$16,027.64 " "$16,865.86 " "$15,362.55 " "$9,583.89 " N/A "$18,393.32 " N/A "$9,680.69 " "$31,929.65 " "$10,648.76 " "$39,403.79 " "$32,610.57 " N/A N/A N/A "$65,648.70 " "$45,530.23 " "$61,745.78 " N/A "$9,971.11 " "$12,004.06 " N/A N/A N/A N/A N/A "$13,552.97 " N/A "$9,680.69 " "$9,680.69 " "$10,551.96 " N/A N/A N/A N/A N/A N/A N/A "$37,076.18 " "$29,973.43 " "$29,973.43 " "$29,973.43 " "$29,973.43 " "$18,063.03 " "$10,648.76 " "$9,680.69 " "$19,480.83 " N/A N/A N/A N/A "$9,680.69 " "$9,583.89 " "$65,648.70 " 330104 869 OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC I N/A N/A "$6,906.17 " N/A "$11,246.83 " "$11,835.02 " "$10,780.12 " "$6,837.11 " N/A "$13,121.72 " N/A "$6,906.17 " "$22,405.50 " "$7,596.79 " "$27,650.21 " "$22,883.31 " N/A N/A N/A "$46,066.65 " "$31,949.22 " "$43,327.91 " N/A "$7,113.35 " "$8,563.65 " N/A N/A N/A N/A N/A "$9,668.64 " N/A "$6,906.17 " "$6,906.17 " "$7,527.72 " N/A N/A N/A N/A N/A N/A N/A "$26,016.90 " "$21,032.79 " "$21,032.79 " "$21,032.79 " "$21,032.79 " "$12,675.09 " "$7,596.79 " "$6,906.17 " "$13,669.98 " N/A N/A N/A N/A "$6,906.17 " "$6,837.11 " "$46,066.65 " 330104 870 SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS I N/A N/A "$60,212.46 " N/A "$103,099.44 " "$108,491.42 " "$98,821.18 " "$59,610.33 " N/A "$114,403.67 " N/A "$60,212.46 " "$205,390.77 " "$66,233.70 " "$253,468.98 " "$209,770.90 " N/A N/A N/A "$422,292.12 " "$292,877.94 " "$397,186.16 " N/A "$62,018.83 " "$74,663.45 " N/A N/A N/A N/A N/A "$84,297.44 " N/A "$60,212.46 " "$60,212.46 " "$65,631.58 " N/A N/A N/A N/A N/A N/A N/A "$238,496.41 " "$192,807.23 " "$192,807.23 " "$192,807.23 " "$192,807.23 " "$116,192.30 " "$66,233.70 " "$60,212.46 " "$125,312.48 " N/A N/A N/A N/A "$60,212.46 " "$59,610.33 " "$422,292.12 " 330104 871 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC I N/A N/A "$17,623.64 " N/A "$29,714.21 " "$31,268.23 " "$28,481.17 " "$17,447.40 " N/A "$33,484.91 " N/A "$17,623.64 " "$59,195.51 " "$19,386.00 " "$73,052.10 " "$60,457.91 " N/A N/A N/A "$121,708.48 " "$84,410.12 " "$114,472.71 " N/A "$18,152.35 " "$21,853.31 " N/A N/A N/A N/A N/A "$24,673.10 " N/A "$17,623.64 " "$17,623.64 " "$19,209.77 " N/A N/A N/A N/A N/A N/A N/A "$68,736.86 " "$55,568.82 " "$55,568.82 " "$55,568.82 " "$55,568.82 " "$33,487.69 " "$19,386.00 " "$17,623.64 " "$36,116.21 " N/A N/A N/A N/A "$17,623.64 " "$17,447.40 " "$121,708.48 " 330104 872 SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC I N/A N/A "$9,436.63 " N/A "$15,607.10 " "$16,423.33 " "$14,959.46 " "$9,342.27 " N/A "$17,929.60 " N/A "$9,436.63 " "$31,091.86 " "$10,380.30 " "$38,369.89 " "$31,754.92 " N/A N/A N/A "$63,926.18 " "$44,335.58 " "$60,125.66 " N/A "$9,719.73 " "$11,701.43 " N/A N/A N/A N/A N/A "$13,211.29 " N/A "$9,436.63 " "$9,436.63 " "$10,285.93 " N/A N/A N/A N/A N/A N/A N/A "$36,103.36 " "$29,186.98 " "$29,186.98 " "$29,186.98 " "$29,186.98 " "$17,589.08 " "$10,380.30 " "$9,436.63 " "$18,969.68 " N/A N/A N/A N/A "$9,436.63 " "$9,342.27 " "$63,926.18 " 330104 876 O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS I N/A N/A "$28,541.12 " N/A "$48,526.23 " "$3,577.00 " "$3,257.00 " "$28,255.70 " N/A "$54,228.12 " N/A "$28,541.12 " "$96,672.09 " "$31,395.23 " "$119,301.26 " "$98,733.71 " N/A N/A N/A "$198,761.92 " "$137,850.03 " "$186,945.19 " N/A "$29,397.35 " "$35,390.98 " N/A N/A N/A N/A N/A "$39,957.56 " N/A "$28,541.12 " "$28,541.12 " "$31,109.82 " N/A N/A N/A N/A N/A N/A N/A "$112,254.06 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$54,688.69 " "$31,395.23 " "$28,541.12 " "$58,981.32 " N/A N/A N/A N/A "$28,541.12 " "$3,257.00 " "$198,761.92 " 330104 880 ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION I N/A N/A "$8,363.48 " N/A "$13,757.93 " "$3,577.00 " "$3,257.00 " "$8,279.84 " N/A "$1,886.00 " N/A $982.00 "$27,408.02 " "$9,199.82 " "$33,823.73 " "$27,992.52 " N/A N/A N/A "$56,352.05 " "$4,147.00 " "$3,727.00 " N/A "$8,614.38 " "$10,370.71 " N/A "$6,195.00 " N/A "$1,113.00 " "$1,108.00 " "$1,176.00 " $840.00 "$8,363.48 " "$8,363.48 " "$9,116.19 " N/A N/A N/A N/A N/A N/A N/A "$31,825.74 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$2,419.00 " "$9,199.82 " "$8,363.48 " "$16,722.11 " N/A N/A N/A N/A "$8,363.48 " $840.00 "$56,352.05 " 330104 881 DEPRESSIVE NEUROSES I N/A N/A "$7,916.77 " N/A "$12,988.20 " "$3,577.00 " "$3,257.00 " "$7,837.60 " N/A "$1,886.00 " N/A $982.00 "$25,874.60 " "$8,708.45 " "$31,931.37 " "$26,426.40 " N/A N/A N/A "$53,199.27 " "$4,147.00 " "$3,727.00 " N/A "$8,154.27 " "$9,816.79 " N/A "$6,195.00 " N/A "$1,113.00 " "$1,108.00 " "$1,176.00 " $840.00 "$7,916.77 " "$7,916.77 " "$8,629.28 " N/A N/A N/A N/A N/A N/A N/A "$30,045.16 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$2,419.00 " "$8,708.45 " "$7,916.77 " "$15,786.54 " N/A N/A N/A N/A "$7,916.77 " $840.00 "$53,199.27 " 330104 882 NEUROSES EXCEPT DEPRESSIVE I N/A N/A "$8,075.36 " N/A "$13,261.48 " "$3,577.00 " "$3,257.00 " "$7,994.61 " N/A "$1,886.00 " N/A $982.00 "$26,419.01 " "$8,882.90 " "$32,603.21 " "$26,982.42 " N/A N/A N/A "$54,318.60 " "$4,147.00 " "$3,727.00 " N/A "$8,317.62 " "$10,013.45 " N/A "$6,195.00 " N/A "$1,113.00 " "$1,108.00 " "$1,176.00 " $840.00 "$8,075.36 " "$8,075.36 " "$8,802.15 " N/A N/A N/A N/A N/A N/A N/A "$30,677.32 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$2,419.00 " "$8,882.90 " "$8,075.36 " "$16,118.70 " N/A N/A N/A N/A "$8,075.36 " $840.00 "$54,318.60 " 330104 883 DISORDERS OF PERSONALITY AND IMPULSE CONTROL I N/A N/A "$14,604.17 " N/A "$24,511.34 " "$3,577.00 " "$3,257.00 " "$14,458.13 " N/A "$1,886.00 " N/A $982.00 "$48,830.55 " "$16,064.59 " "$60,260.89 " "$49,871.90 " N/A N/A N/A "$100,397.68 " "$4,147.00 " "$3,727.00 " N/A "$15,042.30 " "$18,109.18 " N/A "$6,195.00 " N/A "$1,113.00 " "$1,108.00 " "$1,176.00 " $840.00 "$14,604.17 " "$14,604.17 " "$15,918.55 " N/A N/A N/A N/A N/A N/A N/A "$56,701.24 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$2,419.00 " "$16,064.59 " "$14,604.17 " "$29,792.37 " N/A N/A N/A N/A "$14,604.17 " $840.00 "$100,397.68 " 330104 884 ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY I N/A N/A "$14,212.09 " N/A "$23,835.74 " "$3,577.00 " "$3,257.00 " "$14,069.97 " N/A "$1,886.00 " N/A $982.00 "$47,484.65 " "$15,633.30 " "$58,599.94 " "$48,497.30 " N/A N/A N/A "$97,630.45 " "$4,147.00 " "$3,727.00 " N/A "$14,638.46 " "$17,623.00 " N/A "$6,195.00 " N/A "$1,113.00 " "$1,108.00 " "$1,176.00 " $840.00 "$14,212.09 " "$14,212.09 " "$15,491.18 " N/A N/A N/A N/A N/A N/A N/A "$55,138.40 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$2,419.00 " "$15,633.30 " "$14,212.09 " "$28,971.21 " N/A N/A N/A N/A "$14,212.09 " $840.00 "$97,630.45 " 330104 885 PSYCHOSES I N/A N/A "$11,793.53 " N/A "$19,668.28 " "$3,577.00 " "$3,257.00 " "$11,675.59 " N/A "$1,886.00 " N/A $982.00 "$39,182.40 " "$12,972.88 " "$48,354.28 " "$40,018.00 " N/A N/A N/A "$80,560.67 " "$4,147.00 " "$3,727.00 " N/A "$12,147.33 " "$14,623.97 " N/A "$6,195.00 " N/A "$1,113.00 " "$1,108.00 " "$1,176.00 " $840.00 "$11,793.53 " "$11,793.53 " "$12,854.94 " N/A N/A N/A N/A N/A N/A N/A "$45,497.96 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$2,419.00 " "$12,972.88 " "$11,793.53 " "$23,905.86 " N/A N/A N/A N/A "$11,793.53 " $840.00 "$80,560.67 " 330104 886 BEHAVIORAL AND DEVELOPMENTAL DISORDERS I N/A N/A "$12,405.88 " N/A "$20,723.43 " "$3,577.00 " "$3,257.00 " "$12,281.82 " N/A "$1,886.00 " N/A $982.00 "$41,284.43 " "$13,646.46 " "$50,948.35 " "$42,164.85 " N/A N/A N/A "$84,882.52 " "$4,147.00 " "$3,727.00 " N/A "$12,778.05 " "$15,383.29 " N/A "$6,195.00 " N/A "$1,113.00 " "$1,108.00 " "$1,176.00 " $840.00 "$12,405.88 " "$12,405.88 " "$13,522.41 " N/A N/A N/A N/A N/A N/A N/A "$47,938.80 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$2,419.00 " "$13,646.46 " "$12,405.88 " "$25,188.35 " N/A N/A N/A N/A "$12,405.88 " $840.00 "$84,882.52 " 330104 887 OTHER MENTAL DISORDER DIAGNOSES I N/A N/A "$11,802.34 " N/A "$19,683.46 " "$3,577.00 " "$3,257.00 " "$11,684.31 " N/A "$1,886.00 " N/A $982.00 "$39,212.64 " "$12,982.57 " "$48,391.60 " "$40,048.89 " N/A N/A N/A "$80,622.85 " "$4,147.00 " "$3,727.00 " N/A "$12,156.41 " "$14,634.90 " N/A "$6,195.00 " N/A "$1,113.00 " "$1,108.00 " "$1,176.00 " $840.00 "$11,802.34 " "$11,802.34 " "$12,864.55 " N/A N/A N/A N/A N/A N/A N/A "$45,533.08 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$2,419.00 " "$12,982.57 " "$11,802.34 " "$23,924.31 " N/A N/A N/A N/A "$11,802.34 " $840.00 "$80,622.85 " 330104 894 "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA" I N/A N/A "$5,417.14 " N/A "$8,681.07 " "$3,577.00 " "$3,257.00 " "$5,362.97 " N/A "$1,754.00 " N/A $923.00 "$17,294.09 " "$5,958.86 " "$21,342.32 " "$17,662.90 " N/A N/A N/A "$35,557.38 " "$24,660.59 " "$33,443.44 " N/A "$5,579.66 " "$6,717.26 " N/A "$6,195.00 " N/A N/A N/A "$7,584.00 " N/A "$5,417.14 " "$5,417.14 " "$5,904.68 " N/A N/A N/A N/A N/A N/A N/A "$20,081.62 " "$16,234.55 " "$16,234.55 " "$16,234.55 " "$16,234.55 " "$2,419.00 " "$5,958.86 " "$5,417.14 " "$10,551.43 " N/A N/A N/A N/A "$5,417.14 " $923.00 "$35,557.38 " 330104 895 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY" I N/A N/A "$14,112.53 " N/A "$23,664.18 " "$3,577.00 " "$3,257.00 " "$13,971.41 " N/A "$1,754.00 " N/A $923.00 "$47,142.88 " "$15,523.78 " "$58,178.17 " "$48,148.24 " N/A N/A N/A "$96,927.76 " "$67,223.61 " "$91,165.25 " N/A "$14,535.91 " "$17,499.54 " N/A "$6,195.00 " N/A N/A N/A "$19,757.54 " N/A "$14,112.53 " "$14,112.53 " "$15,382.66 " N/A N/A N/A N/A N/A N/A N/A "$54,741.54 " "$44,254.61 " "$44,254.61 " "$44,254.61 " "$44,254.61 " "$2,419.00 " "$15,523.78 " "$14,112.53 " "$28,762.69 " N/A N/A N/A N/A "$14,112.53 " $923.00 "$96,927.76 " 330104 896 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC" I N/A N/A "$15,847.38 " N/A "$26,653.52 " "$3,577.00 " "$3,257.00 " "$15,688.91 " N/A "$1,754.00 " N/A $923.00 "$53,098.12 " "$17,432.12 " "$65,527.42 " "$54,230.48 " N/A N/A N/A "$109,171.99 " "$75,715.52 " "$102,681.53 " N/A "$16,322.80 " "$19,650.75 " N/A "$6,195.00 " N/A N/A N/A "$22,186.33 " N/A "$15,847.38 " "$15,847.38 " "$17,273.64 " N/A N/A N/A N/A N/A N/A N/A "$61,656.67 " "$49,845.00 " "$49,845.00 " "$49,845.00 " "$49,845.00 " "$2,419.00 " "$17,432.12 " "$15,847.38 " "$32,396.09 " N/A N/A N/A N/A "$15,847.38 " $923.00 "$109,171.99 " 330104 897 "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC" I N/A N/A "$7,879.76 " N/A "$12,924.44 " "$3,577.00 " "$3,257.00 " "$7,800.97 " N/A "$1,754.00 " N/A $923.00 "$25,747.57 " "$8,667.74 " "$31,774.60 " "$26,296.66 " N/A N/A N/A "$52,938.09 " "$36,714.87 " "$49,790.83 " N/A "$8,116.16 " "$9,770.91 " N/A "$6,195.00 " N/A N/A N/A "$11,031.67 " N/A "$7,879.76 " "$7,879.76 " "$8,588.94 " N/A N/A N/A N/A N/A N/A N/A "$29,897.66 " "$24,170.11 " "$24,170.11 " "$24,170.11 " "$24,170.11 " "$2,419.00 " "$8,667.74 " "$7,879.76 " "$15,709.04 " N/A N/A N/A N/A "$7,879.76 " $923.00 "$52,938.09 " 330104 901 WOUND DEBRIDEMENTS FOR INJURIES WITH MCC I N/A N/A "$39,134.35 " N/A "$66,779.55 " "$70,272.03 " "$64,008.43 " "$38,743.01 " N/A "$74,355.27 " N/A "$39,134.35 " "$133,035.66 " "$43,047.79 " "$164,176.87 " "$135,872.75 " N/A N/A N/A "$273,526.94 " "$189,702.82 " "$257,265.32 " N/A "$40,308.38 " "$48,526.60 " N/A N/A N/A N/A N/A "$54,788.10 " N/A "$39,134.35 " "$39,134.35 " "$42,656.45 " N/A N/A N/A N/A N/A N/A N/A "$154,478.83 " "$124,885.05 " "$124,885.05 " "$124,885.05 " "$124,885.05 " "$75,260.05 " "$43,047.79 " "$39,134.35 " "$81,167.37 " N/A N/A N/A N/A "$39,134.35 " "$38,743.01 " "$273,526.94 " 330104 902 WOUND DEBRIDEMENTS FOR INJURIES WITH CC I N/A N/A "$17,840.39 " N/A "$30,087.69 " "$31,661.24 " "$28,839.15 " "$17,661.98 " N/A "$33,896.73 " N/A "$17,840.39 " "$59,939.54 " "$19,624.42 " "$73,970.29 " "$61,217.80 " N/A N/A N/A "$123,238.23 " "$85,471.07 " "$115,911.52 " N/A "$18,375.60 " "$22,122.08 " N/A N/A N/A N/A N/A "$24,976.54 " N/A "$17,840.39 " "$17,840.39 " "$19,446.02 " N/A N/A N/A N/A N/A N/A N/A "$69,600.82 " "$56,267.27 " "$56,267.27 " "$56,267.27 " "$56,267.27 " "$33,908.60 " "$19,624.42 " "$17,840.39 " "$36,570.16 " N/A N/A N/A N/A "$17,840.39 " "$17,661.98 " "$123,238.23 " 330104 903 WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC I N/A N/A "$11,089.54 " N/A "$18,455.24 " "$19,420.43 " "$17,689.41 " "$10,978.65 " N/A "$21,070.13 " N/A "$11,089.54 " "$36,765.82 " "$12,198.50 " "$45,372.03 " "$37,549.88 " N/A N/A N/A "$75,592.09 " "$52,426.40 " "$71,098.01 " N/A "$11,422.23 " "$13,751.03 " N/A N/A N/A N/A N/A "$15,525.36 " N/A "$11,089.54 " "$11,089.54 " "$12,087.60 " N/A N/A N/A N/A N/A N/A N/A "$42,691.87 " "$34,513.32 " "$34,513.32 " "$34,513.32 " "$34,513.32 " "$20,798.92 " "$12,198.50 " "$11,089.54 " "$22,431.47 " N/A N/A N/A N/A "$11,089.54 " "$10,978.65 " "$75,592.09 " 330104 904 SKIN GRAFTS FOR INJURIES WITH CC/MCC I N/A N/A "$31,674.24 " N/A "$53,924.95 " "$56,745.15 " "$51,687.25 " "$31,357.50 " N/A "$60,181.06 " N/A "$31,674.24 " "$107,427.22 " "$34,841.66 " "$132,573.96 " "$109,718.19 " N/A N/A N/A "$220,874.90 " "$153,186.34 " "$207,743.53 " N/A "$32,624.47 " "$39,276.06 " N/A N/A N/A N/A N/A "$44,343.94 " N/A "$31,674.24 " "$31,674.24 " "$34,524.92 " N/A N/A N/A N/A N/A N/A N/A "$124,742.73 " "$100,845.54 " "$100,845.54 " "$100,845.54 " "$100,845.54 " "$60,773.01 " "$34,841.66 " "$31,674.24 " "$65,543.21 " N/A N/A N/A N/A "$31,674.24 " "$31,357.50 " "$220,874.90 " 330104 905 SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC I N/A N/A "$14,123.10 " N/A "$23,682.40 " "$24,920.96 " "$22,699.66 " "$13,981.87 " N/A "$26,833.90 " N/A "$14,123.10 " "$47,179.18 " "$15,535.41 " "$58,222.96 " "$48,185.31 " N/A N/A N/A "$97,002.38 " "$67,275.37 " "$91,235.43 " N/A "$14,546.80 " "$17,512.65 " N/A N/A N/A N/A N/A "$19,772.35 " N/A "$14,123.10 " "$14,123.10 " "$15,394.18 " N/A N/A N/A N/A N/A N/A N/A "$54,783.69 " "$44,288.68 " "$44,288.68 " "$44,288.68 " "$44,288.68 " "$26,689.89 " "$15,535.41 " "$14,123.10 " "$28,784.83 " N/A N/A N/A N/A "$14,123.10 " "$13,981.87 " "$97,002.38 " 330104 906 HAND PROCEDURES FOR INJURIES I N/A N/A "$16,131.09 " N/A "$27,142.38 " "$28,561.89 " "$26,016.07 " "$15,969.78 " N/A "$30,649.07 " N/A "$16,131.09 " "$54,072.01 " "$17,744.20 " "$66,729.28 " "$55,225.14 " N/A N/A N/A "$111,174.34 " "$77,104.24 " "$104,564.85 " N/A "$16,615.02 " "$20,002.55 " N/A N/A N/A N/A N/A "$22,583.52 " N/A "$16,131.09 " "$16,131.09 " "$17,582.89 " N/A N/A N/A N/A N/A N/A N/A "$62,787.54 " "$50,759.22 " "$50,759.22 " "$50,759.22 " "$50,759.22 " "$30,589.26 " "$17,744.20 " "$16,131.09 " "$32,990.27 " N/A N/A N/A N/A "$16,131.09 " "$15,969.78 " "$111,174.34 " 330104 907 OTHER O.R. PROCEDURES FOR INJURIES WITH MCC I N/A N/A "$34,439.07 " N/A "$58,689.06 " "$61,758.42 " "$56,253.67 " "$34,094.68 " N/A "$65,434.24 " N/A "$34,439.07 " "$116,918.10 " "$37,882.98 " "$144,286.48 " "$119,411.47 " N/A N/A N/A "$240,388.55 " "$166,719.91 " "$226,097.06 " N/A "$35,472.24 " "$42,704.45 " N/A N/A N/A N/A N/A "$48,214.70 " N/A "$34,439.07 " "$34,439.07 " "$37,538.59 " N/A N/A N/A N/A N/A N/A N/A "$135,763.38 " "$109,754.95 " "$109,754.95 " "$109,754.95 " "$109,754.95 " "$66,142.13 " "$37,882.98 " "$34,439.07 " "$71,333.76 " N/A N/A N/A N/A "$34,439.07 " "$34,094.68 " "$240,388.55 " 330104 908 OTHER O.R. PROCEDURES FOR INJURIES WITH CC I N/A N/A "$18,498.55 " N/A "$31,221.78 " "$32,854.64 " "$29,926.19 " "$18,313.57 " N/A "$35,147.25 " N/A "$18,498.55 " "$62,198.84 " "$20,348.41 " "$76,758.45 " "$63,525.29 " N/A N/A N/A "$127,883.45 " "$88,692.73 " "$120,280.57 " N/A "$19,053.51 " "$22,938.21 " N/A N/A N/A N/A N/A "$25,897.97 " N/A "$18,498.55 " "$18,498.55 " "$20,163.42 " N/A N/A N/A N/A N/A N/A N/A "$72,224.28 " "$58,388.15 " "$58,388.15 " "$58,388.15 " "$58,388.15 " "$35,186.72 " "$20,348.41 " "$18,498.55 " "$37,948.59 " N/A N/A N/A N/A "$18,498.55 " "$18,313.57 " "$127,883.45 " 330104 909 OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC I N/A N/A "$12,403.23 " N/A "$20,718.88 " "$21,802.45 " "$19,859.11 " "$12,279.20 " N/A "$23,566.14 " N/A "$12,403.23 " "$41,275.35 " "$13,643.56 " "$50,937.15 " "$42,155.58 " N/A N/A N/A "$84,863.87 " "$58,856.78 " "$79,818.57 " N/A "$12,775.33 " "$15,380.01 " N/A N/A N/A N/A N/A "$17,364.53 " N/A "$12,403.23 " "$12,403.23 " "$13,519.52 " N/A N/A N/A N/A N/A N/A N/A "$47,928.26 " "$38,746.56 " "$38,746.56 " "$38,746.56 " "$38,746.56 " "$23,350.02 " "$13,643.56 " "$12,403.23 " "$25,182.81 " N/A N/A N/A N/A "$12,403.23 " "$12,279.20 " "$84,863.87 " 330104 913 TRAUMATIC INJURY WITH MCC I N/A N/A "$13,719.57 " N/A "$22,987.07 " "$24,189.26 " "$22,033.18 " "$13,582.37 " N/A "$26,067.18 " N/A "$13,719.57 " "$45,793.95 " "$15,091.53 " "$56,513.48 " "$46,770.55 " N/A N/A N/A "$94,154.31 " "$65,300.10 " "$88,556.68 " N/A "$14,131.16 " "$17,012.27 " N/A N/A N/A N/A N/A "$19,207.40 " N/A "$13,719.57 " "$13,719.57 " "$14,954.33 " N/A N/A N/A N/A N/A N/A N/A "$53,175.19 " "$42,988.33 " "$42,988.33 " "$42,988.33 " "$42,988.33 " "$25,906.25 " "$15,091.53 " "$13,719.57 " "$27,939.69 " N/A N/A N/A N/A "$13,719.57 " "$13,582.37 " "$94,154.31 " 330104 914 TRAUMATIC INJURY WITHOUT MCC I N/A N/A "$8,212.81 " N/A "$13,498.32 " "$14,204.26 " "$12,938.18 " "$8,130.68 " N/A "$15,604.34 " N/A "$8,212.81 " "$26,890.83 " "$9,034.09 " "$33,185.48 " "$27,464.30 " N/A N/A N/A "$55,288.68 " "$38,345.10 " "$52,001.68 " N/A "$8,459.20 " "$10,183.89 " N/A N/A N/A N/A N/A "$11,497.94 " N/A "$8,212.81 " "$8,212.81 " "$8,951.97 " N/A N/A N/A N/A N/A N/A N/A "$31,225.19 " "$25,243.33 " "$25,243.33 " "$25,243.33 " "$25,243.33 " "$15,212.50 " "$9,034.09 " "$8,212.81 " "$16,406.56 " N/A N/A N/A N/A "$8,212.81 " "$8,130.68 " "$55,288.68 " 330104 915 ALLERGIC REACTIONS WITH MCC I N/A N/A "$16,415.68 " N/A "$27,632.76 " "$29,077.92 " "$26,486.10 " "$16,251.52 " N/A "$31,189.79 " N/A "$16,415.68 " "$55,048.92 " "$18,057.24 " "$67,934.87 " "$56,222.89 " N/A N/A N/A "$113,182.92 " "$78,497.27 " "$106,454.01 " N/A "$16,908.15 " "$20,355.44 " N/A N/A N/A N/A N/A "$22,981.95 " N/A "$16,415.68 " "$16,415.68 " "$17,893.09 " N/A N/A N/A N/A N/A N/A N/A "$63,921.91 " "$51,676.28 " "$51,676.28 " "$51,676.28 " "$51,676.28 " "$31,141.91 " "$18,057.24 " "$16,415.68 " "$33,586.31 " N/A N/A N/A N/A "$16,415.68 " "$16,251.52 " "$113,182.92 " 330104 916 ALLERGIC REACTIONS WITHOUT MCC I N/A N/A "$6,231.26 " N/A "$10,083.88 " "$10,611.26 " "$9,665.44 " "$6,168.95 " N/A "$11,839.40 " N/A "$6,231.26 " "$20,088.73 " "$6,854.39 " "$24,791.13 " "$20,517.14 " N/A N/A N/A "$41,303.28 " "$28,645.62 " "$38,847.73 " N/A "$6,418.20 " "$7,726.76 " N/A N/A N/A N/A N/A "$8,723.76 " N/A "$6,231.26 " "$6,231.26 " "$6,792.07 " N/A N/A N/A N/A N/A N/A N/A "$23,326.70 " "$18,857.97 " "$18,857.97 " "$18,857.97 " "$18,857.97 " "$11,364.46 " "$6,854.39 " "$6,231.26 " "$12,256.48 " N/A N/A N/A N/A "$6,231.26 " "$6,168.95 " "$41,303.28 " 330104 917 POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC I N/A N/A "$13,793.58 " N/A "$23,114.60 " "$24,323.46 " "$22,155.42 " "$13,655.64 " N/A "$26,207.80 " N/A "$13,793.58 " "$46,048.01 " "$15,172.94 " "$56,827.01 " "$47,030.03 " N/A N/A N/A "$94,676.66 " "$65,662.38 " "$89,047.98 " N/A "$14,207.39 " "$17,104.04 " N/A N/A N/A N/A N/A "$19,311.01 " N/A "$13,793.58 " "$13,793.58 " "$15,035.00 " N/A N/A N/A N/A N/A N/A N/A "$53,470.20 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$26,049.97 " "$15,172.94 " "$13,793.58 " "$28,094.69 " N/A N/A N/A N/A "$13,793.58 " "$3,408.00 " "$94,676.66 " 330104 918 POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC I N/A N/A "$7,583.72 " N/A "$12,414.32 " "$13,063.58 " "$11,899.17 " "$7,507.88 " N/A "$14,409.07 " N/A "$7,583.72 " "$24,731.34 " "$8,342.09 " "$30,520.49 " "$25,258.75 " N/A N/A N/A "$50,848.67 " "$35,265.77 " "$47,825.64 " N/A "$7,811.23 " "$9,403.81 " N/A N/A N/A N/A N/A "$10,617.21 " N/A "$7,583.72 " "$7,583.72 " "$8,266.26 " N/A N/A N/A N/A N/A N/A N/A "$28,717.62 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$3,408.00 " "$13,990.85 " "$8,342.09 " "$7,583.72 " "$15,089.02 " N/A N/A N/A N/A "$7,583.72 " "$3,408.00 " "$50,848.67 " 330104 919 COMPLICATIONS OF TREATMENT WITH MCC I N/A N/A "$16,182.19 " N/A "$27,230.44 " "$28,654.55 " "$26,100.47 " "$16,020.37 " N/A "$30,746.16 " N/A "$16,182.19 " "$54,247.43 " "$17,800.41 " "$66,945.76 " "$55,404.30 " N/A N/A N/A "$111,535.02 " "$77,354.38 " "$104,904.08 " N/A "$16,667.66 " "$20,065.92 " N/A N/A N/A N/A N/A "$22,655.07 " N/A "$16,182.19 " "$16,182.19 " "$17,638.59 " N/A N/A N/A N/A N/A N/A N/A "$62,991.23 " "$50,923.89 " "$50,923.89 " "$50,923.89 " "$50,923.89 " "$30,688.50 " "$17,800.41 " "$16,182.19 " "$33,097.30 " N/A N/A N/A N/A "$16,182.19 " "$16,020.37 " "$111,535.02 " 330104 920 COMPLICATIONS OF TREATMENT WITH CC I N/A N/A "$9,382.01 " N/A "$15,512.97 " "$16,324.28 " "$14,869.23 " "$9,288.19 " N/A "$17,825.81 " N/A "$9,382.01 " "$30,904.34 " "$10,320.21 " "$38,138.48 " "$31,563.40 " N/A N/A N/A "$63,540.63 " "$44,068.19 " "$59,763.04 " N/A "$9,663.47 " "$11,633.69 " N/A N/A N/A N/A N/A "$13,134.81 " N/A "$9,382.01 " "$9,382.01 " "$10,226.39 " N/A N/A N/A N/A N/A N/A N/A "$35,885.62 " "$29,010.95 " "$29,010.95 " "$29,010.95 " "$29,010.95 " "$17,483.00 " "$10,320.21 " "$9,382.01 " "$18,855.28 " N/A N/A N/A N/A "$9,382.01 " "$9,288.19 " "$63,540.63 " 330104 921 COMPLICATIONS OF TREATMENT WITHOUT CC/MCC I N/A N/A "$6,792.51 " N/A "$11,050.98 " "$11,628.93 " "$10,592.40 " "$6,724.58 " N/A "$12,905.77 " N/A "$6,792.51 " "$22,015.34 " "$7,471.76 " "$27,168.72 " "$22,484.83 " N/A N/A N/A "$45,264.46 " "$31,392.87 " "$42,573.42 " N/A "$6,996.28 " "$8,422.71 " N/A N/A N/A N/A N/A "$9,509.51 " N/A "$6,792.51 " "$6,792.51 " "$7,403.84 " N/A N/A N/A N/A N/A N/A N/A "$25,563.85 " "$20,666.54 " "$20,666.54 " "$20,666.54 " "$20,666.54 " "$12,454.37 " "$7,471.76 " "$6,792.51 " "$13,431.94 " N/A N/A N/A N/A "$6,792.51 " "$6,724.58 " "$45,264.46 " 330104 922 "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC" I N/A N/A "$14,086.98 " N/A "$23,620.16 " "$24,855.46 " "$22,640.00 " "$13,946.11 " N/A "$26,765.26 " N/A "$14,086.98 " "$47,055.17 " "$15,495.68 " "$58,069.92 " "$48,058.66 " N/A N/A N/A "$96,747.42 " "$67,098.54 " "$90,995.63 " N/A "$14,509.59 " "$17,467.86 " N/A N/A N/A N/A N/A "$19,721.77 " N/A "$14,086.98 " "$14,086.98 " "$15,354.81 " N/A N/A N/A N/A N/A N/A N/A "$54,639.70 " "$44,172.27 " "$44,172.27 " "$44,172.27 " "$44,172.27 " "$26,619.74 " "$15,495.68 " "$14,086.98 " "$28,709.18 " N/A N/A N/A N/A "$14,086.98 " "$13,946.11 " "$96,747.42 " 330104 923 "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC" I N/A N/A "$8,689.48 " N/A "$14,319.66 " "$15,068.56 " "$13,725.45 " "$8,602.58 " N/A "$16,510.01 " N/A "$8,689.48 " "$28,527.08 " "$9,558.42 " "$35,204.75 " "$29,135.45 " N/A N/A N/A "$58,652.89 " "$40,678.33 " "$55,165.88 " N/A "$8,950.16 " "$10,774.95 " N/A N/A N/A N/A N/A "$12,165.27 " N/A "$8,689.48 " "$8,689.48 " "$9,471.53 " N/A N/A N/A N/A N/A N/A N/A "$33,125.18 " "$26,779.33 " "$26,779.33 " "$26,779.33 " "$26,779.33 " "$16,138.15 " "$9,558.42 " "$8,689.48 " "$17,404.87 " N/A N/A N/A N/A "$8,689.48 " "$8,602.58 " "$58,652.89 " 330104 927 EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT I N/A N/A "$167,627.70 " N/A "$288,187.76 " "$303,259.63 " "$276,228.97 " "$165,951.42 " N/A "$318,492.63 " N/A "$167,627.70 " "$574,116.64 " "$184,390.47 " "$708,506.82 " "$586,360.16 " N/A N/A N/A "$1,180,408.11 " "$818,664.32 " "$1,110,230.91 " N/A "$172,656.53 " "$207,858.35 " N/A N/A N/A N/A N/A "$234,678.78 " N/A "$167,627.70 " "$167,627.70 " "$182,714.19 " N/A N/A N/A N/A N/A N/A N/A "$666,654.86 " "$538,942.62 " "$538,942.62 " "$538,942.62 " "$538,942.62 " "$324,785.44 " "$184,390.47 " "$167,627.70 " "$350,278.54 " N/A N/A N/A N/A "$167,627.70 " "$165,951.42 " "$1,180,408.11 " 330104 928 FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC I N/A N/A "$54,929.49 " N/A "$93,996.32 " "$98,912.21 " "$90,095.80 " "$54,380.20 " N/A "$104,366.04 " N/A "$54,929.49 " "$187,255.87 " "$60,422.44 " "$231,089.03 " "$191,249.26 " N/A N/A N/A "$385,005.99 " "$267,018.39 " "$362,116.75 " N/A "$56,577.38 " "$68,112.57 " N/A N/A N/A N/A N/A "$76,901.29 " N/A "$54,929.49 " "$54,929.49 " "$59,873.15 " N/A N/A N/A N/A N/A N/A N/A "$217,438.46 " "$175,783.39 " "$175,783.39 " "$175,783.39 " "$175,783.39 " "$105,933.14 " "$60,422.44 " "$54,929.49 " "$114,248.06 " N/A N/A N/A N/A "$54,929.49 " "$54,380.20 " "$385,005.99 " 330104 929 FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC I N/A N/A "$26,272.33 " N/A "$44,616.86 " "$46,950.27 " "$42,765.42 " "$26,009.61 " N/A "$49,917.43 " N/A "$26,272.33 " "$88,884.01 " "$28,899.56 " "$109,690.12 " "$90,779.53 " N/A N/A N/A "$182,749.28 " "$126,744.57 " "$171,884.53 " N/A "$27,060.50 " "$32,577.69 " N/A N/A N/A N/A N/A "$36,781.26 " N/A "$26,272.33 " "$26,272.33 " "$28,636.84 " N/A N/A N/A N/A N/A N/A N/A "$103,210.66 " "$83,438.41 " "$83,438.41 " "$83,438.41 " "$83,438.41 " "$50,282.87 " "$28,899.56 " "$26,272.33 " "$54,229.68 " N/A N/A N/A N/A "$26,272.33 " "$26,009.61 " "$182,749.28 " 330104 933 EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT I N/A N/A "$27,102.31 " N/A "$46,047.01 " "$48,455.21 " "$44,136.22 " "$26,831.29 " N/A "$51,494.39 " N/A "$27,102.31 " "$91,733.08 " "$29,812.54 " "$113,206.12 " "$93,689.37 " N/A N/A N/A "$188,607.10 " "$130,807.22 " "$177,394.10 " N/A "$27,915.38 " "$33,606.86 " N/A N/A N/A N/A N/A "$37,943.23 " N/A "$27,102.31 " "$27,102.31 " "$29,541.52 " N/A N/A N/A N/A N/A N/A N/A "$106,518.96 " "$86,112.94 " "$86,112.94 " "$86,112.94 " "$86,112.94 " "$51,894.63 " "$29,812.54 " "$27,102.31 " "$55,967.95 " N/A N/A N/A N/A "$27,102.31 " "$26,831.29 " "$188,607.10 " 330104 934 FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY I N/A N/A "$16,908.20 " N/A "$28,481.43 " "$29,970.98 " "$27,299.55 " "$16,739.12 " N/A "$32,125.58 " N/A "$16,908.20 " "$56,739.62 " "$18,599.02 " "$70,021.32 " "$57,949.64 " N/A N/A N/A "$116,659.06 " "$80,908.13 " "$109,723.49 " N/A "$17,415.45 " "$20,966.17 " N/A N/A N/A N/A N/A "$23,671.48 " N/A "$16,908.20 " "$16,908.20 " "$18,429.94 " N/A N/A N/A N/A N/A N/A N/A "$65,885.12 " "$53,263.39 " "$53,263.39 " "$53,263.39 " "$53,263.39 " "$32,098.36 " "$18,599.02 " "$16,908.20 " "$34,617.83 " N/A N/A N/A N/A "$16,908.20 " "$16,739.12 " "$116,659.06 " 330104 935 NON-EXTENSIVE BURNS I N/A N/A "$18,213.08 " N/A "$30,729.89 " "$32,337.02 " "$29,454.70 " "$18,030.95 " N/A "$34,604.86 " N/A "$18,213.08 " "$61,218.90 " "$20,034.39 " "$75,549.13 " "$62,524.45 " N/A N/A N/A "$125,868.66 " "$87,295.38 " "$118,385.56 " N/A "$18,759.48 " "$22,584.22 " N/A N/A N/A N/A N/A "$25,498.32 " N/A "$18,213.08 " "$18,213.08 " "$19,852.26 " N/A N/A N/A N/A N/A N/A N/A "$71,086.39 " "$57,468.25 " "$57,468.25 " "$57,468.25 " "$57,468.25 " "$34,632.35 " "$20,034.39 " "$18,213.08 " "$37,350.72 " N/A N/A N/A N/A "$18,213.08 " "$18,030.95 " "$125,868.66 " 330104 939 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC I N/A N/A "$27,667.08 " N/A "$47,020.17 " "$49,479.27 " "$45,069.00 " "$27,390.41 " N/A "$52,567.46 " N/A "$27,667.08 " "$93,671.79 " "$30,433.79 " "$115,598.64 " "$95,669.42 " N/A N/A N/A "$192,593.16 " "$133,571.73 " "$181,143.18 " N/A "$28,497.10 " "$34,307.18 " N/A N/A N/A N/A N/A "$38,733.92 " N/A "$27,667.08 " "$27,667.08 " "$30,157.12 " N/A N/A N/A N/A N/A N/A N/A "$108,770.15 " "$87,932.86 " "$87,932.86 " "$87,932.86 " "$87,932.86 " "$52,991.38 " "$30,433.79 " "$27,667.08 " "$57,150.79 " N/A N/A N/A N/A "$27,667.08 " "$27,390.41 " "$192,593.16 " 330104 940 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC I N/A N/A "$19,791.98 " N/A "$33,450.50 " "$35,199.92 " "$32,062.42 " "$19,594.06 " N/A "$37,604.76 " N/A "$19,791.98 " "$66,638.81 " "$21,771.18 " "$82,237.73 " "$68,059.94 " N/A N/A N/A "$137,012.21 " "$95,023.92 " "$128,866.61 " N/A "$20,385.74 " "$24,542.06 " N/A N/A N/A N/A N/A "$27,708.77 " N/A "$19,791.98 " "$19,791.98 " "$21,573.26 " N/A N/A N/A N/A N/A N/A N/A "$77,379.90 " "$62,556.09 " "$62,556.09 " "$62,556.09 " "$62,556.09 " "$37,698.46 " "$21,771.18 " "$19,791.98 " "$40,657.49 " N/A N/A N/A N/A "$19,791.98 " "$19,594.06 " "$137,012.21 " 330104 941 O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC I N/A N/A "$17,008.64 " N/A "$28,654.51 " "$30,153.10 " "$27,465.44 " "$16,838.56 " N/A "$32,316.43 " N/A "$17,008.64 " "$57,084.41 " "$18,709.51 " "$70,446.83 " "$58,301.79 " N/A N/A N/A "$117,367.97 " "$81,399.79 " "$110,390.25 " N/A "$17,518.90 " "$21,090.72 " N/A N/A N/A N/A N/A "$23,812.10 " N/A "$17,008.64 " "$17,008.64 " "$18,539.42 " N/A N/A N/A N/A N/A N/A N/A "$66,285.49 " "$53,587.06 " "$53,587.06 " "$53,587.06 " "$53,587.06 " "$32,293.41 " "$18,709.51 " "$17,008.64 " "$34,828.19 " N/A N/A N/A N/A "$17,008.64 " "$16,838.56 " "$117,367.97 " 330104 945 REHABILITATION WITH CC/MCC I N/A N/A "$13,641.15 " N/A "$22,851.95 " "$24,047.08 " "$21,903.67 " "$13,504.74 " N/A "$25,918.19 " N/A "$13,641.15 " "$45,524.77 " "$15,005.27 " "$56,181.29 " "$46,495.63 " N/A N/A N/A "$5,308.00 " "$5,005.00 " "$4,134.00 " N/A "$14,050.39 " "$16,915.03 " N/A "$3,666.00 " N/A N/A N/A "$19,097.61 " N/A "$13,641.15 " "$13,641.15 " "$14,868.86 " N/A N/A N/A N/A N/A N/A N/A "$52,862.62 " "$5,733.00 " "$5,733.00 " "$5,733.00 " "$5,733.00 " "$25,753.97 " "$15,005.27 " "$13,641.15 " "$27,775.46 " N/A N/A N/A N/A "$13,641.15 " "$3,666.00 " "$56,181.29 " 330104 946 REHABILITATION WITHOUT CC/MCC I N/A N/A "$10,270.14 " N/A "$17,043.31 " "$17,934.66 " "$16,336.08 " "$10,167.44 " N/A "$19,513.26 " N/A "$10,270.14 " "$33,953.04 " "$11,297.15 " "$41,900.82 " "$34,677.11 " N/A N/A N/A "$5,308.00 " "$5,005.00 " "$4,134.00 " N/A "$10,578.24 " "$12,734.97 " N/A "$3,666.00 " N/A N/A N/A "$14,378.19 " N/A "$10,270.14 " "$10,270.14 " "$11,194.45 " N/A N/A N/A N/A N/A N/A N/A "$39,425.71 " "$5,733.00 " "$5,733.00 " "$5,733.00 " "$5,733.00 " "$19,207.69 " "$11,297.15 " "$10,270.14 " "$20,715.34 " N/A N/A N/A N/A "$10,270.14 " "$3,666.00 " "$41,900.82 " 330104 947 SIGNS AND SYMPTOMS WITH MCC I N/A N/A "$11,089.54 " N/A "$18,455.24 " "$19,420.43 " "$17,689.41 " "$10,978.65 " N/A "$21,070.13 " N/A "$11,089.54 " "$36,765.82 " "$12,198.50 " "$45,372.03 " "$37,549.88 " N/A N/A N/A "$75,592.09 " "$52,426.40 " "$71,098.01 " N/A "$11,422.23 " "$13,751.03 " N/A N/A N/A N/A N/A "$15,525.36 " N/A "$11,089.54 " "$11,089.54 " "$12,087.60 " N/A N/A N/A N/A N/A N/A N/A "$42,691.87 " "$34,513.32 " "$34,513.32 " "$34,513.32 " "$34,513.32 " "$20,798.92 " "$12,198.50 " "$11,089.54 " "$22,431.47 " N/A N/A N/A N/A "$11,089.54 " "$10,978.65 " "$75,592.09 " 330104 948 SIGNS AND SYMPTOMS WITHOUT MCC I N/A N/A "$7,230.41 " N/A "$11,805.52 " "$12,422.94 " "$11,315.64 " "$7,158.10 " N/A "$13,737.77 " N/A "$7,230.41 " "$23,518.51 " "$7,953.45 " "$29,023.76 " "$24,020.06 " N/A N/A N/A "$48,355.06 " "$33,536.33 " "$45,480.27 " N/A "$7,447.32 " "$8,965.70 " N/A N/A N/A N/A N/A "$10,122.57 " N/A "$7,230.41 " "$7,230.41 " "$7,881.14 " N/A N/A N/A N/A N/A N/A N/A "$27,309.31 " "$22,077.62 " "$22,077.62 " "$22,077.62 " "$22,077.62 " "$13,304.74 " "$7,953.45 " "$7,230.41 " "$14,349.05 " N/A N/A N/A N/A "$7,230.41 " "$7,158.10 " "$48,355.06 " 330104 949 AFTERCARE WITH CC/MCC I N/A N/A "$10,881.61 " N/A "$18,096.94 " "$19,043.39 " "$17,345.98 " "$10,772.79 " N/A "$20,675.05 " N/A "$10,881.61 " "$36,052.04 " "$11,969.77 " "$44,491.16 " "$36,820.88 " N/A N/A N/A "$74,124.52 " "$51,408.58 " "$69,717.70 " N/A "$11,208.06 " "$13,493.19 " N/A N/A N/A N/A N/A "$15,234.25 " N/A "$10,881.61 " "$10,881.61 " "$11,860.95 " N/A N/A N/A N/A N/A N/A N/A "$41,863.04 " "$33,843.26 " "$33,843.26 " "$33,843.26 " "$33,843.26 " "$20,395.12 " "$11,969.77 " "$10,881.61 " "$21,995.98 " N/A N/A N/A N/A "$10,881.61 " "$10,772.79 " "$74,124.52 " 330104 950 AFTERCARE WITHOUT CC/MCC I N/A N/A "$6,630.39 " N/A "$10,771.63 " "$11,334.97 " "$10,324.64 " "$6,564.09 " N/A "$12,597.74 " N/A "$6,630.39 " "$21,458.83 " "$7,293.43 " "$26,481.95 " "$21,916.46 " N/A N/A N/A "$44,120.26 " "$30,599.32 " "$41,497.24 " N/A "$6,829.30 " "$8,221.68 " N/A N/A N/A N/A N/A "$9,282.55 " N/A "$6,630.39 " "$6,630.39 " "$7,227.13 " N/A N/A N/A N/A N/A N/A N/A "$24,917.64 " "$20,144.12 " "$20,144.12 " "$20,144.12 " "$20,144.12 " "$12,139.55 " "$7,293.43 " "$6,630.39 " "$13,092.40 " N/A N/A N/A N/A "$6,630.39 " "$6,564.09 " "$44,120.26 " 330104 951 OTHER FACTORS INFLUENCING HEALTH STATUS I N/A N/A "$5,394.23 " N/A "$8,641.59 " "$9,093.54 " "$8,283.00 " "$5,340.29 " N/A "$10,249.04 " N/A "$5,394.23 " "$17,215.45 " "$5,933.66 " "$21,245.28 " "$17,582.59 " N/A N/A N/A "$35,395.70 " "$24,548.46 " "$33,291.37 " N/A "$5,556.06 " "$6,688.85 " N/A N/A N/A N/A N/A "$7,551.93 " N/A "$5,394.23 " "$5,394.23 " "$5,879.71 " N/A N/A N/A N/A N/A N/A N/A "$19,990.30 " "$16,160.73 " "$16,160.73 " "$16,160.73 " "$16,160.73 " "$9,739.01 " "$5,933.66 " "$5,394.23 " "$10,503.45 " N/A N/A N/A N/A "$5,394.23 " "$5,340.29 " "$35,395.70 " 330104 955 CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA I N/A N/A "$59,728.74 " N/A "$102,265.95 " "$107,614.34 " "$98,022.27 " "$59,131.46 " N/A "$113,484.61 " N/A "$59,728.74 " "$203,730.32 " "$65,701.62 " "$251,419.85 " "$208,075.04 " N/A N/A N/A "$418,878.16 " "$290,510.21 " "$393,975.17 " N/A "$61,520.61 " "$74,063.64 " N/A N/A N/A N/A N/A "$83,620.24 " N/A "$59,728.74 " "$59,728.74 " "$65,104.33 " N/A N/A N/A N/A N/A N/A N/A "$236,568.32 " "$191,248.51 " "$191,248.51 " "$191,248.51 " "$191,248.51 " "$115,252.96 " "$65,701.62 " "$59,728.74 " "$124,299.41 " N/A N/A N/A N/A "$59,728.74 " "$59,131.46 " "$418,878.16 " 330104 956 "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA" I N/A N/A "$33,897.21 " N/A "$57,755.36 " "$60,775.90 " "$55,358.72 " "$33,558.24 " N/A "$64,404.69 " N/A "$33,897.21 " "$115,058.03 " "$37,286.93 " "$141,991.00 " "$117,511.74 " N/A N/A N/A "$236,564.18 " "$164,067.54 " "$222,500.05 " N/A "$34,914.12 " "$42,032.54 " N/A N/A N/A N/A N/A "$47,456.09 " N/A "$33,897.21 " "$33,897.21 " "$36,947.96 " N/A N/A N/A N/A N/A N/A N/A "$133,603.50 " "$108,008.85 " "$108,008.85 " "$108,008.85 " "$108,008.85 " "$65,089.86 " "$37,286.93 " "$33,897.21 " "$70,198.90 " N/A N/A N/A N/A "$33,897.21 " "$33,558.24 " "$236,564.18 " 330104 957 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC I N/A N/A "$65,671.64 " N/A "$112,506.21 " "$118,390.15 " "$107,837.60 " "$65,014.92 " N/A "$124,776.11 " N/A "$65,671.64 " "$224,130.57 " "$72,238.80 " "$276,595.43 " "$228,910.35 " N/A N/A N/A "$460,821.94 " "$319,600.04 " "$433,425.32 " N/A "$67,641.78 " "$81,432.83 " N/A N/A N/A N/A N/A "$91,940.29 " N/A "$65,671.64 " "$65,671.64 " "$71,582.08 " N/A N/A N/A N/A N/A N/A N/A "$260,256.76 " "$210,398.92 " "$210,398.92 " "$210,398.92 " "$210,398.92 " "$126,793.65 " "$72,238.80 " "$65,671.64 " "$136,745.96 " N/A N/A N/A N/A "$65,671.64 " "$65,014.92 " "$460,821.94 " 330104 958 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC I N/A N/A "$37,124.61 " N/A "$63,316.53 " "$66,627.91 " "$60,689.12 " "$36,753.36 " N/A "$70,536.75 " N/A "$37,124.61 " "$126,136.77 " "$40,837.07 " "$155,663.08 " "$128,826.74 " N/A N/A N/A "$259,342.54 " "$179,865.32 " "$243,924.20 " N/A "$38,238.35 " "$46,034.51 " N/A N/A N/A N/A N/A "$51,974.45 " N/A "$37,124.61 " "$37,124.61 " "$40,465.82 " N/A N/A N/A N/A N/A N/A N/A "$146,467.96 " "$118,408.84 " "$118,408.84 " "$118,408.84 " "$118,408.84 " "$71,357.25 " "$40,837.07 " "$37,124.61 " "$76,958.24 " N/A N/A N/A N/A "$37,124.61 " "$36,753.36 " "$259,342.54 " 330104 959 OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC I N/A N/A "$23,011.45 " N/A "$38,998.00 " "$41,037.55 " "$37,379.72 " "$22,781.34 " N/A "$43,721.76 " N/A "$23,011.45 " "$77,690.33 " "$25,312.60 " "$95,876.21 " "$79,347.14 " N/A N/A N/A "$159,734.61 " "$110,782.89 " "$150,238.13 " N/A "$23,701.79 " "$28,534.20 " N/A N/A N/A N/A N/A "$32,216.03 " N/A "$23,011.45 " "$23,011.45 " "$25,082.48 " N/A N/A N/A N/A N/A N/A N/A "$90,212.74 " "$72,930.53 " "$72,930.53 " "$72,930.53 " "$72,930.53 " "$43,950.46 " "$25,312.60 " "$23,011.45 " "$47,400.22 " N/A N/A N/A N/A "$23,011.45 " "$22,781.34 " "$159,734.61 " 330104 963 OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC I N/A N/A "$24,813.26 " N/A "$42,102.72 " "$44,304.64 " "$40,355.61 " "$24,565.13 " N/A "$47,145.20 " N/A "$24,813.26 " "$83,875.43 " "$27,294.59 " "$103,509.14 " "$85,664.15 " N/A N/A N/A "$172,451.44 " "$119,602.57 " "$162,198.92 " N/A "$25,557.66 " "$30,768.44 " N/A N/A N/A N/A N/A "$34,738.57 " N/A "$24,813.26 " "$24,813.26 " "$27,046.45 " N/A N/A N/A N/A N/A N/A N/A "$97,394.78 " "$78,736.69 " "$78,736.69 " "$78,736.69 " "$78,736.69 " "$47,449.45 " "$27,294.59 " "$24,813.26 " "$51,173.86 " N/A N/A N/A N/A "$24,813.26 " "$24,565.13 " "$172,451.44 " 330104 964 OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC I N/A N/A "$13,282.55 " N/A "$22,234.04 " "$23,396.85 " "$21,311.40 " "$13,149.73 " N/A "$25,236.85 " N/A "$13,282.55 " "$44,293.80 " "$14,610.81 " "$54,662.17 " "$45,238.40 " N/A N/A N/A "$91,069.93 " "$63,160.96 " "$85,655.68 " N/A "$13,681.03 " "$16,470.37 " N/A N/A N/A N/A N/A "$18,595.57 " N/A "$13,282.55 " "$13,282.55 " "$14,477.98 " N/A N/A N/A N/A N/A N/A N/A "$51,433.24 " "$41,580.08 " "$41,580.08 " "$41,580.08 " "$41,580.08 " "$25,057.59 " "$14,610.81 " "$13,282.55 " "$27,024.42 " N/A N/A N/A N/A "$13,282.55 " "$13,149.73 " "$91,069.93 " 330104 965 OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC I N/A N/A "$8,396.08 " N/A "$13,814.10 " "$14,536.56 " "$13,240.86 " "$8,312.12 " N/A "$15,952.55 " N/A "$8,396.08 " "$27,519.93 " "$9,235.68 " "$33,961.84 " "$28,106.81 " N/A N/A N/A "$56,582.13 " "$39,242.17 " "$53,218.23 " N/A "$8,647.96 " "$10,411.14 " N/A N/A N/A N/A N/A "$11,754.51 " N/A "$8,396.08 " "$8,396.08 " "$9,151.72 " N/A N/A N/A N/A N/A N/A N/A "$31,955.69 " "$25,833.88 " "$25,833.88 " "$25,833.88 " "$25,833.88 " "$15,568.39 " "$9,235.68 " "$8,396.08 " "$16,790.38 " N/A N/A N/A N/A "$8,396.08 " "$8,312.12 " "$56,582.13 " 330104 969 HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC I N/A N/A "$64,236.35 " N/A "$110,033.06 " "$115,787.66 " "$105,467.08 " "$63,593.99 " N/A "$122,049.07 " N/A "$64,236.35 " "$219,203.66 " "$70,659.99 " "$270,515.22 " "$223,878.36 " N/A N/A N/A "$450,692.01 " "$312,574.49 " "$423,897.63 " N/A "$66,163.44 " "$79,653.08 " N/A N/A N/A N/A N/A "$89,930.90 " N/A "$64,236.35 " "$64,236.35 " "$70,017.63 " N/A N/A N/A N/A N/A N/A N/A "$254,535.71 " "$205,773.86 " "$205,773.86 " "$205,773.86 " "$205,773.86 " "$124,006.44 " "$70,659.99 " "$64,236.35 " "$133,739.96 " N/A N/A N/A N/A "$64,236.35 " "$63,593.99 " "$450,692.01 " 330104 970 HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC I N/A N/A "$27,590.43 " N/A "$46,888.09 " "$49,340.28 " "$44,942.40 " "$27,314.52 " N/A "$52,421.81 " N/A "$27,590.43 " "$93,408.66 " "$30,349.47 " "$115,273.91 " "$95,400.68 " N/A N/A N/A "$192,052.15 " "$133,196.52 " "$180,634.34 " N/A "$28,418.14 " "$34,212.13 " N/A N/A N/A N/A N/A "$38,626.60 " N/A "$27,590.43 " "$27,590.43 " "$30,073.57 " N/A N/A N/A N/A N/A N/A N/A "$108,464.61 " "$87,685.85 " "$87,685.85 " "$87,685.85 " "$87,685.85 " "$52,842.52 " "$30,349.47 " "$27,590.43 " "$56,990.25 " N/A N/A N/A N/A "$27,590.43 " "$27,314.52 " "$192,052.15 " 330104 974 HIV WITH MAJOR RELATED CONDITION WITH MCC I N/A N/A "$25,692.58 " N/A "$43,617.89 " "$45,899.05 " "$41,807.90 " "$25,435.65 " N/A "$48,815.90 " N/A "$25,692.58 " "$86,893.89 " "$28,261.84 " "$107,234.15 " "$88,746.97 " N/A N/A N/A "$178,657.51 " "$123,906.74 " "$168,036.02 " N/A "$26,463.36 " "$31,858.80 " N/A N/A N/A N/A N/A "$35,969.61 " N/A "$25,692.58 " "$25,692.58 " "$28,004.91 " N/A N/A N/A N/A N/A N/A N/A "$100,899.76 " "$81,570.22 " "$81,570.22 " "$81,570.22 " "$81,570.22 " "$49,157.03 " "$28,261.84 " "$25,692.58 " "$53,015.47 " N/A N/A N/A N/A "$25,692.58 " "$25,435.65 " "$178,657.51 " 330104 975 HIV WITH MAJOR RELATED CONDITION WITH CC I N/A N/A "$12,500.15 " N/A "$20,885.88 " "$21,978.18 " "$20,019.19 " "$12,375.15 " N/A "$23,750.29 " N/A "$12,500.15 " "$41,608.05 " "$13,750.17 " "$51,347.73 " "$42,495.37 " N/A N/A N/A "$85,547.90 " "$59,331.19 " "$80,461.94 " N/A "$12,875.16 " "$15,500.19 " N/A N/A N/A N/A N/A "$17,500.21 " N/A "$12,500.15 " "$12,500.15 " "$13,625.17 " N/A N/A N/A N/A N/A N/A N/A "$48,314.58 " "$39,058.87 " "$39,058.87 " "$39,058.87 " "$39,058.87 " "$23,538.23 " "$13,750.17 " "$12,500.15 " "$25,385.79 " N/A N/A N/A N/A "$12,500.15 " "$12,375.15 " "$85,547.90 " 330104 976 HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC I N/A N/A "$8,509.74 " N/A "$14,009.95 " "$14,742.65 " "$13,428.59 " "$8,424.64 " N/A "$16,168.50 " N/A "$8,509.74 " "$27,910.09 " "$9,360.71 " "$34,443.33 " "$28,505.29 " N/A N/A N/A "$57,384.32 " "$39,798.52 " "$53,972.73 " N/A "$8,765.03 " "$10,552.07 " N/A N/A N/A N/A N/A "$11,913.63 " N/A "$8,509.74 " "$8,509.74 " "$9,275.61 " N/A N/A N/A N/A N/A N/A N/A "$32,408.74 " "$26,200.14 " "$26,200.14 " "$26,200.14 " "$26,200.14 " "$15,789.11 " "$9,360.71 " "$8,509.74 " "$17,028.43 " N/A N/A N/A N/A "$8,509.74 " "$8,424.64 " "$57,384.32 " 330104 977 HIV WITH OR WITHOUT OTHER RELATED CONDITION I N/A N/A "$11,832.29 " N/A "$19,735.08 " "$20,767.20 " "$18,916.14 " "$11,713.97 " N/A "$22,481.36 " N/A "$11,832.29 " "$39,315.48 " "$13,015.52 " "$48,518.51 " "$40,153.91 " N/A N/A N/A "$80,834.28 " "$56,062.09 " "$76,028.55 " N/A "$12,187.26 " "$14,672.04 " N/A N/A N/A N/A N/A "$16,565.21 " N/A "$11,832.29 " "$11,832.29 " "$12,897.20 " N/A N/A N/A N/A N/A N/A N/A "$45,652.49 " "$36,906.76 " "$36,906.76 " "$36,906.76 " "$36,906.76 " "$22,241.29 " "$13,015.52 " "$11,832.29 " "$23,987.05 " N/A N/A N/A N/A "$11,832.29 " "$11,713.97 " "$80,834.28 " 330104 981 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC I N/A N/A "$40,736.16 " N/A "$69,539.63 " "$73,176.47 " "$66,653.98 " "$40,328.80 " N/A "$77,398.70 " N/A "$40,736.16 " "$138,534.20 " "$44,809.77 " "$170,962.51 " "$141,488.56 " N/A N/A N/A "$284,832.17 " "$197,543.49 " "$267,898.44 " N/A "$41,958.24 " "$50,512.84 " N/A N/A N/A N/A N/A "$57,030.62 " N/A "$40,736.16 " "$40,736.16 " "$44,402.41 " N/A N/A N/A N/A N/A N/A N/A "$160,863.65 " "$130,046.72 " "$130,046.72 " "$130,046.72 " "$130,046.72 " "$78,370.64 " "$44,809.77 " "$40,736.16 " "$84,522.12 " N/A N/A N/A N/A "$40,736.16 " "$40,328.80 " "$284,832.17 " 330104 982 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC I N/A N/A "$22,478.40 " N/A "$38,079.49 " "$40,071.00 " "$36,499.33 " "$22,253.61 " N/A "$42,708.95 " N/A "$22,478.40 " "$75,860.51 " "$24,726.24 " "$93,618.06 " "$77,478.30 " N/A N/A N/A "$155,972.42 " "$108,173.65 " "$146,699.60 " N/A "$23,152.75 " "$27,873.21 " N/A N/A N/A N/A N/A "$31,469.75 " N/A "$22,478.40 " "$22,478.40 " "$24,501.45 " N/A N/A N/A N/A N/A N/A N/A "$88,087.98 " "$71,212.81 " "$71,212.81 " "$71,212.81 " "$71,212.81 " "$42,915.30 " "$24,726.24 " "$22,478.40 " "$46,283.81 " N/A N/A N/A N/A "$22,478.40 " "$22,253.61 " "$155,972.42 " 330104 983 EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC I N/A N/A "$15,094.94 " N/A "$25,356.98 " "$26,683.12 " "$24,304.75 " "$14,943.99 " N/A "$28,680.38 " N/A "$15,094.94 " "$50,515.20 " "$16,604.43 " "$62,339.88 " "$51,592.48 " N/A N/A N/A "$103,861.39 " "$72,032.39 " "$97,686.66 " N/A "$15,547.78 " "$18,717.72 " N/A N/A N/A N/A N/A "$21,132.91 " N/A "$15,094.94 " "$15,094.94 " "$16,453.48 " N/A N/A N/A N/A N/A N/A N/A "$58,657.42 " "$47,420.32 " "$47,420.32 " "$47,420.32 " "$47,420.32 " "$28,577.12 " "$16,604.43 " "$15,094.94 " "$30,820.20 " N/A N/A N/A N/A "$15,094.94 " "$14,943.99 " "$103,861.39 " 330104 987 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC I N/A N/A "$29,616.92 " N/A "$50,379.95 " "$53,014.76 " "$48,289.36 " "$29,320.75 " N/A "$56,272.14 " N/A "$29,616.92 " "$100,365.01 " "$32,578.61 " "$123,858.62 " "$102,505.38 " N/A N/A N/A "$206,354.70 " "$143,115.96 " "$194,086.58 " N/A "$30,505.42 " "$36,724.98 " N/A N/A N/A N/A N/A "$41,463.68 " N/A "$29,616.92 " "$29,616.92 " "$32,282.44 " N/A N/A N/A N/A N/A N/A N/A "$116,542.21 " "$94,216.01 " "$94,216.01 " "$94,216.01 " "$94,216.01 " "$56,777.82 " "$32,578.61 " "$29,616.92 " "$61,234.44 " N/A N/A N/A N/A "$29,616.92 " "$29,320.75 " "$206,354.70 " 330104 988 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC I N/A N/A "$15,325.78 " N/A "$25,754.74 " "$27,101.69 " "$24,686.01 " "$15,172.52 " N/A "$29,118.98 " N/A "$15,325.78 " "$51,307.62 " "$16,858.36 " "$63,317.79 " "$52,401.80 " N/A N/A N/A "$105,490.63 " "$73,162.34 " "$99,219.04 " N/A "$15,785.55 " "$19,003.97 " N/A N/A N/A N/A N/A "$21,456.09 " N/A "$15,325.78 " "$15,325.78 " "$16,705.10 " N/A N/A N/A N/A N/A N/A N/A "$59,577.57 " "$48,164.19 " "$48,164.19 " "$48,164.19 " "$48,164.19 " "$29,025.40 " "$16,858.36 " "$15,325.78 " "$31,303.67 " N/A N/A N/A N/A "$15,325.78 " "$15,172.52 " "$105,490.63 " 330104 989 NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC I N/A N/A "$10,092.16 " N/A "$16,736.64 " "$17,611.94 " "$16,042.12 " "$9,991.24 " N/A "$19,175.10 " N/A "$10,092.16 " "$33,342.09 " "$11,101.37 " "$41,146.86 " "$34,053.14 " N/A N/A N/A "$68,552.74 " "$47,544.31 " "$64,477.17 " N/A "$10,394.92 " "$12,514.28 " N/A N/A N/A N/A N/A "$14,129.02 " N/A "$10,092.16 " "$10,092.16 " "$11,000.45 " N/A N/A N/A N/A N/A N/A N/A "$38,716.29 " "$31,299.34 " "$31,299.34 " "$31,299.34 " "$31,299.34 " "$18,862.06 " "$11,101.37 " "$10,092.16 " "$20,342.59 " N/A N/A N/A N/A "$10,092.16 " "$9,991.24 " "$68,552.74 " 330104 1 1 Liver transplant &/or intestinal transplant I N/A "$42,290.64 " N/A "$42,290.64 " N/A N/A N/A N/A "$40,176.11 " N/A "$40,599.01 " N/A N/A N/A N/A N/A "$54,132.02 " "$42,290.64 " N/A N/A N/A N/A "$43,559.36 " N/A N/A "$59,206.89 " "$164,806.64 " "$42,290.64 " "$57,092.36 " "$52,017.49 " N/A "$43,559.36 " N/A N/A N/A N/A N/A "$42,290.64 " "$144,732.77 " "$86,695.81 " "$42,290.64 " "$42,290.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,290.64 " "$42,290.64 " "$48,634.23 " "$42,290.64 " N/A "$40,176.11 " "$164,806.64 " 330104 1 2 Liver transplant &/or intestinal transplant I N/A "$42,290.64 " N/A "$42,290.64 " N/A N/A N/A N/A "$40,176.11 " N/A "$40,599.01 " N/A N/A N/A N/A N/A "$54,132.02 " "$42,290.64 " N/A N/A N/A N/A "$43,559.36 " N/A N/A "$59,206.89 " "$164,806.64 " "$42,290.64 " "$57,092.36 " "$52,017.49 " N/A "$43,559.36 " N/A N/A N/A N/A N/A "$42,290.64 " "$144,732.77 " "$86,695.81 " "$42,290.64 " "$42,290.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,290.64 " "$42,290.64 " "$48,634.23 " "$42,290.64 " N/A "$40,176.11 " "$164,806.64 " 330104 1 3 Liver transplant &/or intestinal transplant I N/A "$57,298.29 " N/A "$57,298.29 " N/A N/A N/A N/A "$54,433.37 " N/A "$55,006.35 " N/A N/A N/A N/A N/A "$73,341.81 " "$57,298.29 " N/A N/A N/A N/A "$59,017.23 " N/A N/A "$80,217.60 " "$223,720.21 " "$57,298.29 " "$77,352.69 " "$70,476.89 " N/A "$59,017.23 " N/A N/A N/A N/A N/A "$57,298.29 " "$196,470.52 " "$117,461.49 " "$57,298.29 " "$57,298.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$57,298.29 " "$57,298.29 " "$65,893.03 " "$57,298.29 " N/A "$54,433.37 " "$223,720.21 " 330104 1 4 Liver transplant &/or intestinal transplant I N/A "$119,550.19 " N/A "$119,550.19 " N/A N/A N/A N/A "$113,572.68 " N/A "$114,768.18 " N/A N/A N/A N/A N/A "$153,024.24 " "$119,550.19 " N/A N/A N/A N/A "$123,136.69 " N/A N/A "$167,370.26 " "$468,094.40 " "$119,550.19 " "$161,392.75 " "$147,046.73 " N/A "$123,136.69 " N/A N/A N/A N/A N/A "$119,550.19 " "$411,079.31 " "$245,077.89 " "$119,550.19 " "$119,550.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$119,550.19 " "$119,550.19 " "$137,482.72 " "$119,550.19 " N/A "$113,572.68 " "$468,094.40 " 330104 2 1 Heart &/or lung transplant I N/A "$82,730.64 " N/A "$82,730.64 " N/A N/A N/A N/A "$78,594.10 " N/A "$79,421.41 " N/A N/A N/A N/A N/A "$105,895.21 " "$82,730.64 " N/A N/A N/A N/A "$85,212.56 " N/A N/A "$115,822.89 " "$323,556.67 " "$82,730.64 " "$111,686.36 " "$101,758.68 " N/A "$85,212.56 " N/A N/A N/A N/A N/A "$82,730.64 " "$284,146.65 " "$169,597.80 " "$82,730.64 " "$82,730.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$82,730.64 " "$82,730.64 " "$95,140.23 " "$82,730.64 " N/A "$78,594.10 " "$323,556.67 " 330104 2 2 Heart &/or lung transplant I N/A "$87,810.16 " N/A "$87,810.16 " N/A N/A N/A N/A "$83,419.65 " N/A "$84,297.75 " N/A N/A N/A N/A N/A "$112,397.00 " "$87,810.16 " N/A N/A N/A N/A "$90,444.46 " N/A N/A "$122,934.22 " "$343,496.69 " "$87,810.16 " "$118,543.71 " "$108,006.49 " N/A "$90,444.46 " N/A N/A N/A N/A N/A "$87,810.16 " "$301,657.92 " "$180,010.82 " "$87,810.16 " "$87,810.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$87,810.16 " "$87,810.16 " "$100,981.68 " "$87,810.16 " N/A "$83,419.65 " "$343,496.69 " 330104 2 3 Heart &/or lung transplant I N/A "$102,952.68 " N/A "$102,952.68 " N/A N/A N/A N/A "$97,805.04 " N/A "$98,834.57 " N/A N/A N/A N/A N/A "$131,779.43 " "$102,952.68 " N/A N/A N/A N/A "$106,041.26 " N/A N/A "$144,133.75 " "$402,939.71 " "$102,952.68 " "$138,986.12 " "$126,631.79 " N/A "$106,041.26 " N/A N/A N/A N/A N/A "$102,952.68 " "$353,860.63 " "$211,052.99 " "$102,952.68 " "$102,952.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$102,952.68 " "$102,952.68 " "$118,395.58 " "$102,952.68 " N/A "$97,805.04 " "$402,939.71 " 330104 2 4 Heart &/or lung transplant I N/A "$237,992.90 " N/A "$237,992.90 " N/A N/A N/A N/A "$226,093.25 " N/A "$228,473.18 " N/A N/A N/A N/A N/A "$304,630.91 " "$237,992.90 " N/A N/A N/A N/A "$245,132.68 " N/A N/A "$333,190.06 " "$933,049.52 " "$237,992.90 " "$321,290.41 " "$292,731.26 " N/A "$245,132.68 " N/A N/A N/A N/A N/A "$237,992.90 " "$819,401.71 " "$487,885.44 " "$237,992.90 " "$237,992.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$237,992.90 " "$237,992.90 " "$273,691.83 " "$237,992.90 " N/A "$226,093.25 " "$933,049.52 " 330104 3 1 Bone marrow transplant I N/A "$45,439.71 " N/A "$45,439.71 " N/A N/A N/A N/A "$43,167.73 " N/A "$43,622.12 " N/A N/A N/A N/A N/A "$58,162.83 " "$45,439.71 " N/A N/A N/A N/A "$46,802.90 " N/A N/A "$63,615.60 " "$177,168.54 " "$45,439.71 " "$61,343.61 " "$55,890.84 " N/A "$46,802.90 " N/A N/A N/A N/A N/A "$45,439.71 " "$155,588.96 " "$93,151.41 " "$45,439.71 " "$45,439.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$45,439.71 " "$45,439.71 " "$52,255.67 " "$45,439.71 " N/A "$43,167.73 " "$177,168.54 " 330104 3 2 Bone marrow transplant I N/A "$53,171.05 " N/A "$53,171.05 " N/A N/A N/A N/A "$50,512.49 " N/A "$51,044.21 " N/A N/A N/A N/A N/A "$68,058.94 " "$53,171.05 " N/A N/A N/A N/A "$54,766.18 " N/A N/A "$74,439.47 " "$207,518.44 " "$53,171.05 " "$71,780.91 " "$65,400.39 " N/A "$54,766.18 " N/A N/A N/A N/A N/A "$53,171.05 " "$182,242.17 " "$109,000.65 " "$53,171.05 " "$53,171.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$53,171.05 " "$53,171.05 " "$61,146.70 " "$53,171.05 " N/A "$50,512.49 " "$207,518.44 " 330104 3 3 Bone marrow transplant I N/A "$80,843.78 " N/A "$80,843.78 " N/A N/A N/A N/A "$76,801.59 " N/A "$77,610.03 " N/A N/A N/A N/A N/A "$103,480.04 " "$80,843.78 " N/A N/A N/A N/A "$83,269.09 " N/A N/A "$113,181.29 " "$316,149.69 " "$80,843.78 " "$109,139.10 " "$99,437.85 " N/A "$83,269.09 " N/A N/A N/A N/A N/A "$80,843.78 " "$277,641.86 " "$165,729.75 " "$80,843.78 " "$80,843.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$80,843.78 " "$80,843.78 " "$92,970.35 " "$80,843.78 " N/A "$76,801.59 " "$316,149.69 " 330104 3 4 Bone marrow transplant I N/A "$152,961.14 " N/A "$152,961.14 " N/A N/A N/A N/A "$145,313.08 " N/A "$146,842.70 " N/A N/A N/A N/A N/A "$195,790.26 " "$152,961.14 " N/A N/A N/A N/A "$157,549.98 " N/A N/A "$214,145.60 " "$599,251.42 " "$152,961.14 " "$206,497.54 " "$188,142.20 " N/A "$157,549.98 " N/A N/A N/A N/A N/A "$152,961.14 " "$526,261.07 " "$313,570.34 " "$152,961.14 " "$152,961.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$152,961.14 " "$152,961.14 " "$175,905.31 " "$152,961.14 " N/A "$145,313.08 " "$599,251.42 " 330104 4 1 Tracheostomy w MV 96+ hours w extensive procedure or ECMO I N/A "$49,274.73 " N/A "$49,274.73 " N/A N/A N/A N/A "$46,810.99 " N/A "$47,303.74 " N/A N/A N/A N/A N/A "$63,071.65 " "$49,274.73 " N/A N/A N/A N/A "$50,752.97 " N/A N/A "$68,984.62 " "$192,223.16 " "$49,274.73 " "$66,520.88 " "$60,607.91 " N/A "$50,752.97 " N/A N/A N/A N/A N/A "$49,274.73 " "$168,809.89 " "$101,013.19 " "$49,274.73 " "$49,274.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$49,274.73 " "$49,274.73 " "$56,665.93 " "$49,274.73 " N/A "$46,810.99 " "$192,223.16 " 330104 4 2 Tracheostomy w MV 96+ hours w extensive procedure or ECMO I N/A "$49,274.73 " N/A "$49,274.73 " N/A N/A N/A N/A "$46,810.99 " N/A "$47,303.74 " N/A N/A N/A N/A N/A "$63,071.65 " "$49,274.73 " N/A N/A N/A N/A "$50,752.97 " N/A N/A "$68,984.62 " "$192,223.16 " "$49,274.73 " "$66,520.88 " "$60,607.91 " N/A "$50,752.97 " N/A N/A N/A N/A N/A "$49,274.73 " "$168,809.89 " "$101,013.19 " "$49,274.73 " "$49,274.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$49,274.73 " "$49,274.73 " "$56,665.93 " "$49,274.73 " N/A "$46,810.99 " "$192,223.16 " 330104 4 3 Tracheostomy w MV 96+ hours w extensive procedure or ECMO I N/A "$68,906.19 " N/A "$68,906.19 " N/A N/A N/A N/A "$65,460.88 " N/A "$66,149.94 " N/A N/A N/A N/A N/A "$88,199.92 " "$68,906.19 " N/A N/A N/A N/A "$70,973.38 " N/A N/A "$96,468.67 " "$269,287.84 " "$68,906.19 " "$93,023.36 " "$84,754.61 " N/A "$70,973.38 " N/A N/A N/A N/A N/A "$68,906.19 " "$236,487.90 " "$141,257.69 " "$68,906.19 " "$68,906.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$68,906.19 " "$68,906.19 " "$79,242.12 " "$68,906.19 " N/A "$65,460.88 " "$269,287.84 " 330104 4 4 Tracheostomy w MV 96+ hours w extensive procedure or ECMO I N/A "$123,410.41 " N/A "$123,410.41 " N/A N/A N/A N/A "$117,239.89 " N/A "$118,473.99 " N/A N/A N/A N/A N/A "$157,965.32 " "$123,410.41 " N/A N/A N/A N/A "$127,112.72 " N/A N/A "$172,774.57 " "$483,247.95 " "$123,410.41 " "$166,604.05 " "$151,794.80 " N/A "$127,112.72 " N/A N/A N/A N/A N/A "$123,410.41 " "$424,387.12 " "$252,991.33 " "$123,410.41 " "$123,410.41 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$123,410.41 " "$123,410.41 " "$141,921.97 " "$123,410.41 " N/A "$117,239.89 " "$483,247.95 " 330104 5 1 Tracheostomy w MV 96+ hours w/o extensive procedure I N/A "$39,108.19 " N/A "$39,108.19 " N/A N/A N/A N/A "$37,152.78 " N/A "$37,543.86 " N/A N/A N/A N/A N/A "$50,058.48 " "$39,108.19 " N/A N/A N/A N/A "$40,281.43 " N/A N/A "$54,751.46 " "$152,313.71 " "$39,108.19 " "$52,796.06 " "$48,103.07 " N/A "$40,281.43 " N/A N/A N/A N/A N/A "$39,108.19 " "$133,761.52 " "$80,171.79 " "$39,108.19 " "$39,108.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$39,108.19 " "$39,108.19 " "$44,974.42 " "$39,108.19 " N/A "$37,152.78 " "$152,313.71 " 330104 5 2 Tracheostomy w MV 96+ hours w/o extensive procedure I N/A "$40,112.92 " N/A "$40,112.92 " N/A N/A N/A N/A "$38,107.28 " N/A "$38,508.41 " N/A N/A N/A N/A N/A "$51,344.54 " "$40,112.92 " N/A N/A N/A N/A "$41,316.31 " N/A N/A "$56,158.09 " "$156,257.86 " "$40,112.92 " "$54,152.45 " "$49,338.89 " N/A "$41,316.31 " N/A N/A N/A N/A N/A "$40,112.92 " "$137,225.26 " "$82,231.49 " "$40,112.92 " "$40,112.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$40,112.92 " "$40,112.92 " "$46,129.86 " "$40,112.92 " N/A "$38,107.28 " "$156,257.86 " 330104 5 3 Tracheostomy w MV 96+ hours w/o extensive procedure I N/A "$63,198.62 " N/A "$63,198.62 " N/A N/A N/A N/A "$60,038.69 " N/A "$60,670.68 " N/A N/A N/A N/A N/A "$80,894.24 " "$63,198.62 " N/A N/A N/A N/A "$65,094.58 " N/A N/A "$88,478.07 " "$246,882.40 " "$63,198.62 " "$85,318.14 " "$77,734.31 " N/A "$65,094.58 " N/A N/A N/A N/A N/A "$63,198.62 " "$216,811.49 " "$129,557.18 " "$63,198.62 " "$63,198.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$63,198.62 " "$63,198.62 " "$72,678.42 " "$63,198.62 " N/A "$60,038.69 " "$246,882.40 " 330104 5 4 Tracheostomy w MV 96+ hours w/o extensive procedure I N/A "$94,238.41 " N/A "$94,238.41 " N/A N/A N/A N/A "$89,526.49 " N/A "$90,468.87 " N/A N/A N/A N/A N/A "$120,625.16 " "$94,238.41 " N/A N/A N/A N/A "$97,065.56 " N/A N/A "$131,933.77 " "$368,731.23 " "$94,238.41 " "$127,221.85 " "$115,913.24 " N/A "$97,065.56 " N/A N/A N/A N/A N/A "$94,238.41 " "$323,818.83 " "$193,188.73 " "$94,238.41 " "$94,238.41 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$94,238.41 " "$94,238.41 " "$108,374.17 " "$94,238.41 " N/A "$89,526.49 " "$368,731.23 " 330104 6 1 Pancreas transplant I N/A "$34,743.90 " N/A "$34,743.90 " N/A N/A N/A N/A "$33,006.71 " N/A "$33,354.14 " N/A N/A N/A N/A N/A "$44,472.19 " "$34,743.90 " N/A N/A N/A N/A "$35,786.22 " N/A N/A "$48,641.46 " "$135,181.40 " "$34,743.90 " "$46,904.27 " "$42,735.00 " N/A "$35,786.22 " N/A N/A N/A N/A N/A "$34,743.90 " "$118,715.96 " "$71,225.00 " "$34,743.90 " "$34,743.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,743.90 " "$34,743.90 " "$39,955.49 " "$34,743.90 " N/A "$33,006.71 " "$135,181.40 " 330104 6 2 Pancreas transplant I N/A "$34,743.90 " N/A "$34,743.90 " N/A N/A N/A N/A "$33,006.71 " N/A "$33,354.14 " N/A N/A N/A N/A N/A "$44,472.19 " "$34,743.90 " N/A N/A N/A N/A "$35,786.22 " N/A N/A "$48,641.46 " "$135,181.40 " "$34,743.90 " "$46,904.27 " "$42,735.00 " N/A "$35,786.22 " N/A N/A N/A N/A N/A "$34,743.90 " "$118,715.96 " "$71,225.00 " "$34,743.90 " "$34,743.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,743.90 " "$34,743.90 " "$39,955.49 " "$34,743.90 " N/A "$33,006.71 " "$135,181.40 " 330104 6 3 Pancreas transplant I N/A "$50,130.28 " N/A "$50,130.28 " N/A N/A N/A N/A "$47,623.77 " N/A "$48,125.07 " N/A N/A N/A N/A N/A "$64,166.76 " "$50,130.28 " N/A N/A N/A N/A "$51,634.19 " N/A N/A "$70,182.39 " "$195,581.71 " "$50,130.28 " "$67,675.88 " "$61,660.25 " N/A "$51,634.19 " N/A N/A N/A N/A N/A "$50,130.28 " "$171,759.36 " "$102,767.08 " "$50,130.28 " "$50,130.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$50,130.28 " "$50,130.28 " "$57,649.82 " "$50,130.28 " N/A "$47,623.77 " "$195,581.71 " 330104 6 4 Pancreas transplant I N/A "$52,342.06 " N/A "$52,342.06 " N/A N/A N/A N/A "$49,724.95 " N/A "$50,248.37 " N/A N/A N/A N/A N/A "$66,997.83 " "$52,342.06 " N/A N/A N/A N/A "$53,912.32 " N/A N/A "$73,278.88 " "$204,264.19 " "$52,342.06 " "$70,661.78 " "$64,380.73 " N/A "$53,912.32 " N/A N/A N/A N/A N/A "$52,342.06 " "$179,384.29 " "$107,301.22 " "$52,342.06 " "$52,342.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$52,342.06 " "$52,342.06 " "$60,193.37 " "$52,342.06 " N/A "$49,724.95 " "$204,264.19 " 330104 20 1 Craniotomy for trauma I N/A "$12,470.84 " N/A "$12,470.84 " N/A N/A N/A N/A "$11,847.30 " N/A "$11,972.01 " N/A N/A N/A N/A N/A "$15,962.68 " "$12,470.84 " N/A N/A N/A N/A "$12,844.97 " N/A N/A "$17,459.18 " "$47,746.94 " "$12,470.84 " "$16,835.64 " "$15,339.13 " N/A "$12,844.97 " N/A N/A N/A N/A N/A "$12,470.84 " "$41,931.24 " "$25,565.22 " "$12,470.84 " "$12,470.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,470.84 " "$12,470.84 " "$14,341.47 " "$12,470.84 " N/A "$11,847.30 " "$47,746.94 " 330104 20 2 Craniotomy for trauma I N/A "$15,671.00 " N/A "$15,671.00 " N/A N/A N/A N/A "$14,887.45 " N/A "$15,044.16 " N/A N/A N/A N/A N/A "$20,058.88 " "$15,671.00 " N/A N/A N/A N/A "$16,141.13 " N/A N/A "$21,939.40 " "$60,309.40 " "$15,671.00 " "$21,155.85 " "$19,275.33 " N/A "$16,141.13 " N/A N/A N/A N/A N/A "$15,671.00 " "$52,963.56 " "$32,125.55 " "$15,671.00 " "$15,671.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,671.00 " "$15,671.00 " "$18,021.65 " "$15,671.00 " N/A "$14,887.45 " "$60,309.40 " 330104 20 3 Craniotomy for trauma I N/A "$24,437.72 " N/A "$24,437.72 " N/A N/A N/A N/A "$23,215.84 " N/A "$23,460.21 " N/A N/A N/A N/A N/A "$31,280.29 " "$24,437.72 " N/A N/A N/A N/A "$25,170.85 " N/A N/A "$34,212.81 " "$94,723.78 " "$24,437.72 " "$32,990.93 " "$30,058.40 " N/A "$25,170.85 " N/A N/A N/A N/A N/A "$24,437.72 " "$83,186.18 " "$50,097.33 " "$24,437.72 " "$24,437.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,437.72 " "$24,437.72 " "$28,103.38 " "$24,437.72 " N/A "$23,215.84 " "$94,723.78 " 330104 20 4 Craniotomy for trauma I N/A "$45,878.39 " N/A "$45,878.39 " N/A N/A N/A N/A "$43,584.47 " N/A "$44,043.25 " N/A N/A N/A N/A N/A "$58,724.34 " "$45,878.39 " N/A N/A N/A N/A "$47,254.74 " N/A N/A "$64,229.74 " "$178,890.60 " "$45,878.39 " "$61,935.82 " "$56,430.42 " N/A "$47,254.74 " N/A N/A N/A N/A N/A "$45,878.39 " "$157,101.27 " "$94,050.69 " "$45,878.39 " "$45,878.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$45,878.39 " "$45,878.39 " "$52,760.15 " "$45,878.39 " N/A "$43,584.47 " "$178,890.60 " 330104 21 1 Craniotomy except for trauma I N/A "$13,209.92 " N/A "$13,209.92 " N/A N/A N/A N/A "$12,549.42 " N/A "$12,681.52 " N/A N/A N/A N/A N/A "$16,908.69 " "$13,209.92 " N/A N/A N/A N/A "$13,606.21 " N/A N/A "$18,493.88 " "$50,648.23 " "$13,209.92 " "$17,833.39 " "$16,248.20 " N/A "$13,606.21 " N/A N/A N/A N/A N/A "$13,209.92 " "$44,479.15 " "$27,080.33 " "$13,209.92 " "$13,209.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,209.92 " "$13,209.92 " "$15,191.40 " "$13,209.92 " N/A "$12,549.42 " "$50,648.23 " 330104 21 2 Craniotomy except for trauma I N/A "$18,544.20 " N/A "$18,544.20 " N/A N/A N/A N/A "$17,616.99 " N/A "$17,802.43 " N/A N/A N/A N/A N/A "$23,736.57 " "$18,544.20 " N/A N/A N/A N/A "$19,100.52 " N/A N/A "$25,961.88 " "$71,588.33 " "$18,544.20 " "$25,034.67 " "$22,809.36 " N/A "$19,100.52 " N/A N/A N/A N/A N/A "$18,544.20 " "$62,868.69 " "$38,015.60 " "$18,544.20 " "$18,544.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,544.20 " "$18,544.20 " "$21,325.83 " "$18,544.20 " N/A "$17,616.99 " "$71,588.33 " 330104 21 3 Craniotomy except for trauma I N/A "$29,815.60 " N/A "$29,815.60 " N/A N/A N/A N/A "$28,324.82 " N/A "$28,622.98 " N/A N/A N/A N/A N/A "$38,163.97 " "$29,815.60 " N/A N/A N/A N/A "$30,710.07 " N/A N/A "$41,741.84 " "$115,835.01 " "$29,815.60 " "$40,251.06 " "$36,673.19 " N/A "$30,710.07 " N/A N/A N/A N/A N/A "$29,815.60 " "$101,726.01 " "$61,121.98 " "$29,815.60 " "$29,815.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$29,815.60 " "$29,815.60 " "$34,287.94 " "$29,815.60 " N/A "$28,324.82 " "$115,835.01 " 330104 21 4 Craniotomy except for trauma I N/A "$49,634.39 " N/A "$49,634.39 " N/A N/A N/A N/A "$47,152.67 " N/A "$47,649.01 " N/A N/A N/A N/A N/A "$63,532.01 " "$49,634.39 " N/A N/A N/A N/A "$51,123.42 " N/A N/A "$69,488.14 " "$193,635.04 " "$49,634.39 " "$67,006.42 " "$61,050.30 " N/A "$51,123.42 " N/A N/A N/A N/A N/A "$49,634.39 " "$170,049.80 " "$101,750.49 " "$49,634.39 " "$49,634.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$49,634.39 " "$49,634.39 " "$57,079.54 " "$49,634.39 " N/A "$47,152.67 " "$193,635.04 " 330104 22 1 Ventricular shunt procedures I N/A "$8,991.40 " N/A "$8,991.40 " N/A N/A N/A N/A "$8,541.83 " N/A "$8,631.74 " N/A N/A N/A N/A N/A "$11,508.99 " "$8,991.40 " N/A N/A N/A N/A "$9,261.14 " N/A N/A "$12,587.96 " "$34,088.15 " "$8,991.40 " "$12,138.39 " "$11,059.42 " N/A "$9,261.14 " N/A N/A N/A N/A N/A "$8,991.40 " "$29,936.13 " "$18,432.37 " "$8,991.40 " "$8,991.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,991.40 " "$8,991.40 " "$10,340.11 " "$8,991.40 " N/A "$8,541.83 " "$34,088.15 " 330104 22 2 Ventricular shunt procedures I N/A "$11,410.93 " N/A "$11,410.93 " N/A N/A N/A N/A "$10,840.39 " N/A "$10,954.50 " N/A N/A N/A N/A N/A "$14,605.99 " "$11,410.93 " N/A N/A N/A N/A "$11,753.26 " N/A N/A "$15,975.31 " "$43,586.20 " "$11,410.93 " "$15,404.76 " "$14,035.45 " N/A "$11,753.26 " N/A N/A N/A N/A N/A "$11,410.93 " "$38,277.29 " "$23,392.41 " "$11,410.93 " "$11,410.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,410.93 " "$11,410.93 " "$13,122.57 " "$11,410.93 " N/A "$10,840.39 " "$43,586.20 " 330104 22 3 Ventricular shunt procedures I N/A "$18,508.78 " N/A "$18,508.78 " N/A N/A N/A N/A "$17,583.34 " N/A "$17,768.42 " N/A N/A N/A N/A N/A "$23,691.23 " "$18,508.78 " N/A N/A N/A N/A "$19,064.04 " N/A N/A "$25,912.29 " "$71,449.28 " "$18,508.78 " "$24,986.85 " "$22,765.79 " N/A "$19,064.04 " N/A N/A N/A N/A N/A "$18,508.78 " "$62,746.58 " "$37,942.99 " "$18,508.78 " "$18,508.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,508.78 " "$18,508.78 " "$21,285.09 " "$18,508.78 " N/A "$17,583.34 " "$71,449.28 " 330104 22 4 Ventricular shunt procedures I N/A "$37,006.08 " N/A "$37,006.08 " N/A N/A N/A N/A "$35,155.78 " N/A "$35,525.84 " N/A N/A N/A N/A N/A "$47,367.79 " "$37,006.08 " N/A N/A N/A N/A "$38,116.27 " N/A N/A "$51,808.52 " "$144,061.75 " "$37,006.08 " "$49,958.21 " "$45,517.48 " N/A "$38,116.27 " N/A N/A N/A N/A N/A "$37,006.08 " "$126,514.66 " "$75,862.47 " "$37,006.08 " "$37,006.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$37,006.08 " "$37,006.08 " "$42,557.00 " "$37,006.08 " N/A "$35,155.78 " "$144,061.75 " 330104 23 1 Spinal procedures I N/A "$11,485.86 " N/A "$11,485.86 " N/A N/A N/A N/A "$10,911.57 " N/A "$11,026.43 " N/A N/A N/A N/A N/A "$14,701.90 " "$11,485.86 " N/A N/A N/A N/A "$11,830.44 " N/A N/A "$16,080.21 " "$43,880.34 " "$11,485.86 " "$15,505.91 " "$14,127.61 " N/A "$11,830.44 " N/A N/A N/A N/A N/A "$11,485.86 " "$38,535.60 " "$23,546.02 " "$11,485.86 " "$11,485.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,485.86 " "$11,485.86 " "$13,208.74 " "$11,485.86 " N/A "$10,911.57 " "$43,880.34 " 330104 23 2 Spinal procedures I N/A "$15,334.50 " N/A "$15,334.50 " N/A N/A N/A N/A "$14,567.78 " N/A "$14,721.12 " N/A N/A N/A N/A N/A "$19,628.16 " "$15,334.50 " N/A N/A N/A N/A "$15,794.54 " N/A N/A "$21,468.30 " "$58,988.44 " "$15,334.50 " "$20,701.58 " "$18,861.44 " N/A "$15,794.54 " N/A N/A N/A N/A N/A "$15,334.50 " "$51,803.50 " "$31,435.73 " "$15,334.50 " "$15,334.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,334.50 " "$15,334.50 " "$17,634.68 " "$15,334.50 " N/A "$14,567.78 " "$58,988.44 " 330104 23 3 Spinal procedures I N/A "$29,573.78 " N/A "$29,573.78 " N/A N/A N/A N/A "$28,095.09 " N/A "$28,390.83 " N/A N/A N/A N/A N/A "$37,854.44 " "$29,573.78 " N/A N/A N/A N/A "$30,461.00 " N/A N/A "$41,403.30 " "$114,885.74 " "$29,573.78 " "$39,924.61 " "$36,375.75 " N/A "$30,461.00 " N/A N/A N/A N/A N/A "$29,573.78 " "$100,892.36 " "$60,626.25 " "$29,573.78 " "$29,573.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$29,573.78 " "$29,573.78 " "$34,009.85 " "$29,573.78 " N/A "$28,095.09 " "$114,885.74 " 330104 23 4 Spinal procedures I N/A "$55,361.02 " N/A "$55,361.02 " N/A N/A N/A N/A "$52,592.97 " N/A "$53,146.58 " N/A N/A N/A N/A N/A "$70,862.11 " "$55,361.02 " N/A N/A N/A N/A "$57,021.86 " N/A N/A "$77,505.43 " "$216,115.35 " "$55,361.02 " "$74,737.38 " "$68,094.06 " N/A "$57,021.86 " N/A N/A N/A N/A N/A "$55,361.02 " "$189,791.95 " "$113,490.10 " "$55,361.02 " "$55,361.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$55,361.02 " "$55,361.02 " "$63,665.18 " "$55,361.02 " N/A "$52,592.97 " "$216,115.35 " 330104 24 1 Extracranial vascular procedures I N/A "$10,536.98 " N/A "$10,536.98 " N/A N/A N/A N/A "$10,010.14 " N/A "$10,115.51 " N/A N/A N/A N/A N/A "$13,487.34 " "$10,536.98 " N/A N/A N/A N/A "$10,853.09 " N/A N/A "$14,751.78 " "$40,155.46 " "$10,536.98 " "$14,224.93 " "$12,960.49 " N/A "$10,853.09 " N/A N/A N/A N/A N/A "$10,536.98 " "$35,264.42 " "$21,600.82 " "$10,536.98 " "$10,536.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,536.98 " "$10,536.98 " "$12,117.53 " "$10,536.98 " N/A "$10,010.14 " "$40,155.46 " 330104 24 2 Extracranial vascular procedures I N/A "$14,820.21 " N/A "$14,820.21 " N/A N/A N/A N/A "$14,079.20 " N/A "$14,227.40 " N/A N/A N/A N/A N/A "$18,969.87 " "$14,820.21 " N/A N/A N/A N/A "$15,264.82 " N/A N/A "$20,748.30 " "$56,969.57 " "$14,820.21 " "$20,007.29 " "$18,228.86 " N/A "$15,264.82 " N/A N/A N/A N/A N/A "$14,820.21 " "$50,030.53 " "$30,381.44 " "$14,820.21 " "$14,820.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,820.21 " "$14,820.21 " "$17,043.25 " "$14,820.21 " N/A "$14,079.20 " "$56,969.57 " 330104 24 3 Extracranial vascular procedures I N/A "$25,445.18 " N/A "$25,445.18 " N/A N/A N/A N/A "$24,172.92 " N/A "$24,427.37 " N/A N/A N/A N/A N/A "$32,569.83 " "$25,445.18 " N/A N/A N/A N/A "$26,208.54 " N/A N/A "$35,623.25 " "$98,678.62 " "$25,445.18 " "$34,350.99 " "$31,297.57 " N/A "$26,208.54 " N/A N/A N/A N/A N/A "$25,445.18 " "$86,659.31 " "$52,162.62 " "$25,445.18 " "$25,445.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,445.18 " "$25,445.18 " "$29,261.96 " "$25,445.18 " N/A "$24,172.92 " "$98,678.62 " 330104 24 4 Extracranial vascular procedures I N/A "$46,584.08 " N/A "$46,584.08 " N/A N/A N/A N/A "$44,254.88 " N/A "$44,720.72 " N/A N/A N/A N/A N/A "$59,627.63 " "$46,584.08 " N/A N/A N/A N/A "$47,981.61 " N/A N/A "$65,217.72 " "$181,660.86 " "$46,584.08 " "$62,888.51 " "$57,298.42 " N/A "$47,981.61 " N/A N/A N/A N/A N/A "$46,584.08 " "$159,534.11 " "$95,497.37 " "$46,584.08 " "$46,584.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$46,584.08 " "$46,584.08 " "$53,571.70 " "$46,584.08 " N/A "$44,254.88 " "$181,660.86 " 330104 26 1 Other nervous system & related procedures I N/A "$8,663.75 " N/A "$8,663.75 " N/A N/A N/A N/A "$8,230.57 " N/A "$8,317.20 " N/A N/A N/A N/A N/A "$11,089.60 " "$8,663.75 " N/A N/A N/A N/A "$8,923.67 " N/A N/A "$12,129.26 " "$32,801.96 " "$8,663.75 " "$11,696.07 " "$10,656.42 " N/A "$8,923.67 " N/A N/A N/A N/A N/A "$8,663.75 " "$28,806.60 " "$17,760.70 " "$8,663.75 " "$8,663.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,663.75 " "$8,663.75 " "$9,963.32 " "$8,663.75 " N/A "$8,230.57 " "$32,801.96 " 330104 26 2 Other nervous system & related procedures I N/A "$12,541.68 " N/A "$12,541.68 " N/A N/A N/A N/A "$11,914.60 " N/A "$12,040.02 " N/A N/A N/A N/A N/A "$16,053.35 " "$12,541.68 " N/A N/A N/A N/A "$12,917.93 " N/A N/A "$17,558.36 " "$48,025.04 " "$12,541.68 " "$16,931.27 " "$15,426.27 " N/A "$12,917.93 " N/A N/A N/A N/A N/A "$12,541.68 " "$42,175.47 " "$25,710.45 " "$12,541.68 " "$12,541.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,541.68 " "$12,541.68 " "$14,422.94 " "$12,541.68 " N/A "$11,914.60 " "$48,025.04 " 330104 26 3 Other nervous system & related procedures I N/A "$18,484.25 " N/A "$18,484.25 " N/A N/A N/A N/A "$17,560.04 " N/A "$17,744.88 " N/A N/A N/A N/A N/A "$23,659.84 " "$18,484.25 " N/A N/A N/A N/A "$19,038.78 " N/A N/A "$25,877.96 " "$71,353.02 " "$18,484.25 " "$24,953.74 " "$22,735.63 " N/A "$19,038.78 " N/A N/A N/A N/A N/A "$18,484.25 " "$62,662.04 " "$37,892.72 " "$18,484.25 " "$18,484.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,484.25 " "$18,484.25 " "$21,256.89 " "$18,484.25 " N/A "$17,560.04 " "$71,353.02 " 330104 26 4 Other nervous system & related procedures I N/A "$43,057.64 " N/A "$43,057.64 " N/A N/A N/A N/A "$40,904.76 " N/A "$41,335.34 " N/A N/A N/A N/A N/A "$55,113.78 " "$43,057.64 " N/A N/A N/A N/A "$44,349.37 " N/A N/A "$60,280.70 " "$167,817.57 " "$43,057.64 " "$58,127.82 " "$52,960.90 " N/A "$44,349.37 " N/A N/A N/A N/A N/A "$43,057.64 " "$147,376.96 " "$88,268.17 " "$43,057.64 " "$43,057.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,057.64 " "$43,057.64 " "$49,516.29 " "$43,057.64 " N/A "$40,904.76 " "$167,817.57 " 330104 40 1 Spinal disorders & injuries I N/A "$5,865.49 " N/A "$5,865.49 " N/A N/A N/A N/A "$5,572.21 " N/A "$5,630.87 " N/A N/A N/A N/A N/A "$7,507.82 " "$5,865.49 " N/A N/A N/A N/A "$6,041.45 " N/A N/A "$8,211.68 " "$21,817.17 " "$5,865.49 " "$7,918.41 " "$7,214.55 " N/A "$6,041.45 " N/A N/A N/A N/A N/A "$5,865.49 " "$19,159.78 " "$12,024.25 " "$5,865.49 " "$5,865.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,865.49 " "$5,865.49 " "$6,745.31 " "$5,865.49 " N/A "$5,572.21 " "$21,817.17 " 330104 40 2 Spinal disorders & injuries I N/A "$9,056.11 " N/A "$9,056.11 " N/A N/A N/A N/A "$8,603.30 " N/A "$8,693.87 " N/A N/A N/A N/A N/A "$11,591.82 " "$9,056.11 " N/A N/A N/A N/A "$9,327.79 " N/A N/A "$12,678.55 " "$34,342.18 " "$9,056.11 " "$12,225.75 " "$11,139.02 " N/A "$9,327.79 " N/A N/A N/A N/A N/A "$9,056.11 " "$30,159.22 " "$18,565.03 " "$9,056.11 " "$9,056.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,056.11 " "$9,056.11 " "$10,414.53 " "$9,056.11 " N/A "$8,603.30 " "$34,342.18 " 330104 40 3 Spinal disorders & injuries I N/A "$15,950.96 " N/A "$15,950.96 " N/A N/A N/A N/A "$15,153.42 " N/A "$15,312.93 " N/A N/A N/A N/A N/A "$20,417.23 " "$15,950.96 " N/A N/A N/A N/A "$16,429.49 " N/A N/A "$22,331.35 " "$61,408.41 " "$15,950.96 " "$21,533.80 " "$19,619.69 " N/A "$16,429.49 " N/A N/A N/A N/A N/A "$15,950.96 " "$53,928.71 " "$32,699.48 " "$15,950.96 " "$15,950.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,950.96 " "$15,950.96 " "$18,343.61 " "$15,950.96 " N/A "$15,153.42 " "$61,408.41 " 330104 40 4 Spinal disorders & injuries I N/A "$18,808.49 " N/A "$18,808.49 " N/A N/A N/A N/A "$17,868.07 " N/A "$18,056.15 " N/A N/A N/A N/A N/A "$24,074.87 " "$18,808.49 " N/A N/A N/A N/A "$19,372.75 " N/A N/A "$26,331.89 " "$72,625.84 " "$18,808.49 " "$25,391.47 " "$23,134.45 " N/A "$19,372.75 " N/A N/A N/A N/A N/A "$18,808.49 " "$63,779.83 " "$38,557.41 " "$18,808.49 " "$18,808.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,808.49 " "$18,808.49 " "$21,629.77 " "$18,808.49 " N/A "$17,868.07 " "$72,625.84 " 330104 41 1 Nervous system malignancy I N/A "$5,422.04 " N/A "$5,422.04 " N/A N/A N/A N/A "$5,150.94 " N/A "$5,205.16 " N/A N/A N/A N/A N/A "$6,940.21 " "$5,422.04 " N/A N/A N/A N/A "$5,584.70 " N/A N/A "$7,590.86 " "$20,076.39 " "$5,422.04 " "$7,319.76 " "$6,669.11 " N/A "$5,584.70 " N/A N/A N/A N/A N/A "$5,422.04 " "$17,631.04 " "$11,115.19 " "$5,422.04 " "$5,422.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,422.04 " "$5,422.04 " "$6,235.35 " "$5,422.04 " N/A "$5,150.94 " "$20,076.39 " 330104 41 2 Nervous system malignancy I N/A "$6,209.48 " N/A "$6,209.48 " N/A N/A N/A N/A "$5,899.01 " N/A "$5,961.10 " N/A N/A N/A N/A N/A "$7,948.13 " "$6,209.48 " N/A N/A N/A N/A "$6,395.76 " N/A N/A "$8,693.27 " "$23,167.54 " "$6,209.48 " "$8,382.80 " "$7,637.66 " N/A "$6,395.76 " N/A N/A N/A N/A N/A "$6,209.48 " "$20,345.67 " "$12,729.43 " "$6,209.48 " "$6,209.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,209.48 " "$6,209.48 " "$7,140.90 " "$6,209.48 " N/A "$5,899.01 " "$23,167.54 " 330104 41 3 Nervous system malignancy I N/A "$10,347.62 " N/A "$10,347.62 " N/A N/A N/A N/A "$9,830.24 " N/A "$9,933.71 " N/A N/A N/A N/A N/A "$13,244.95 " "$10,347.62 " N/A N/A N/A N/A "$10,658.05 " N/A N/A "$14,486.67 " "$39,412.09 " "$10,347.62 " "$13,969.28 " "$12,727.57 " N/A "$10,658.05 " N/A N/A N/A N/A N/A "$10,347.62 " "$34,611.59 " "$21,212.62 " "$10,347.62 " "$10,347.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,347.62 " "$10,347.62 " "$11,899.76 " "$10,347.62 " N/A "$9,830.24 " "$39,412.09 " 330104 41 4 Nervous system malignancy I N/A "$18,912.71 " N/A "$18,912.71 " N/A N/A N/A N/A "$17,967.08 " N/A "$18,156.20 " N/A N/A N/A N/A N/A "$24,208.27 " "$18,912.71 " N/A N/A N/A N/A "$19,480.09 " N/A N/A "$26,477.80 " "$73,034.96 " "$18,912.71 " "$25,532.16 " "$23,262.64 " N/A "$19,480.09 " N/A N/A N/A N/A N/A "$18,912.71 " "$64,139.12 " "$38,771.06 " "$18,912.71 " "$18,912.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,912.71 " "$18,912.71 " "$21,749.62 " "$18,912.71 " N/A "$17,967.08 " "$73,034.96 " 330104 42 1 Degenerative nervous system disorders exc mult sclerosis I N/A "$4,648.23 " N/A "$4,648.23 " N/A N/A N/A N/A "$4,415.82 " N/A "$4,462.30 " N/A N/A N/A N/A N/A "$5,949.73 " "$4,648.23 " N/A N/A N/A N/A "$4,787.67 " N/A N/A "$6,507.52 " "$17,038.73 " "$4,648.23 " "$6,275.11 " "$5,717.32 " N/A "$4,787.67 " N/A N/A N/A N/A N/A "$4,648.23 " "$14,963.37 " "$9,528.87 " "$4,648.23 " "$4,648.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,648.23 " "$4,648.23 " "$5,345.46 " "$4,648.23 " N/A "$4,415.82 " "$17,038.73 " 330104 42 2 Degenerative nervous system disorders exc mult sclerosis I N/A "$6,320.51 " N/A "$6,320.51 " N/A N/A N/A N/A "$6,004.49 " N/A "$6,067.69 " N/A N/A N/A N/A N/A "$8,090.26 " "$6,320.51 " N/A N/A N/A N/A "$6,510.13 " N/A N/A "$8,848.72 " "$23,603.40 " "$6,320.51 " "$8,532.69 " "$7,774.23 " N/A "$6,510.13 " N/A N/A N/A N/A N/A "$6,320.51 " "$20,728.44 " "$12,957.05 " "$6,320.51 " "$6,320.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,320.51 " "$6,320.51 " "$7,268.59 " "$6,320.51 " N/A "$6,004.49 " "$23,603.40 " 330104 42 3 Degenerative nervous system disorders exc mult sclerosis I N/A "$12,743.99 " N/A "$12,743.99 " N/A N/A N/A N/A "$12,106.79 " N/A "$12,234.23 " N/A N/A N/A N/A N/A "$16,312.31 " "$12,743.99 " N/A N/A N/A N/A "$13,126.31 " N/A N/A "$17,841.59 " "$48,819.22 " "$12,743.99 " "$17,204.39 " "$15,675.11 " N/A "$13,126.31 " N/A N/A N/A N/A N/A "$12,743.99 " "$42,872.91 " "$26,125.18 " "$12,743.99 " "$12,743.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,743.99 " "$12,743.99 " "$14,655.59 " "$12,743.99 " N/A "$12,106.79 " "$48,819.22 " 330104 42 4 Degenerative nervous system disorders exc mult sclerosis I N/A "$13,545.73 " N/A "$13,545.73 " N/A N/A N/A N/A "$12,868.45 " N/A "$13,003.91 " N/A N/A N/A N/A N/A "$17,338.54 " "$13,545.73 " N/A N/A N/A N/A "$13,952.11 " N/A N/A "$18,964.03 " "$51,966.52 " "$13,545.73 " "$18,286.74 " "$16,661.25 " N/A "$13,952.11 " N/A N/A N/A N/A N/A "$13,545.73 " "$45,636.86 " "$27,768.76 " "$13,545.73 " "$13,545.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,545.73 " "$13,545.73 " "$15,577.60 " "$13,545.73 " N/A "$12,868.45 " "$51,966.52 " 330104 43 1 Multiple sclerosis & other demyelinating diseases I N/A "$5,647.51 " N/A "$5,647.51 " N/A N/A N/A N/A "$5,365.14 " N/A "$5,421.61 " N/A N/A N/A N/A N/A "$7,228.81 " "$5,647.51 " N/A N/A N/A N/A "$5,816.94 " N/A N/A "$7,906.52 " "$20,961.49 " "$5,647.51 " "$7,624.14 " "$6,946.44 " N/A "$5,816.94 " N/A N/A N/A N/A N/A "$5,647.51 " "$18,408.32 " "$11,577.40 " "$5,647.51 " "$5,647.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,647.51 " "$5,647.51 " "$6,494.64 " "$5,647.51 " N/A "$5,365.14 " "$20,961.49 " 330104 43 2 Multiple sclerosis & other demyelinating diseases I N/A "$7,629.05 " N/A "$7,629.05 " N/A N/A N/A N/A "$7,247.60 " N/A "$7,323.89 " N/A N/A N/A N/A N/A "$9,765.18 " "$7,629.05 " N/A N/A N/A N/A "$7,857.92 " N/A N/A "$10,680.67 " "$28,740.15 " "$7,629.05 " "$10,299.22 " "$9,383.73 " N/A "$7,857.92 " N/A N/A N/A N/A N/A "$7,629.05 " "$25,239.53 " "$15,639.55 " "$7,629.05 " "$7,629.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,629.05 " "$7,629.05 " "$8,773.41 " "$7,629.05 " N/A "$7,247.60 " "$28,740.15 " 330104 43 3 Multiple sclerosis & other demyelinating diseases I N/A "$15,689.39 " N/A "$15,689.39 " N/A N/A N/A N/A "$14,904.92 " N/A "$15,061.82 " N/A N/A N/A N/A N/A "$20,082.42 " "$15,689.39 " N/A N/A N/A N/A "$16,160.07 " N/A N/A "$21,965.15 " "$60,381.59 " "$15,689.39 " "$21,180.68 " "$19,297.95 " N/A "$16,160.07 " N/A N/A N/A N/A N/A "$15,689.39 " "$53,026.96 " "$32,163.25 " "$15,689.39 " "$15,689.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,689.39 " "$15,689.39 " "$18,042.80 " "$15,689.39 " N/A "$14,904.92 " "$60,381.59 " 330104 43 4 Multiple sclerosis & other demyelinating diseases I N/A "$40,617.67 " N/A "$40,617.67 " N/A N/A N/A N/A "$38,586.79 " N/A "$38,992.97 " N/A N/A N/A N/A N/A "$51,990.62 " "$40,617.67 " N/A N/A N/A N/A "$41,836.20 " N/A N/A "$56,864.74 " "$158,239.30 " "$40,617.67 " "$54,833.86 " "$49,959.74 " N/A "$41,836.20 " N/A N/A N/A N/A N/A "$40,617.67 " "$138,965.35 " "$83,266.23 " "$40,617.67 " "$40,617.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$40,617.67 " "$40,617.67 " "$46,710.32 " "$40,617.67 " N/A "$38,586.79 " "$158,239.30 " 330104 44 1 Intracranial hemorrhage I N/A "$7,120.21 " N/A "$7,120.21 " N/A N/A N/A N/A "$6,764.20 " N/A "$6,835.40 " N/A N/A N/A N/A N/A "$9,113.87 " "$7,120.21 " N/A N/A N/A N/A "$7,333.82 " N/A N/A "$9,968.30 " "$26,742.67 " "$7,120.21 " "$9,612.29 " "$8,757.86 " N/A "$7,333.82 " N/A N/A N/A N/A N/A "$7,120.21 " "$23,485.35 " "$14,596.43 " "$7,120.21 " "$7,120.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,120.21 " "$7,120.21 " "$8,188.24 " "$7,120.21 " N/A "$6,764.20 " "$26,742.67 " 330104 44 2 Intracranial hemorrhage I N/A "$10,274.05 " N/A "$10,274.05 " N/A N/A N/A N/A "$9,760.35 " N/A "$9,863.09 " N/A N/A N/A N/A N/A "$13,150.79 " "$10,274.05 " N/A N/A N/A N/A "$10,582.27 " N/A N/A "$14,383.67 " "$39,123.29 " "$10,274.05 " "$13,869.97 " "$12,637.08 " N/A "$10,582.27 " N/A N/A N/A N/A N/A "$10,274.05 " "$34,357.98 " "$21,061.81 " "$10,274.05 " "$10,274.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,274.05 " "$10,274.05 " "$11,815.16 " "$10,274.05 " N/A "$9,760.35 " "$39,123.29 " 330104 44 3 Intracranial hemorrhage I N/A "$14,718.04 " N/A "$14,718.04 " N/A N/A N/A N/A "$13,982.14 " N/A "$14,129.32 " N/A N/A N/A N/A N/A "$18,839.09 " "$14,718.04 " N/A N/A N/A N/A "$15,159.58 " N/A N/A "$20,605.25 " "$56,568.47 " "$14,718.04 " "$19,869.35 " "$18,103.19 " N/A "$15,159.58 " N/A N/A N/A N/A N/A "$14,718.04 " "$49,678.29 " "$30,171.98 " "$14,718.04 " "$14,718.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,718.04 " "$14,718.04 " "$16,925.74 " "$14,718.04 " N/A "$13,982.14 " "$56,568.47 " 330104 44 4 Intracranial hemorrhage I N/A "$19,235.59 " N/A "$19,235.59 " N/A N/A N/A N/A "$18,273.81 " N/A "$18,466.17 " N/A N/A N/A N/A N/A "$24,621.55 " "$19,235.59 " N/A N/A N/A N/A "$19,812.66 " N/A N/A "$26,929.83 " "$74,302.44 " "$19,235.59 " "$25,968.05 " "$23,659.78 " N/A "$19,812.66 " N/A N/A N/A N/A N/A "$19,235.59 " "$65,252.21 " "$39,432.96 " "$19,235.59 " "$19,235.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,235.59 " "$19,235.59 " "$22,120.93 " "$19,235.59 " N/A "$18,273.81 " "$74,302.44 " 330104 45 1 CVA & precerebral occlusion w infarct I N/A "$5,738.79 " N/A "$5,738.79 " N/A N/A N/A N/A "$5,451.85 " N/A "$5,509.24 " N/A N/A N/A N/A N/A "$7,345.65 " "$5,738.79 " N/A N/A N/A N/A "$5,910.95 " N/A N/A "$8,034.30 " "$21,319.80 " "$5,738.79 " "$7,747.36 " "$7,058.71 " N/A "$5,910.95 " N/A N/A N/A N/A N/A "$5,738.79 " "$18,723.00 " "$11,764.52 " "$5,738.79 " "$5,738.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,738.79 " "$5,738.79 " "$6,599.61 " "$5,738.79 " N/A "$5,451.85 " "$21,319.80 " 330104 45 2 CVA & precerebral occlusion w infarct I N/A "$7,877.68 " N/A "$7,877.68 " N/A N/A N/A N/A "$7,483.79 " N/A "$7,562.57 " N/A N/A N/A N/A N/A "$10,083.43 " "$7,877.68 " N/A N/A N/A N/A "$8,114.01 " N/A N/A "$11,028.75 " "$29,716.16 " "$7,877.68 " "$10,634.86 " "$9,689.54 " N/A "$8,114.01 " N/A N/A N/A N/A N/A "$7,877.68 " "$26,096.66 " "$16,149.24 " "$7,877.68 " "$7,877.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,877.68 " "$7,877.68 " "$9,059.33 " "$7,877.68 " N/A "$7,483.79 " "$29,716.16 " 330104 45 3 CVA & precerebral occlusion w infarct I N/A "$12,032.85 " N/A "$12,032.85 " N/A N/A N/A N/A "$11,431.20 " N/A "$11,551.53 " N/A N/A N/A N/A N/A "$15,402.04 " "$12,032.85 " N/A N/A N/A N/A "$12,393.83 " N/A N/A "$16,845.98 " "$46,027.56 " "$12,032.85 " "$16,244.34 " "$14,800.40 " N/A "$12,393.83 " N/A N/A N/A N/A N/A "$12,032.85 " "$40,421.29 " "$24,667.33 " "$12,032.85 " "$12,032.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,032.85 " "$12,032.85 " "$13,837.77 " "$12,032.85 " N/A "$11,431.20 " "$46,027.56 " 330104 45 4 CVA & precerebral occlusion w infarct I N/A "$23,605.33 " N/A "$23,605.33 " N/A N/A N/A N/A "$22,425.06 " N/A "$22,661.11 " N/A N/A N/A N/A N/A "$30,214.82 " "$23,605.33 " N/A N/A N/A N/A "$24,313.49 " N/A N/A "$33,047.46 " "$91,456.15 " "$23,605.33 " "$31,867.19 " "$29,034.55 " N/A "$24,313.49 " N/A N/A N/A N/A N/A "$23,605.33 " "$80,316.56 " "$48,390.92 " "$23,605.33 " "$23,605.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,605.33 " "$23,605.33 " "$27,146.13 " "$23,605.33 " N/A "$22,425.06 " "$91,456.15 " 330104 46 1 Nonspecific CVA & precerebral occlusion w/o infarct I N/A "$4,609.40 " N/A "$4,609.40 " N/A N/A N/A N/A "$4,378.93 " N/A "$4,425.02 " N/A N/A N/A N/A N/A "$5,900.03 " "$4,609.40 " N/A N/A N/A N/A "$4,747.68 " N/A N/A "$6,453.16 " "$16,886.31 " "$4,609.40 " "$6,222.69 " "$5,669.56 " N/A "$4,747.68 " N/A N/A N/A N/A N/A "$4,609.40 " "$14,829.51 " "$9,449.27 " "$4,609.40 " "$4,609.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,609.40 " "$4,609.40 " "$5,300.81 " "$4,609.40 " N/A "$4,378.93 " "$16,886.31 " 330104 46 2 Nonspecific CVA & precerebral occlusion w/o infarct I N/A "$6,086.87 " N/A "$6,086.87 " N/A N/A N/A N/A "$5,782.53 " N/A "$5,843.39 " N/A N/A N/A N/A N/A "$7,791.19 " "$6,086.87 " N/A N/A N/A N/A "$6,269.47 " N/A N/A "$8,521.62 " "$22,686.22 " "$6,086.87 " "$8,217.27 " "$7,486.85 " N/A "$6,269.47 " N/A N/A N/A N/A N/A "$6,086.87 " "$19,922.98 " "$12,478.08 " "$6,086.87 " "$6,086.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,086.87 " "$6,086.87 " "$6,999.90 " "$6,086.87 " N/A "$5,782.53 " "$22,686.22 " 330104 46 3 Nonspecific CVA & precerebral occlusion w/o infarct I N/A "$7,840.21 " N/A "$7,840.21 " N/A N/A N/A N/A "$7,448.20 " N/A "$7,526.60 " N/A N/A N/A N/A N/A "$10,035.47 " "$7,840.21 " N/A N/A N/A N/A "$8,075.42 " N/A N/A "$10,976.30 " "$29,569.09 " "$7,840.21 " "$10,584.29 " "$9,643.46 " N/A "$8,075.42 " N/A N/A N/A N/A N/A "$7,840.21 " "$25,967.50 " "$16,072.44 " "$7,840.21 " "$7,840.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,840.21 " "$7,840.21 " "$9,016.25 " "$7,840.21 " N/A "$7,448.20 " "$29,569.09 " 330104 46 4 Nonspecific CVA & precerebral occlusion w/o infarct I N/A "$8,178.76 " N/A "$8,178.76 " N/A N/A N/A N/A "$7,769.82 " N/A "$7,851.61 " N/A N/A N/A N/A N/A "$10,468.81 " "$8,178.76 " N/A N/A N/A N/A "$8,424.12 " N/A N/A "$11,450.26 " "$30,898.07 " "$8,178.76 " "$11,041.32 " "$10,059.87 " N/A "$8,424.12 " N/A N/A N/A N/A N/A "$8,178.76 " "$27,134.61 " "$16,766.45 " "$8,178.76 " "$8,178.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,178.76 " "$8,178.76 " "$9,405.57 " "$8,178.76 " N/A "$7,769.82 " "$30,898.07 " 330104 47 1 Transient ischemia I N/A "$3,804.93 " N/A "$3,804.93 " N/A N/A N/A N/A "$3,614.69 " N/A "$3,652.74 " N/A N/A N/A N/A N/A "$4,870.31 " "$3,804.93 " N/A N/A N/A N/A "$3,919.08 " N/A N/A "$5,326.91 " "$13,728.32 " "$3,804.93 " "$5,136.66 " "$4,680.07 " N/A "$3,919.08 " N/A N/A N/A N/A N/A "$3,804.93 " "$12,056.17 " "$7,800.11 " "$3,804.93 " "$3,804.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,804.93 " "$3,804.93 " "$4,375.67 " "$3,804.93 " N/A "$3,614.69 " "$13,728.32 " 330104 47 2 Transient ischemia I N/A "$4,618.94 " N/A "$4,618.94 " N/A N/A N/A N/A "$4,387.99 " N/A "$4,434.18 " N/A N/A N/A N/A N/A "$5,912.24 " "$4,618.94 " N/A N/A N/A N/A "$4,757.50 " N/A N/A "$6,466.51 " "$16,923.75 " "$4,618.94 " "$6,235.56 " "$5,681.29 " N/A "$4,757.50 " N/A N/A N/A N/A N/A "$4,618.94 " "$14,862.39 " "$9,468.82 " "$4,618.94 " "$4,618.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,618.94 " "$4,618.94 " "$5,311.78 " "$4,618.94 " N/A "$4,387.99 " "$16,923.75 " 330104 47 3 Transient ischemia I N/A "$6,272.15 " N/A "$6,272.15 " N/A N/A N/A N/A "$5,958.54 " N/A "$6,021.26 " N/A N/A N/A N/A N/A "$8,028.35 " "$6,272.15 " N/A N/A N/A N/A "$6,460.31 " N/A N/A "$8,781.01 " "$23,413.54 " "$6,272.15 " "$8,467.40 " "$7,714.74 " N/A "$6,460.31 " N/A N/A N/A N/A N/A "$6,272.15 " "$20,561.71 " "$12,857.90 " "$6,272.15 " "$6,272.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,272.15 " "$6,272.15 " "$7,212.97 " "$6,272.15 " N/A "$5,958.54 " "$23,413.54 " 330104 47 4 Transient ischemia I N/A "$6,414.51 " N/A "$6,414.51 " N/A N/A N/A N/A "$6,093.79 " N/A "$6,157.93 " N/A N/A N/A N/A N/A "$8,210.58 " "$6,414.51 " N/A N/A N/A N/A "$6,606.95 " N/A N/A "$8,980.32 " "$23,972.41 " "$6,414.51 " "$8,659.59 " "$7,889.85 " N/A "$6,606.95 " N/A N/A N/A N/A N/A "$6,414.51 " "$21,052.51 " "$13,149.75 " "$6,414.51 " "$6,414.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,414.51 " "$6,414.51 " "$7,376.69 " "$6,414.51 " N/A "$6,093.79 " "$23,972.41 " 330104 48 1 Peripheral cranial & autonomic nerve disorders I N/A "$4,080.13 " N/A "$4,080.13 " N/A N/A N/A N/A "$3,876.12 " N/A "$3,916.92 " N/A N/A N/A N/A N/A "$5,222.56 " "$4,080.13 " N/A N/A N/A N/A "$4,202.53 " N/A N/A "$5,712.18 " "$14,808.61 " "$4,080.13 " "$5,508.17 " "$5,018.56 " N/A "$4,202.53 " N/A N/A N/A N/A N/A "$4,080.13 " "$13,004.89 " "$8,364.26 " "$4,080.13 " "$4,080.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,080.13 " "$4,080.13 " "$4,692.15 " "$4,080.13 " N/A "$3,876.12 " "$14,808.61 " 330104 48 2 Peripheral cranial & autonomic nerve disorders I N/A "$5,343.71 " N/A "$5,343.71 " N/A N/A N/A N/A "$5,076.52 " N/A "$5,129.96 " N/A N/A N/A N/A N/A "$6,839.94 " "$5,343.71 " N/A N/A N/A N/A "$5,504.02 " N/A N/A "$7,481.19 " "$19,768.88 " "$5,343.71 " "$7,214.00 " "$6,572.76 " N/A "$5,504.02 " N/A N/A N/A N/A N/A "$5,343.71 " "$17,360.98 " "$10,954.60 " "$5,343.71 " "$5,343.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,343.71 " "$5,343.71 " "$6,145.26 " "$5,343.71 " N/A "$5,076.52 " "$19,768.88 " 330104 48 3 Peripheral cranial & autonomic nerve disorders I N/A "$7,842.26 " N/A "$7,842.26 " N/A N/A N/A N/A "$7,450.14 " N/A "$7,528.57 " N/A N/A N/A N/A N/A "$10,038.09 " "$7,842.26 " N/A N/A N/A N/A "$8,077.52 " N/A N/A "$10,979.16 " "$29,577.11 " "$7,842.26 " "$10,587.05 " "$9,645.98 " N/A "$8,077.52 " N/A N/A N/A N/A N/A "$7,842.26 " "$25,974.55 " "$16,076.63 " "$7,842.26 " "$7,842.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,842.26 " "$7,842.26 " "$9,018.60 " "$7,842.26 " N/A "$7,450.14 " "$29,577.11 " 330104 48 4 Peripheral cranial & autonomic nerve disorders I N/A "$24,041.96 " N/A "$24,041.96 " N/A N/A N/A N/A "$22,839.86 " N/A "$23,080.28 " N/A N/A N/A N/A N/A "$30,773.71 " "$24,041.96 " N/A N/A N/A N/A "$24,763.22 " N/A N/A "$33,658.74 " "$93,170.18 " "$24,041.96 " "$32,456.65 " "$29,571.61 " N/A "$24,763.22 " N/A N/A N/A N/A N/A "$24,041.96 " "$81,821.82 " "$49,286.02 " "$24,041.96 " "$24,041.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,041.96 " "$24,041.96 " "$27,648.25 " "$24,041.96 " N/A "$22,839.86 " "$93,170.18 " 330104 49 1 Bacterial & tuberculous infections of nervous system I N/A "$8,242.11 " N/A "$8,242.11 " N/A N/A N/A N/A "$7,830.00 " N/A "$7,912.42 " N/A N/A N/A N/A N/A "$10,549.90 " "$8,242.11 " N/A N/A N/A N/A "$8,489.37 " N/A N/A "$11,538.95 " "$31,146.75 " "$8,242.11 " "$11,126.84 " "$10,137.79 " N/A "$8,489.37 " N/A N/A N/A N/A N/A "$8,242.11 " "$27,353.00 " "$16,896.32 " "$8,242.11 " "$8,242.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,242.11 " "$8,242.11 " "$9,478.42 " "$8,242.11 " N/A "$7,830.00 " "$31,146.75 " 330104 49 2 Bacterial & tuberculous infections of nervous system I N/A "$17,262.91 " N/A "$17,262.91 " N/A N/A N/A N/A "$16,399.76 " N/A "$16,572.39 " N/A N/A N/A N/A N/A "$22,096.52 " "$17,262.91 " N/A N/A N/A N/A "$17,780.79 " N/A N/A "$24,168.07 " "$66,558.53 " "$17,262.91 " "$23,304.92 " "$21,233.38 " N/A "$17,780.79 " N/A N/A N/A N/A N/A "$17,262.91 " "$58,451.54 " "$35,388.96 " "$17,262.91 " "$17,262.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,262.91 " "$17,262.91 " "$19,852.34 " "$17,262.91 " N/A "$16,399.76 " "$66,558.53 " 330104 49 3 Bacterial & tuberculous infections of nervous system I N/A "$22,108.79 " N/A "$22,108.79 " N/A N/A N/A N/A "$21,003.35 " N/A "$21,224.43 " N/A N/A N/A N/A N/A "$28,299.25 " "$22,108.79 " N/A N/A N/A N/A "$22,772.05 " N/A N/A "$30,952.30 " "$85,581.37 " "$22,108.79 " "$29,846.86 " "$27,193.81 " N/A "$22,772.05 " N/A N/A N/A N/A N/A "$22,108.79 " "$75,157.34 " "$45,323.01 " "$22,108.79 " "$22,108.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,108.79 " "$22,108.79 " "$25,425.10 " "$22,108.79 " N/A "$21,003.35 " "$85,581.37 " 330104 49 4 Bacterial & tuberculous infections of nervous system I N/A "$40,956.90 " N/A "$40,956.90 " N/A N/A N/A N/A "$38,909.05 " N/A "$39,318.62 " N/A N/A N/A N/A N/A "$52,424.83 " "$40,956.90 " N/A N/A N/A N/A "$42,185.61 " N/A N/A "$57,339.66 " "$159,570.95 " "$40,956.90 " "$55,291.81 " "$50,376.98 " N/A "$42,185.61 " N/A N/A N/A N/A N/A "$40,956.90 " "$140,134.80 " "$83,961.64 " "$40,956.90 " "$40,956.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$40,956.90 " "$40,956.90 " "$47,100.43 " "$40,956.90 " N/A "$38,909.05 " "$159,570.95 " 330104 50 1 Non-bacterial infections of nervous system exc viral meningitis I N/A "$5,420.00 " N/A "$5,420.00 " N/A N/A N/A N/A "$5,149.00 " N/A "$5,203.20 " N/A N/A N/A N/A N/A "$6,937.60 " "$5,420.00 " N/A N/A N/A N/A "$5,582.60 " N/A N/A "$7,588.00 " "$20,068.37 " "$5,420.00 " "$7,317.00 " "$6,666.60 " N/A "$5,582.60 " N/A N/A N/A N/A N/A "$5,420.00 " "$17,623.99 " "$11,111.00 " "$5,420.00 " "$5,420.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,420.00 " "$5,420.00 " "$6,233.00 " "$5,420.00 " N/A "$5,149.00 " "$20,068.37 " 330104 50 2 Non-bacterial infections of nervous system exc viral meningitis I N/A "$9,520.67 " N/A "$9,520.67 " N/A N/A N/A N/A "$9,044.64 " N/A "$9,139.84 " N/A N/A N/A N/A N/A "$12,186.46 " "$9,520.67 " N/A N/A N/A N/A "$9,806.29 " N/A N/A "$13,328.94 " "$36,165.85 " "$9,520.67 " "$12,852.91 " "$11,710.43 " N/A "$9,806.29 " N/A N/A N/A N/A N/A "$9,520.67 " "$31,760.76 " "$19,517.38 " "$9,520.67 " "$9,520.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,520.67 " "$9,520.67 " "$10,948.77 " "$9,520.67 " N/A "$9,044.64 " "$36,165.85 " 330104 50 3 Non-bacterial infections of nervous system exc viral meningitis I N/A "$15,324.96 " N/A "$15,324.96 " N/A N/A N/A N/A "$14,558.72 " N/A "$14,711.97 " N/A N/A N/A N/A N/A "$19,615.95 " "$15,324.96 " N/A N/A N/A N/A "$15,784.71 " N/A N/A "$21,454.95 " "$58,951.00 " "$15,324.96 " "$20,688.70 " "$18,849.71 " N/A "$15,784.71 " N/A N/A N/A N/A N/A "$15,324.96 " "$51,770.62 " "$31,416.18 " "$15,324.96 " "$15,324.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,324.96 " "$15,324.96 " "$17,623.71 " "$15,324.96 " N/A "$14,558.72 " "$58,951.00 " 330104 50 4 Non-bacterial infections of nervous system exc viral meningitis I N/A "$36,726.80 " N/A "$36,726.80 " N/A N/A N/A N/A "$34,890.46 " N/A "$35,257.73 " N/A N/A N/A N/A N/A "$47,010.31 " "$36,726.80 " N/A N/A N/A N/A "$37,828.61 " N/A N/A "$51,417.52 " "$142,965.41 " "$36,726.80 " "$49,581.18 " "$45,173.97 " N/A "$37,828.61 " N/A N/A N/A N/A N/A "$36,726.80 " "$125,551.86 " "$75,289.94 " "$36,726.80 " "$36,726.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$36,726.80 " "$36,726.80 " "$42,235.82 " "$36,726.80 " N/A "$34,890.46 " "$142,965.41 " 330104 51 1 Viral meningitis I N/A "$4,511.99 " N/A "$4,511.99 " N/A N/A N/A N/A "$4,286.39 " N/A "$4,331.51 " N/A N/A N/A N/A N/A "$5,775.35 " "$4,511.99 " N/A N/A N/A N/A "$4,647.35 " N/A N/A "$6,316.79 " "$16,503.93 " "$4,511.99 " "$6,091.19 " "$5,549.75 " N/A "$4,647.35 " N/A N/A N/A N/A N/A "$4,511.99 " "$14,493.71 " "$9,249.58 " "$4,511.99 " "$4,511.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,511.99 " "$4,511.99 " "$5,188.79 " "$4,511.99 " N/A "$4,286.39 " "$16,503.93 " 330104 51 2 Viral meningitis I N/A "$5,642.74 " N/A "$5,642.74 " N/A N/A N/A N/A "$5,360.61 " N/A "$5,417.03 " N/A N/A N/A N/A N/A "$7,222.71 " "$5,642.74 " N/A N/A N/A N/A "$5,812.02 " N/A N/A "$7,899.84 " "$20,942.77 " "$5,642.74 " "$7,617.70 " "$6,940.57 " N/A "$5,812.02 " N/A N/A N/A N/A N/A "$5,642.74 " "$18,391.89 " "$11,567.62 " "$5,642.74 " "$5,642.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,642.74 " "$5,642.74 " "$6,489.15 " "$5,642.74 " N/A "$5,360.61 " "$20,942.77 " 330104 51 3 Viral meningitis I N/A "$10,639.84 " N/A "$10,639.84 " N/A N/A N/A N/A "$10,107.85 " N/A "$10,214.25 " N/A N/A N/A N/A N/A "$13,619.00 " "$10,639.84 " N/A N/A N/A N/A "$10,959.04 " N/A N/A "$14,895.78 " "$40,559.23 " "$10,639.84 " "$14,363.79 " "$13,087.01 " N/A "$10,959.04 " N/A N/A N/A N/A N/A "$10,639.84 " "$35,619.01 " "$21,811.68 " "$10,639.84 " "$10,639.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,639.84 " "$10,639.84 " "$12,235.82 " "$10,639.84 " N/A "$10,107.85 " "$40,559.23 " 330104 51 4 Viral meningitis I N/A "$12,098.24 " N/A "$12,098.24 " N/A N/A N/A N/A "$11,493.33 " N/A "$11,614.31 " N/A N/A N/A N/A N/A "$15,485.74 " "$12,098.24 " N/A N/A N/A N/A "$12,461.19 " N/A N/A "$16,937.53 " "$46,284.27 " "$12,098.24 " "$16,332.62 " "$14,880.83 " N/A "$12,461.19 " N/A N/A N/A N/A N/A "$12,098.24 " "$40,646.72 " "$24,801.39 " "$12,098.24 " "$12,098.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,098.24 " "$12,098.24 " "$13,912.97 " "$12,098.24 " N/A "$11,493.33 " "$46,284.27 " 330104 52 1 Nontraumatic stupor & coma I N/A "$4,090.34 " N/A "$4,090.34 " N/A N/A N/A N/A "$3,885.83 " N/A "$3,926.73 " N/A N/A N/A N/A N/A "$5,235.64 " "$4,090.34 " N/A N/A N/A N/A "$4,213.06 " N/A N/A "$5,726.48 " "$14,848.72 " "$4,090.34 " "$5,521.97 " "$5,031.12 " N/A "$4,213.06 " N/A N/A N/A N/A N/A "$4,090.34 " "$13,040.11 " "$8,385.21 " "$4,090.34 " "$4,090.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,090.34 " "$4,090.34 " "$4,703.90 " "$4,090.34 " N/A "$3,885.83 " "$14,848.72 " 330104 52 2 Nontraumatic stupor & coma I N/A "$5,258.56 " N/A "$5,258.56 " N/A N/A N/A N/A "$4,995.63 " N/A "$5,048.22 " N/A N/A N/A N/A N/A "$6,730.96 " "$5,258.56 " N/A N/A N/A N/A "$5,416.32 " N/A N/A "$7,361.98 " "$19,434.63 " "$5,258.56 " "$7,099.06 " "$6,468.03 " N/A "$5,416.32 " N/A N/A N/A N/A N/A "$5,258.56 " "$17,067.44 " "$10,780.05 " "$5,258.56 " "$5,258.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,258.56 " "$5,258.56 " "$6,047.34 " "$5,258.56 " N/A "$4,995.63 " "$19,434.63 " 330104 52 3 Nontraumatic stupor & coma I N/A "$7,135.20 " N/A "$7,135.20 " N/A N/A N/A N/A "$6,778.44 " N/A "$6,849.79 " N/A N/A N/A N/A N/A "$9,133.05 " "$7,135.20 " N/A N/A N/A N/A "$7,349.25 " N/A N/A "$9,989.28 " "$26,801.50 " "$7,135.20 " "$9,632.52 " "$8,776.29 " N/A "$7,349.25 " N/A N/A N/A N/A N/A "$7,135.20 " "$23,537.01 " "$14,627.15 " "$7,135.20 " "$7,135.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,135.20 " "$7,135.20 " "$8,205.48 " "$7,135.20 " N/A "$6,778.44 " "$26,801.50 " 330104 52 4 Nontraumatic stupor & coma I N/A "$15,819.50 " N/A "$15,819.50 " N/A N/A N/A N/A "$15,028.52 " N/A "$15,186.72 " N/A N/A N/A N/A N/A "$20,248.96 " "$15,819.50 " N/A N/A N/A N/A "$16,294.08 " N/A N/A "$22,147.30 " "$60,892.33 " "$15,819.50 " "$21,356.32 " "$19,457.98 " N/A "$16,294.08 " N/A N/A N/A N/A N/A "$15,819.50 " "$53,475.49 " "$32,429.97 " "$15,819.50 " "$15,819.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,819.50 " "$15,819.50 " "$18,192.42 " "$15,819.50 " N/A "$15,028.52 " "$60,892.33 " 330104 53 1 Seizure I N/A "$3,631.91 " N/A "$3,631.91 " N/A N/A N/A N/A "$3,450.32 " N/A "$3,486.64 " N/A N/A N/A N/A N/A "$4,648.85 " "$3,631.91 " N/A N/A N/A N/A "$3,740.87 " N/A N/A "$5,084.68 " "$13,049.12 " "$3,631.91 " "$4,903.08 " "$4,467.25 " N/A "$3,740.87 " N/A N/A N/A N/A N/A "$3,631.91 " "$11,459.70 " "$7,445.42 " "$3,631.91 " "$3,631.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,631.91 " "$3,631.91 " "$4,176.70 " "$3,631.91 " N/A "$3,450.32 " "$13,049.12 " 330104 53 2 Seizure I N/A "$4,272.90 " N/A "$4,272.90 " N/A N/A N/A N/A "$4,059.25 " N/A "$4,101.98 " N/A N/A N/A N/A N/A "$5,469.31 " "$4,272.90 " N/A N/A N/A N/A "$4,401.09 " N/A N/A "$5,982.06 " "$15,565.35 " "$4,272.90 " "$5,768.41 " "$5,255.67 " N/A "$4,401.09 " N/A N/A N/A N/A N/A "$4,272.90 " "$13,669.45 " "$8,759.44 " "$4,272.90 " "$4,272.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,272.90 " "$4,272.90 " "$4,913.83 " "$4,272.90 " N/A "$4,059.25 " "$15,565.35 " 330104 53 3 Seizure I N/A "$5,892.73 " N/A "$5,892.73 " N/A N/A N/A N/A "$5,598.10 " N/A "$5,657.02 " N/A N/A N/A N/A N/A "$7,542.70 " "$5,892.73 " N/A N/A N/A N/A "$6,069.52 " N/A N/A "$8,249.83 " "$21,924.13 " "$5,892.73 " "$7,955.19 " "$7,248.06 " N/A "$6,069.52 " N/A N/A N/A N/A N/A "$5,892.73 " "$19,253.71 " "$12,080.10 " "$5,892.73 " "$5,892.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,892.73 " "$5,892.73 " "$6,776.64 " "$5,892.73 " N/A "$5,598.10 " "$21,924.13 " 330104 53 4 Seizure I N/A "$18,542.15 " N/A "$18,542.15 " N/A N/A N/A N/A "$17,615.05 " N/A "$17,800.47 " N/A N/A N/A N/A N/A "$23,733.96 " "$18,542.15 " N/A N/A N/A N/A "$19,098.42 " N/A N/A "$25,959.02 " "$71,580.31 " "$18,542.15 " "$25,031.91 " "$22,806.85 " N/A "$19,098.42 " N/A N/A N/A N/A N/A "$18,542.15 " "$62,861.64 " "$38,011.41 " "$18,542.15 " "$18,542.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,542.15 " "$18,542.15 " "$21,323.48 " "$18,542.15 " N/A "$17,615.05 " "$71,580.31 " 330104 54 1 Migraine & other headaches I N/A "$3,659.84 " N/A "$3,659.84 " N/A N/A N/A N/A "$3,476.85 " N/A "$3,513.45 " N/A N/A N/A N/A N/A "$4,684.60 " "$3,659.84 " N/A N/A N/A N/A "$3,769.64 " N/A N/A "$5,123.78 " "$13,158.75 " "$3,659.84 " "$4,940.79 " "$4,501.61 " N/A "$3,769.64 " N/A N/A N/A N/A N/A "$3,659.84 " "$11,555.98 " "$7,502.68 " "$3,659.84 " "$3,659.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,659.84 " "$3,659.84 " "$4,208.82 " "$3,659.84 " N/A "$3,476.85 " "$13,158.75 " 330104 54 2 Migraine & other headaches I N/A "$4,477.93 " N/A "$4,477.93 " N/A N/A N/A N/A "$4,254.04 " N/A "$4,298.82 " N/A N/A N/A N/A N/A "$5,731.75 " "$4,477.93 " N/A N/A N/A N/A "$4,612.27 " N/A N/A "$6,269.11 " "$16,370.23 " "$4,477.93 " "$6,045.21 " "$5,507.86 " N/A "$4,612.27 " N/A N/A N/A N/A N/A "$4,477.93 " "$14,376.29 " "$9,179.76 " "$4,477.93 " "$4,477.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,477.93 " "$4,477.93 " "$5,149.62 " "$4,477.93 " N/A "$4,254.04 " "$16,370.23 " 330104 54 3 Migraine & other headaches I N/A "$5,688.38 " N/A "$5,688.38 " N/A N/A N/A N/A "$5,403.96 " N/A "$5,460.85 " N/A N/A N/A N/A N/A "$7,281.13 " "$5,688.38 " N/A N/A N/A N/A "$5,859.03 " N/A N/A "$7,963.73 " "$21,121.93 " "$5,688.38 " "$7,679.31 " "$6,996.71 " N/A "$5,859.03 " N/A N/A N/A N/A N/A "$5,688.38 " "$18,549.22 " "$11,661.18 " "$5,688.38 " "$5,688.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,688.38 " "$5,688.38 " "$6,541.64 " "$5,688.38 " N/A "$5,403.96 " "$21,121.93 " 330104 54 4 Migraine & other headaches I N/A "$5,787.15 " N/A "$5,787.15 " N/A N/A N/A N/A "$5,497.79 " N/A "$5,555.67 " N/A N/A N/A N/A N/A "$7,407.55 " "$5,787.15 " N/A N/A N/A N/A "$5,960.77 " N/A N/A "$8,102.01 " "$21,509.66 " "$5,787.15 " "$7,812.65 " "$7,118.20 " N/A "$5,960.77 " N/A N/A N/A N/A N/A "$5,787.15 " "$18,889.73 " "$11,863.66 " "$5,787.15 " "$5,787.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,787.15 " "$5,787.15 " "$6,655.22 " "$5,787.15 " N/A "$5,497.79 " "$21,509.66 " 330104 55 1 Head trauma w coma >1 hr or hemorrhage I N/A "$4,101.24 " N/A "$4,101.24 " N/A N/A N/A N/A "$3,896.18 " N/A "$3,937.19 " N/A N/A N/A N/A N/A "$5,249.59 " "$4,101.24 " N/A N/A N/A N/A "$4,224.28 " N/A N/A "$5,741.74 " "$14,891.51 " "$4,101.24 " "$5,536.68 " "$5,044.53 " N/A "$4,224.28 " N/A N/A N/A N/A N/A "$4,101.24 " "$13,077.68 " "$8,407.55 " "$4,101.24 " "$4,101.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,101.24 " "$4,101.24 " "$4,716.43 " "$4,101.24 " N/A "$3,896.18 " "$14,891.51 " 330104 55 2 Head trauma w coma >1 hr or hemorrhage I N/A "$6,285.09 " N/A "$6,285.09 " N/A N/A N/A N/A "$5,970.84 " N/A "$6,033.69 " N/A N/A N/A N/A N/A "$8,044.92 " "$6,285.09 " N/A N/A N/A N/A "$6,473.64 " N/A N/A "$8,799.13 " "$23,464.35 " "$6,285.09 " "$8,484.87 " "$7,730.66 " N/A "$6,473.64 " N/A N/A N/A N/A N/A "$6,285.09 " "$20,606.33 " "$12,884.44 " "$6,285.09 " "$6,285.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,285.09 " "$6,285.09 " "$7,227.85 " "$6,285.09 " N/A "$5,970.84 " "$23,464.35 " 330104 55 3 Head trauma w coma >1 hr or hemorrhage I N/A "$10,530.85 " N/A "$10,530.85 " N/A N/A N/A N/A "$10,004.31 " N/A "$10,109.62 " N/A N/A N/A N/A N/A "$13,479.49 " "$10,530.85 " N/A N/A N/A N/A "$10,846.78 " N/A N/A "$14,743.20 " "$40,131.39 " "$10,530.85 " "$14,216.65 " "$12,952.95 " N/A "$10,846.78 " N/A N/A N/A N/A N/A "$10,530.85 " "$35,243.29 " "$21,588.25 " "$10,530.85 " "$10,530.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,530.85 " "$10,530.85 " "$12,110.48 " "$10,530.85 " N/A "$10,004.31 " "$40,131.39 " 330104 55 4 Head trauma w coma >1 hr or hemorrhage I N/A "$23,353.29 " N/A "$23,353.29 " N/A N/A N/A N/A "$22,185.63 " N/A "$22,419.16 " N/A N/A N/A N/A N/A "$29,892.21 " "$23,353.29 " N/A N/A N/A N/A "$24,053.89 " N/A N/A "$32,694.61 " "$90,466.77 " "$23,353.29 " "$31,526.95 " "$28,724.55 " N/A "$24,053.89 " N/A N/A N/A N/A N/A "$23,353.29 " "$79,447.69 " "$47,874.25 " "$23,353.29 " "$23,353.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,353.29 " "$23,353.29 " "$26,856.29 " "$23,353.29 " N/A "$22,185.63 " "$90,466.77 " 330104 56 1 Brain contusion/laceration & complicated skull Fx coma < 1 hr or no coma I N/A "$3,845.12 " N/A "$3,845.12 " N/A N/A N/A N/A "$3,652.87 " N/A "$3,691.32 " N/A N/A N/A N/A N/A "$4,921.76 " "$3,845.12 " N/A N/A N/A N/A "$3,960.48 " N/A N/A "$5,383.17 " "$13,886.08 " "$3,845.12 " "$5,190.91 " "$4,729.50 " N/A "$3,960.48 " N/A N/A N/A N/A N/A "$3,845.12 " "$12,194.72 " "$7,882.50 " "$3,845.12 " "$3,845.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,845.12 " "$3,845.12 " "$4,421.89 " "$3,845.12 " N/A "$3,652.87 " "$13,886.08 " 330104 56 2 Brain contusion/laceration & complicated skull Fx coma < 1 hr or no coma I N/A "$5,768.08 " N/A "$5,768.08 " N/A N/A N/A N/A "$5,479.67 " N/A "$5,537.36 " N/A N/A N/A N/A N/A "$7,383.14 " "$5,768.08 " N/A N/A N/A N/A "$5,941.12 " N/A N/A "$8,075.31 " "$21,434.78 " "$5,768.08 " "$7,786.91 " "$7,094.74 " N/A "$5,941.12 " N/A N/A N/A N/A N/A "$5,768.08 " "$18,823.97 " "$11,824.56 " "$5,768.08 " "$5,768.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,768.08 " "$5,768.08 " "$6,633.29 " "$5,768.08 " N/A "$5,479.67 " "$21,434.78 " 330104 56 3 Brain contusion/laceration & complicated skull Fx coma < 1 hr or no coma I N/A "$10,026.10 " N/A "$10,026.10 " N/A N/A N/A N/A "$9,524.80 " N/A "$9,625.06 " N/A N/A N/A N/A N/A "$12,833.41 " "$10,026.10 " N/A N/A N/A N/A "$10,326.89 " N/A N/A "$14,036.55 " "$38,149.96 " "$10,026.10 " "$13,535.24 " "$12,332.11 " N/A "$10,326.89 " N/A N/A N/A N/A N/A "$10,026.10 " "$33,503.20 " "$20,553.51 " "$10,026.10 " "$10,026.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,026.10 " "$10,026.10 " "$11,530.02 " "$10,026.10 " N/A "$9,524.80 " "$38,149.96 " 330104 56 4 Brain contusion/laceration & complicated skull Fx coma < 1 hr or no coma I N/A "$26,219.68 " N/A "$26,219.68 " N/A N/A N/A N/A "$24,908.69 " N/A "$25,170.89 " N/A N/A N/A N/A N/A "$33,561.19 " "$26,219.68 " N/A N/A N/A N/A "$27,006.27 " N/A N/A "$36,707.55 " "$101,718.96 " "$26,219.68 " "$35,396.56 " "$32,250.20 " N/A "$27,006.27 " N/A N/A N/A N/A N/A "$26,219.68 " "$89,329.33 " "$53,750.34 " "$26,219.68 " "$26,219.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,219.68 " "$26,219.68 " "$30,152.63 " "$26,219.68 " N/A "$24,908.69 " "$101,718.96 " 330104 57 1 Concussion closed skull Fx nosuncomplicated intracranial injury coma < 1 hr or no coma I N/A "$3,011.36 " N/A "$3,011.36 " N/A N/A N/A N/A "$2,860.80 " N/A "$2,890.91 " N/A N/A N/A N/A N/A "$3,854.55 " "$3,011.36 " N/A N/A N/A N/A "$3,101.70 " N/A N/A "$4,215.91 " "$10,613.11 " "$3,011.36 " "$4,065.34 " "$3,703.98 " N/A "$3,101.70 " N/A N/A N/A N/A N/A "$3,011.36 " "$9,320.40 " "$6,173.30 " "$3,011.36 " "$3,011.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,011.36 " "$3,011.36 " "$3,463.07 " "$3,011.36 " N/A "$2,860.80 " "$10,613.11 " 330104 57 2 Concussion closed skull Fx nosuncomplicated intracranial injury coma < 1 hr or no coma I N/A "$3,985.44 " N/A "$3,985.44 " N/A N/A N/A N/A "$3,786.17 " N/A "$3,826.03 " N/A N/A N/A N/A N/A "$5,101.37 " "$3,985.44 " N/A N/A N/A N/A "$4,105.01 " N/A N/A "$5,579.62 " "$14,436.93 " "$3,985.44 " "$5,380.35 " "$4,902.10 " N/A "$4,105.01 " N/A N/A N/A N/A N/A "$3,985.44 " "$12,678.47 " "$8,170.16 " "$3,985.44 " "$3,985.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,985.44 " "$3,985.44 " "$4,583.26 " "$3,985.44 " N/A "$3,786.17 " "$14,436.93 " 330104 57 3 Concussion closed skull Fx nosuncomplicated intracranial injury coma < 1 hr or no coma I N/A "$6,904.28 " N/A "$6,904.28 " N/A N/A N/A N/A "$6,559.06 " N/A "$6,628.11 " N/A N/A N/A N/A N/A "$8,837.48 " "$6,904.28 " N/A N/A N/A N/A "$7,111.41 " N/A N/A "$9,665.99 " "$25,895.02 " "$6,904.28 " "$9,320.78 " "$8,492.26 " N/A "$7,111.41 " N/A N/A N/A N/A N/A "$6,904.28 " "$22,740.94 " "$14,153.77 " "$6,904.28 " "$6,904.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,904.28 " "$6,904.28 " "$7,939.92 " "$6,904.28 " N/A "$6,559.06 " "$25,895.02 " 330104 57 4 Concussion closed skull Fx nosuncomplicated intracranial injury coma < 1 hr or no coma I N/A "$20,428.33 " N/A "$20,428.33 " N/A N/A N/A N/A "$19,406.91 " N/A "$19,611.19 " N/A N/A N/A N/A N/A "$26,148.26 " "$20,428.33 " N/A N/A N/A N/A "$21,041.18 " N/A N/A "$28,599.66 " "$78,984.61 " "$20,428.33 " "$27,578.24 " "$25,126.84 " N/A "$21,041.18 " N/A N/A N/A N/A N/A "$20,428.33 " "$69,364.09 " "$41,878.07 " "$20,428.33 " "$20,428.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,428.33 " "$20,428.33 " "$23,492.58 " "$20,428.33 " N/A "$19,406.91 " "$78,984.61 " 330104 58 1 Other disorders of nervous system I N/A "$3,975.91 " N/A "$3,975.91 " N/A N/A N/A N/A "$3,777.11 " N/A "$3,816.87 " N/A N/A N/A N/A N/A "$5,089.16 " "$3,975.91 " N/A N/A N/A N/A "$4,095.18 " N/A N/A "$5,566.27 " "$14,399.49 " "$3,975.91 " "$5,367.47 " "$4,890.37 " N/A "$4,095.18 " N/A N/A N/A N/A N/A "$3,975.91 " "$12,645.60 " "$8,150.61 " "$3,975.91 " "$3,975.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,975.91 " "$3,975.91 " "$4,572.29 " "$3,975.91 " N/A "$3,777.11 " "$14,399.49 " 330104 58 2 Other disorders of nervous system I N/A "$5,640.70 " N/A "$5,640.70 " N/A N/A N/A N/A "$5,358.66 " N/A "$5,415.07 " N/A N/A N/A N/A N/A "$7,220.09 " "$5,640.70 " N/A N/A N/A N/A "$5,809.92 " N/A N/A "$7,896.98 " "$20,934.75 " "$5,640.70 " "$7,614.94 " "$6,938.06 " N/A "$5,809.92 " N/A N/A N/A N/A N/A "$5,640.70 " "$18,384.84 " "$11,563.43 " "$5,640.70 " "$5,640.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,640.70 " "$5,640.70 " "$6,486.80 " "$5,640.70 " N/A "$5,358.66 " "$20,934.75 " 330104 58 3 Other disorders of nervous system I N/A "$8,919.88 " N/A "$8,919.88 " N/A N/A N/A N/A "$8,473.88 " N/A "$8,563.08 " N/A N/A N/A N/A N/A "$11,417.44 " "$8,919.88 " N/A N/A N/A N/A "$9,187.47 " N/A N/A "$12,487.83 " "$33,807.38 " "$8,919.88 " "$12,041.83 " "$10,971.45 " N/A "$9,187.47 " N/A N/A N/A N/A N/A "$8,919.88 " "$29,689.56 " "$18,285.74 " "$8,919.88 " "$8,919.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,919.88 " "$8,919.88 " "$10,257.86 " "$8,919.88 " N/A "$8,473.88 " "$33,807.38 " 330104 58 4 Other disorders of nervous system I N/A "$23,388.03 " N/A "$23,388.03 " N/A N/A N/A N/A "$22,218.63 " N/A "$22,452.51 " N/A N/A N/A N/A N/A "$29,936.68 " "$23,388.03 " N/A N/A N/A N/A "$24,089.67 " N/A N/A "$32,743.25 " "$90,603.14 " "$23,388.03 " "$31,573.84 " "$28,767.28 " N/A "$24,089.67 " N/A N/A N/A N/A N/A "$23,388.03 " "$79,567.45 " "$47,945.47 " "$23,388.03 " "$23,388.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,388.03 " "$23,388.03 " "$26,896.24 " "$23,388.03 " N/A "$22,218.63 " "$90,603.14 " 330104 70 1 Orbital procedures I N/A "$5,785.79 " N/A "$5,785.79 " N/A N/A N/A N/A "$5,496.50 " N/A "$5,554.36 " N/A N/A N/A N/A N/A "$7,405.81 " "$5,785.79 " N/A N/A N/A N/A "$5,959.36 " N/A N/A "$8,100.11 " "$21,504.31 " "$5,785.79 " "$7,810.82 " "$7,116.52 " N/A "$5,959.36 " N/A N/A N/A N/A N/A "$5,785.79 " "$18,885.03 " "$11,860.87 " "$5,785.79 " "$5,785.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,785.79 " "$5,785.79 " "$6,653.66 " "$5,785.79 " N/A "$5,496.50 " "$21,504.31 " 330104 70 2 Orbital procedures I N/A "$8,712.12 " N/A "$8,712.12 " N/A N/A N/A N/A "$8,276.51 " N/A "$8,363.63 " N/A N/A N/A N/A N/A "$11,151.51 " "$8,712.12 " N/A N/A N/A N/A "$8,973.48 " N/A N/A "$12,196.96 " "$32,991.81 " "$8,712.12 " "$11,761.36 " "$10,715.90 " N/A "$8,973.48 " N/A N/A N/A N/A N/A "$8,712.12 " "$28,973.33 " "$17,859.84 " "$8,712.12 " "$8,712.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,712.12 " "$8,712.12 " "$10,018.93 " "$8,712.12 " N/A "$8,276.51 " "$32,991.81 " 330104 70 3 Orbital procedures I N/A "$14,196.26 " N/A "$14,196.26 " N/A N/A N/A N/A "$13,486.44 " N/A "$13,628.41 " N/A N/A N/A N/A N/A "$18,171.21 " "$14,196.26 " N/A N/A N/A N/A "$14,622.14 " N/A N/A "$19,874.76 " "$54,520.19 " "$14,196.26 " "$19,164.95 " "$17,461.40 " N/A "$14,622.14 " N/A N/A N/A N/A N/A "$14,196.26 " "$47,879.49 " "$29,102.33 " "$14,196.26 " "$14,196.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,196.26 " "$14,196.26 " "$16,325.70 " "$14,196.26 " N/A "$13,486.44 " "$54,520.19 " 330104 70 4 Orbital procedures I N/A "$16,115.81 " N/A "$16,115.81 " N/A N/A N/A N/A "$15,310.02 " N/A "$15,471.18 " N/A N/A N/A N/A N/A "$20,628.23 " "$16,115.81 " N/A N/A N/A N/A "$16,599.28 " N/A N/A "$22,562.13 " "$62,055.52 " "$16,115.81 " "$21,756.34 " "$19,822.44 " N/A "$16,599.28 " N/A N/A N/A N/A N/A "$16,115.81 " "$54,497.00 " "$33,037.41 " "$16,115.81 " "$16,115.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,115.81 " "$16,115.81 " "$18,533.18 " "$16,115.81 " N/A "$15,310.02 " "$62,055.52 " 330104 73 1 Eye procedures except orbit I N/A "$4,796.72 " N/A "$4,796.72 " N/A N/A N/A N/A "$4,556.89 " N/A "$4,604.85 " N/A N/A N/A N/A N/A "$6,139.81 " "$4,796.72 " N/A N/A N/A N/A "$4,940.62 " N/A N/A "$6,715.41 " "$17,621.66 " "$4,796.72 " "$6,475.58 " "$5,899.97 " N/A "$4,940.62 " N/A N/A N/A N/A N/A "$4,796.72 " "$15,475.30 " "$9,833.28 " "$4,796.72 " "$4,796.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,796.72 " "$4,796.72 " "$5,516.23 " "$4,796.72 " N/A "$4,556.89 " "$17,621.66 " 330104 73 2 Eye procedures except orbit I N/A "$6,070.52 " N/A "$6,070.52 " N/A N/A N/A N/A "$5,766.99 " N/A "$5,827.70 " N/A N/A N/A N/A N/A "$7,770.27 " "$6,070.52 " N/A N/A N/A N/A "$6,252.64 " N/A N/A "$8,498.73 " "$22,622.04 " "$6,070.52 " "$8,195.20 " "$7,466.74 " N/A "$6,252.64 " N/A N/A N/A N/A N/A "$6,070.52 " "$19,866.62 " "$12,444.57 " "$6,070.52 " "$6,070.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,070.52 " "$6,070.52 " "$6,981.10 " "$6,070.52 " N/A "$5,766.99 " "$22,622.04 " 330104 73 3 Eye procedures except orbit I N/A "$17,097.38 " N/A "$17,097.38 " N/A N/A N/A N/A "$16,242.51 " N/A "$16,413.49 " N/A N/A N/A N/A N/A "$21,884.65 " "$17,097.38 " N/A N/A N/A N/A "$17,610.30 " N/A N/A "$23,936.33 " "$65,908.75 " "$17,097.38 " "$23,081.46 " "$21,029.78 " N/A "$17,610.30 " N/A N/A N/A N/A N/A "$17,097.38 " "$57,880.90 " "$35,049.63 " "$17,097.38 " "$17,097.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,097.38 " "$17,097.38 " "$19,661.99 " "$17,097.38 " N/A "$16,242.51 " "$65,908.75 " 330104 73 4 Eye procedures except orbit I N/A "$17,858.94 " N/A "$17,858.94 " N/A N/A N/A N/A "$16,965.99 " N/A "$17,144.58 " N/A N/A N/A N/A N/A "$22,859.44 " "$17,858.94 " N/A N/A N/A N/A "$18,394.70 " N/A N/A "$25,002.51 " "$68,898.28 " "$17,858.94 " "$24,109.56 " "$21,966.49 " N/A "$18,394.70 " N/A N/A N/A N/A N/A "$17,858.94 " "$60,506.30 " "$36,610.82 " "$17,858.94 " "$17,858.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,858.94 " "$17,858.94 " "$20,537.78 " "$17,858.94 " N/A "$16,965.99 " "$68,898.28 " 330104 80 1 Acute major eye infections I N/A "$4,052.20 " N/A "$4,052.20 " N/A N/A N/A N/A "$3,849.59 " N/A "$3,890.11 " N/A N/A N/A N/A N/A "$5,186.81 " "$4,052.20 " N/A N/A N/A N/A "$4,173.76 " N/A N/A "$5,673.08 " "$14,698.98 " "$4,052.20 " "$5,470.47 " "$4,984.20 " N/A "$4,173.76 " N/A N/A N/A N/A N/A "$4,052.20 " "$12,908.61 " "$8,307.01 " "$4,052.20 " "$4,052.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,052.20 " "$4,052.20 " "$4,660.03 " "$4,052.20 " N/A "$3,849.59 " "$14,698.98 " 330104 80 2 Acute major eye infections I N/A "$5,091.67 " N/A "$5,091.67 " N/A N/A N/A N/A "$4,837.09 " N/A "$4,888.01 " N/A N/A N/A N/A N/A "$6,517.34 " "$5,091.67 " N/A N/A N/A N/A "$5,244.42 " N/A N/A "$7,128.34 " "$18,779.50 " "$5,091.67 " "$6,873.76 " "$6,262.76 " N/A "$5,244.42 " N/A N/A N/A N/A N/A "$5,091.67 " "$16,492.11 " "$10,437.93 " "$5,091.67 " "$5,091.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,091.67 " "$5,091.67 " "$5,855.42 " "$5,091.67 " N/A "$4,837.09 " "$18,779.50 " 330104 80 3 Acute major eye infections I N/A "$8,558.17 " N/A "$8,558.17 " N/A N/A N/A N/A "$8,130.26 " N/A "$8,215.84 " N/A N/A N/A N/A N/A "$10,954.46 " "$8,558.17 " N/A N/A N/A N/A "$8,814.92 " N/A N/A "$11,981.44 " "$32,387.49 " "$8,558.17 " "$11,553.53 " "$10,526.55 " N/A "$8,814.92 " N/A N/A N/A N/A N/A "$8,558.17 " "$28,442.61 " "$17,544.25 " "$8,558.17 " "$8,558.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,558.17 " "$8,558.17 " "$9,841.90 " "$8,558.17 " N/A "$8,130.26 " "$32,387.49 " 330104 80 4 Acute major eye infections I N/A "$9,517.27 " N/A "$9,517.27 " N/A N/A N/A N/A "$9,041.40 " N/A "$9,136.58 " N/A N/A N/A N/A N/A "$12,182.10 " "$9,517.27 " N/A N/A N/A N/A "$9,802.78 " N/A N/A "$13,324.17 " "$36,152.48 " "$9,517.27 " "$12,848.31 " "$11,706.24 " N/A "$9,802.78 " N/A N/A N/A N/A N/A "$9,517.27 " "$31,749.02 " "$19,510.40 " "$9,517.27 " "$9,517.27 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,517.27 " "$9,517.27 " "$10,944.86 " "$9,517.27 " N/A "$9,041.40 " "$36,152.48 " 330104 82 1 Eye disorders except major infections I N/A "$3,642.13 " N/A "$3,642.13 " N/A N/A N/A N/A "$3,460.03 " N/A "$3,496.45 " N/A N/A N/A N/A N/A "$4,661.93 " "$3,642.13 " N/A N/A N/A N/A "$3,751.40 " N/A N/A "$5,098.98 " "$13,089.23 " "$3,642.13 " "$4,916.88 " "$4,479.82 " N/A "$3,751.40 " N/A N/A N/A N/A N/A "$3,642.13 " "$11,494.93 " "$7,466.37 " "$3,642.13 " "$3,642.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,642.13 " "$3,642.13 " "$4,188.45 " "$3,642.13 " N/A "$3,460.03 " "$13,089.23 " 330104 82 2 Eye disorders except major infections I N/A "$4,350.55 " N/A "$4,350.55 " N/A N/A N/A N/A "$4,133.03 " N/A "$4,176.53 " N/A N/A N/A N/A N/A "$5,568.71 " "$4,350.55 " N/A N/A N/A N/A "$4,481.07 " N/A N/A "$6,090.78 " "$15,870.19 " "$4,350.55 " "$5,873.25 " "$5,351.18 " N/A "$4,481.07 " N/A N/A N/A N/A N/A "$4,350.55 " "$13,937.16 " "$8,918.63 " "$4,350.55 " "$4,350.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,350.55 " "$4,350.55 " "$5,003.14 " "$4,350.55 " N/A "$4,133.03 " "$15,870.19 " 330104 82 3 Eye disorders except major infections I N/A "$7,297.32 " N/A "$7,297.32 " N/A N/A N/A N/A "$6,932.45 " N/A "$7,005.42 " N/A N/A N/A N/A N/A "$9,340.57 " "$7,297.32 " N/A N/A N/A N/A "$7,516.24 " N/A N/A "$10,216.24 " "$27,437.91 " "$7,297.32 " "$9,851.38 " "$8,975.70 " N/A "$7,516.24 " N/A N/A N/A N/A N/A "$7,297.32 " "$24,095.91 " "$14,959.50 " "$7,297.32 " "$7,297.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,297.32 " "$7,297.32 " "$8,391.91 " "$7,297.32 " N/A "$6,932.45 " "$27,437.91 " 330104 82 4 Eye disorders except major infections I N/A "$7,493.50 " N/A "$7,493.50 " N/A N/A N/A N/A "$7,118.82 " N/A "$7,193.76 " N/A N/A N/A N/A N/A "$9,591.67 " "$7,493.50 " N/A N/A N/A N/A "$7,718.30 " N/A N/A "$10,490.89 " "$28,208.03 " "$7,493.50 " "$10,116.22 " "$9,217.00 " N/A "$7,718.30 " N/A N/A N/A N/A N/A "$7,493.50 " "$24,772.22 " "$15,361.66 " "$7,493.50 " "$7,493.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,493.50 " "$7,493.50 " "$8,617.52 " "$7,493.50 " N/A "$7,118.82 " "$28,208.03 " 330104 89 1 Major cranial/facial bone procedures I N/A "$9,594.92 " N/A "$9,594.92 " N/A N/A N/A N/A "$9,115.17 " N/A "$9,211.12 " N/A N/A N/A N/A N/A "$12,281.50 " "$9,594.92 " N/A N/A N/A N/A "$9,882.77 " N/A N/A "$13,432.89 " "$36,457.32 " "$9,594.92 " "$12,953.14 " "$11,801.75 " N/A "$9,882.77 " N/A N/A N/A N/A N/A "$9,594.92 " "$32,016.72 " "$19,669.59 " "$9,594.92 " "$9,594.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,594.92 " "$9,594.92 " "$11,034.16 " "$9,594.92 " N/A "$9,115.17 " "$36,457.32 " 330104 89 2 Major cranial/facial bone procedures I N/A "$15,036.15 " N/A "$15,036.15 " N/A N/A N/A N/A "$14,284.34 " N/A "$14,434.70 " N/A N/A N/A N/A N/A "$19,246.27 " "$15,036.15 " N/A N/A N/A N/A "$15,487.23 " N/A N/A "$21,050.60 " "$57,817.23 " "$15,036.15 " "$20,298.80 " "$18,494.46 " N/A "$15,487.23 " N/A N/A N/A N/A N/A "$15,036.15 " "$50,774.94 " "$30,824.10 " "$15,036.15 " "$15,036.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,036.15 " "$15,036.15 " "$17,291.57 " "$15,036.15 " N/A "$14,284.34 " "$57,817.23 " 330104 89 3 Major cranial/facial bone procedures I N/A "$26,260.55 " N/A "$26,260.55 " N/A N/A N/A N/A "$24,947.52 " N/A "$25,210.13 " N/A N/A N/A N/A N/A "$33,613.50 " "$26,260.55 " N/A N/A N/A N/A "$27,048.36 " N/A N/A "$36,764.77 " "$101,879.40 " "$26,260.55 " "$35,451.74 " "$32,300.47 " N/A "$27,048.36 " N/A N/A N/A N/A N/A "$26,260.55 " "$89,470.23 " "$53,834.12 " "$26,260.55 " "$26,260.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,260.55 " "$26,260.55 " "$30,199.63 " "$26,260.55 " N/A "$24,947.52 " "$101,879.40 " 330104 89 4 Major cranial/facial bone procedures I N/A "$46,754.38 " N/A "$46,754.38 " N/A N/A N/A N/A "$44,416.66 " N/A "$44,884.20 " N/A N/A N/A N/A N/A "$59,845.60 " "$46,754.38 " N/A N/A N/A N/A "$48,157.01 " N/A N/A "$65,456.13 " "$182,329.36 " "$46,754.38 " "$63,118.41 " "$57,507.89 " N/A "$48,157.01 " N/A N/A N/A N/A N/A "$46,754.38 " "$160,121.18 " "$95,846.48 " "$46,754.38 " "$46,754.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$46,754.38 " "$46,754.38 " "$53,767.54 " "$46,754.38 " N/A "$44,416.66 " "$182,329.36 " 330104 90 1 Major larynx & trachea procedures I N/A "$5,475.17 " N/A "$5,475.17 " N/A N/A N/A N/A "$5,201.41 " N/A "$5,256.17 " N/A N/A N/A N/A N/A "$7,008.22 " "$5,475.17 " N/A N/A N/A N/A "$5,639.43 " N/A N/A "$7,665.24 " "$20,284.96 " "$5,475.17 " "$7,391.48 " "$6,734.46 " N/A "$5,639.43 " N/A N/A N/A N/A N/A "$5,475.17 " "$17,814.20 " "$11,224.11 " "$5,475.17 " "$5,475.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,475.17 " "$5,475.17 " "$6,296.45 " "$5,475.17 " N/A "$5,201.41 " "$20,284.96 " 330104 90 2 Major larynx & trachea procedures I N/A "$15,784.76 " N/A "$15,784.76 " N/A N/A N/A N/A "$14,995.52 " N/A "$15,153.37 " N/A N/A N/A N/A N/A "$20,204.49 " "$15,784.76 " N/A N/A N/A N/A "$16,258.30 " N/A N/A "$22,098.66 " "$60,755.95 " "$15,784.76 " "$21,309.42 " "$19,415.25 " N/A "$16,258.30 " N/A N/A N/A N/A N/A "$15,784.76 " "$53,355.72 " "$32,358.75 " "$15,784.76 " "$15,784.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,784.76 " "$15,784.76 " "$18,152.47 " "$15,784.76 " N/A "$14,995.52 " "$60,755.95 " 330104 90 3 Major larynx & trachea procedures I N/A "$28,144.68 " N/A "$28,144.68 " N/A N/A N/A N/A "$26,737.44 " N/A "$27,018.89 " N/A N/A N/A N/A N/A "$36,025.19 " "$28,144.68 " N/A N/A N/A N/A "$28,989.02 " N/A N/A "$39,402.55 " "$109,275.68 " "$28,144.68 " "$37,995.31 " "$34,617.95 " N/A "$28,989.02 " N/A N/A N/A N/A N/A "$28,144.68 " "$95,965.63 " "$57,696.59 " "$28,144.68 " "$28,144.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$28,144.68 " "$28,144.68 " "$32,366.38 " "$28,144.68 " N/A "$26,737.44 " "$109,275.68 " 330104 90 4 Major larynx & trachea procedures I N/A "$76,806.46 " N/A "$76,806.46 " N/A N/A N/A N/A "$72,966.13 " N/A "$73,734.20 " N/A N/A N/A N/A N/A "$98,312.27 " "$76,806.46 " N/A N/A N/A N/A "$79,110.65 " N/A N/A "$107,529.04 " "$300,300.90 " "$76,806.46 " "$103,688.72 " "$94,471.94 " N/A "$79,110.65 " N/A N/A N/A N/A N/A "$76,806.46 " "$263,723.48 " "$157,453.24 " "$76,806.46 " "$76,806.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$76,806.46 " "$76,806.46 " "$88,327.43 " "$76,806.46 " N/A "$72,966.13 " "$300,300.90 " 330104 91 1 Other major head & neck procedures I N/A "$9,398.74 " N/A "$9,398.74 " N/A N/A N/A N/A "$8,928.80 " N/A "$9,022.79 " N/A N/A N/A N/A N/A "$12,030.39 " "$9,398.74 " N/A N/A N/A N/A "$9,680.70 " N/A N/A "$13,158.24 " "$35,687.20 " "$9,398.74 " "$12,688.30 " "$11,560.45 " N/A "$9,680.70 " N/A N/A N/A N/A N/A "$9,398.74 " "$31,340.41 " "$19,267.42 " "$9,398.74 " "$9,398.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,398.74 " "$9,398.74 " "$10,808.55 " "$9,398.74 " N/A "$8,928.80 " "$35,687.20 " 330104 91 2 Other major head & neck procedures I N/A "$19,714.46 " N/A "$19,714.46 " N/A N/A N/A N/A "$18,728.73 " N/A "$18,925.88 " N/A N/A N/A N/A N/A "$25,234.50 " "$19,714.46 " N/A N/A N/A N/A "$20,305.89 " N/A N/A "$27,600.24 " "$76,182.26 " "$19,714.46 " "$26,614.52 " "$24,248.78 " N/A "$20,305.89 " N/A N/A N/A N/A N/A "$19,714.46 " "$66,903.07 " "$40,414.63 " "$19,714.46 " "$19,714.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,714.46 " "$19,714.46 " "$22,671.62 " "$19,714.46 " N/A "$18,728.73 " "$76,182.26 " 330104 91 3 Other major head & neck procedures I N/A "$25,406.35 " N/A "$25,406.35 " N/A N/A N/A N/A "$24,136.04 " N/A "$24,390.10 " N/A N/A N/A N/A N/A "$32,520.13 " "$25,406.35 " N/A N/A N/A N/A "$26,168.54 " N/A N/A "$35,568.90 " "$98,526.20 " "$25,406.35 " "$34,298.58 " "$31,249.82 " N/A "$26,168.54 " N/A N/A N/A N/A N/A "$25,406.35 " "$86,525.46 " "$52,083.03 " "$25,406.35 " "$25,406.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,406.35 " "$25,406.35 " "$29,217.31 " "$25,406.35 " N/A "$24,136.04 " "$98,526.20 " 330104 91 4 Other major head & neck procedures I N/A "$28,526.82 " N/A "$28,526.82 " N/A N/A N/A N/A "$27,100.48 " N/A "$27,385.74 " N/A N/A N/A N/A N/A "$36,514.33 " "$28,526.82 " N/A N/A N/A N/A "$29,382.62 " N/A N/A "$39,937.54 " "$110,775.80 " "$28,526.82 " "$38,511.20 " "$35,087.98 " N/A "$29,382.62 " N/A N/A N/A N/A N/A "$28,526.82 " "$97,283.02 " "$58,479.97 " "$28,526.82 " "$28,526.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$28,526.82 " "$28,526.82 " "$32,805.84 " "$28,526.82 " N/A "$27,100.48 " "$110,775.80 " 330104 92 1 Facial bone procedures except major cranial/facial bone procedures I N/A "$7,471.02 " N/A "$7,471.02 " N/A N/A N/A N/A "$7,097.47 " N/A "$7,172.18 " N/A N/A N/A N/A N/A "$9,562.90 " "$7,471.02 " N/A N/A N/A N/A "$7,695.15 " N/A N/A "$10,459.42 " "$28,119.78 " "$7,471.02 " "$10,085.87 " "$9,189.35 " N/A "$7,695.15 " N/A N/A N/A N/A N/A "$7,471.02 " "$24,694.72 " "$15,315.58 " "$7,471.02 " "$7,471.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,471.02 " "$7,471.02 " "$8,591.67 " "$7,471.02 " N/A "$7,097.47 " "$28,119.78 " 330104 92 2 Facial bone procedures except major cranial/facial bone procedures I N/A "$9,602.41 " N/A "$9,602.41 " N/A N/A N/A N/A "$9,122.29 " N/A "$9,218.32 " N/A N/A N/A N/A N/A "$12,291.09 " "$9,602.41 " N/A N/A N/A N/A "$9,890.49 " N/A N/A "$13,443.38 " "$36,486.73 " "$9,602.41 " "$12,963.26 " "$11,810.97 " N/A "$9,890.49 " N/A N/A N/A N/A N/A "$9,602.41 " "$32,042.55 " "$19,684.95 " "$9,602.41 " "$9,602.41 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,602.41 " "$9,602.41 " "$11,042.77 " "$9,602.41 " N/A "$9,122.29 " "$36,486.73 " 330104 92 3 Facial bone procedures except major cranial/facial bone procedures I N/A "$15,151.95 " N/A "$15,151.95 " N/A N/A N/A N/A "$14,394.35 " N/A "$14,545.87 " N/A N/A N/A N/A N/A "$19,394.49 " "$15,151.95 " N/A N/A N/A N/A "$15,606.50 " N/A N/A "$21,212.72 " "$58,271.81 " "$15,151.95 " "$20,455.13 " "$18,636.89 " N/A "$15,606.50 " N/A N/A N/A N/A N/A "$15,151.95 " "$51,174.15 " "$31,061.49 " "$15,151.95 " "$15,151.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,151.95 " "$15,151.95 " "$17,424.74 " "$15,151.95 " N/A "$14,394.35 " "$58,271.81 " 330104 92 4 Facial bone procedures except major cranial/facial bone procedures I N/A "$50,397.30 " N/A "$50,397.30 " N/A N/A N/A N/A "$47,877.44 " N/A "$48,381.41 " N/A N/A N/A N/A N/A "$64,508.55 " "$50,397.30 " N/A N/A N/A N/A "$51,909.22 " N/A N/A "$70,556.22 " "$196,629.92 " "$50,397.30 " "$68,036.36 " "$61,988.68 " N/A "$51,909.22 " N/A N/A N/A N/A N/A "$50,397.30 " "$172,679.89 " "$103,314.47 " "$50,397.30 " "$50,397.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$50,397.30 " "$50,397.30 " "$57,956.90 " "$50,397.30 " N/A "$47,877.44 " "$196,629.92 " 330104 93 1 Sinus & mastoid procedures I N/A "$6,417.92 " N/A "$6,417.92 " N/A N/A N/A N/A "$6,097.02 " N/A "$6,161.20 " N/A N/A N/A N/A N/A "$8,214.94 " "$6,417.92 " N/A N/A N/A N/A "$6,610.46 " N/A N/A "$8,985.09 " "$23,985.78 " "$6,417.92 " "$8,664.19 " "$7,894.04 " N/A "$6,610.46 " N/A N/A N/A N/A N/A "$6,417.92 " "$21,064.25 " "$13,156.74 " "$6,417.92 " "$6,417.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,417.92 " "$6,417.92 " "$7,380.61 " "$6,417.92 " N/A "$6,097.02 " "$23,985.78 " 330104 93 2 Sinus & mastoid procedures I N/A "$8,712.12 " N/A "$8,712.12 " N/A N/A N/A N/A "$8,276.51 " N/A "$8,363.63 " N/A N/A N/A N/A N/A "$11,151.51 " "$8,712.12 " N/A N/A N/A N/A "$8,973.48 " N/A N/A "$12,196.96 " "$32,991.81 " "$8,712.12 " "$11,761.36 " "$10,715.90 " N/A "$8,973.48 " N/A N/A N/A N/A N/A "$8,712.12 " "$28,973.33 " "$17,859.84 " "$8,712.12 " "$8,712.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,712.12 " "$8,712.12 " "$10,018.93 " "$8,712.12 " N/A "$8,276.51 " "$32,991.81 " 330104 93 3 Sinus & mastoid procedures I N/A "$16,438.69 " N/A "$16,438.69 " N/A N/A N/A N/A "$15,616.75 " N/A "$15,781.14 " N/A N/A N/A N/A N/A "$21,041.52 " "$16,438.69 " N/A N/A N/A N/A "$16,931.85 " N/A N/A "$23,014.16 " "$63,322.99 " "$16,438.69 " "$22,192.22 " "$20,219.58 " N/A "$16,931.85 " N/A N/A N/A N/A N/A "$16,438.69 " "$55,610.09 " "$33,699.30 " "$16,438.69 " "$16,438.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,438.69 " "$16,438.69 " "$18,904.49 " "$16,438.69 " N/A "$15,616.75 " "$63,322.99 " 330104 93 4 Sinus & mastoid procedures I N/A "$19,251.26 " N/A "$19,251.26 " N/A N/A N/A N/A "$18,288.69 " N/A "$18,481.21 " N/A N/A N/A N/A N/A "$24,641.61 " "$19,251.26 " N/A N/A N/A N/A "$19,828.79 " N/A N/A "$26,951.76 " "$74,363.94 " "$19,251.26 " "$25,989.20 " "$23,679.05 " N/A "$19,828.79 " N/A N/A N/A N/A N/A "$19,251.26 " "$65,306.22 " "$39,465.08 " "$19,251.26 " "$19,251.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,251.26 " "$19,251.26 " "$22,138.95 " "$19,251.26 " N/A "$18,288.69 " "$74,363.94 " 330104 95 1 Cleft lip & palate repair I N/A "$5,191.12 " N/A "$5,191.12 " N/A N/A N/A N/A "$4,931.57 " N/A "$4,983.48 " N/A N/A N/A N/A N/A "$6,644.64 " "$5,191.12 " N/A N/A N/A N/A "$5,346.86 " N/A N/A "$7,267.57 " "$19,169.91 " "$5,191.12 " "$7,008.02 " "$6,385.08 " N/A "$5,346.86 " N/A N/A N/A N/A N/A "$5,191.12 " "$16,834.96 " "$10,641.80 " "$5,191.12 " "$5,191.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,191.12 " "$5,191.12 " "$5,969.79 " "$5,191.12 " N/A "$4,931.57 " "$19,169.91 " 330104 95 2 Cleft lip & palate repair I N/A "$6,486.04 " N/A "$6,486.04 " N/A N/A N/A N/A "$6,161.74 " N/A "$6,226.60 " N/A N/A N/A N/A N/A "$8,302.13 " "$6,486.04 " N/A N/A N/A N/A "$6,680.62 " N/A N/A "$9,080.45 " "$24,253.18 " "$6,486.04 " "$8,756.15 " "$7,977.83 " N/A "$6,680.62 " N/A N/A N/A N/A N/A "$6,486.04 " "$21,299.08 " "$13,296.38 " "$6,486.04 " "$6,486.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,486.04 " "$6,486.04 " "$7,458.94 " "$6,486.04 " N/A "$6,161.74 " "$24,253.18 " 330104 95 3 Cleft lip & palate repair I N/A "$9,751.59 " N/A "$9,751.59 " N/A N/A N/A N/A "$9,264.01 " N/A "$9,361.53 " N/A N/A N/A N/A N/A "$12,482.04 " "$9,751.59 " N/A N/A N/A N/A "$10,044.14 " N/A N/A "$13,652.23 " "$37,072.34 " "$9,751.59 " "$13,164.65 " "$11,994.46 " N/A "$10,044.14 " N/A N/A N/A N/A N/A "$9,751.59 " "$32,556.83 " "$19,990.76 " "$9,751.59 " "$9,751.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,751.59 " "$9,751.59 " "$11,214.33 " "$9,751.59 " N/A "$9,264.01 " "$37,072.34 " 330104 95 4 Cleft lip & palate repair I N/A "$17,633.47 " N/A "$17,633.47 " N/A N/A N/A N/A "$16,751.79 " N/A "$16,928.13 " N/A N/A N/A N/A N/A "$22,570.84 " "$17,633.47 " N/A N/A N/A N/A "$18,162.47 " N/A N/A "$24,686.85 " "$68,013.19 " "$17,633.47 " "$23,805.18 " "$21,689.16 " N/A "$18,162.47 " N/A N/A N/A N/A N/A "$17,633.47 " "$59,729.01 " "$36,148.61 " "$17,633.47 " "$17,633.47 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,633.47 " "$17,633.47 " "$20,278.49 " "$17,633.47 " N/A "$16,751.79 " "$68,013.19 " 330104 97 1 Tonsil & adenoid procedures I N/A "$3,606.03 " N/A "$3,606.03 " N/A N/A N/A N/A "$3,425.73 " N/A "$3,461.79 " N/A N/A N/A N/A N/A "$4,615.72 " "$3,606.03 " N/A N/A N/A N/A "$3,714.21 " N/A N/A "$5,048.44 " "$12,947.51 " "$3,606.03 " "$4,868.14 " "$4,435.42 " N/A "$3,714.21 " N/A N/A N/A N/A N/A "$3,606.03 " "$11,370.47 " "$7,392.36 " "$3,606.03 " "$3,606.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,606.03 " "$3,606.03 " "$4,146.93 " "$3,606.03 " N/A "$3,425.73 " "$12,947.51 " 330104 97 2 Tonsil & adenoid procedures I N/A "$5,011.97 " N/A "$5,011.97 " N/A N/A N/A N/A "$4,761.38 " N/A "$4,811.50 " N/A N/A N/A N/A N/A "$6,415.33 " "$5,011.97 " N/A N/A N/A N/A "$5,162.33 " N/A N/A "$7,016.76 " "$18,466.64 " "$5,011.97 " "$6,766.17 " "$6,164.73 " N/A "$5,162.33 " N/A N/A N/A N/A N/A "$5,011.97 " "$16,217.36 " "$10,274.55 " "$5,011.97 " "$5,011.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,011.97 " "$5,011.97 " "$5,763.77 " "$5,011.97 " N/A "$4,761.38 " "$18,466.64 " 330104 97 3 Tonsil & adenoid procedures I N/A "$10,383.04 " N/A "$10,383.04 " N/A N/A N/A N/A "$9,863.89 " N/A "$9,967.72 " N/A N/A N/A N/A N/A "$13,290.29 " "$10,383.04 " N/A N/A N/A N/A "$10,694.53 " N/A N/A "$14,536.26 " "$39,551.13 " "$10,383.04 " "$14,017.10 " "$12,771.14 " N/A "$10,694.53 " N/A N/A N/A N/A N/A "$10,383.04 " "$34,733.71 " "$21,285.23 " "$10,383.04 " "$10,383.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,383.04 " "$10,383.04 " "$11,940.50 " "$10,383.04 " N/A "$9,863.89 " "$39,551.13 " 330104 97 4 Tonsil & adenoid procedures I N/A "$27,379.04 " N/A "$27,379.04 " N/A N/A N/A N/A "$26,010.09 " N/A "$26,283.88 " N/A N/A N/A N/A N/A "$35,045.17 " "$27,379.04 " N/A N/A N/A N/A "$28,200.41 " N/A N/A "$38,330.65 " "$106,270.11 " "$27,379.04 " "$36,961.70 " "$33,676.22 " N/A "$28,200.41 " N/A N/A N/A N/A N/A "$27,379.04 " "$93,326.14 " "$56,127.03 " "$27,379.04 " "$27,379.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,379.04 " "$27,379.04 " "$31,485.89 " "$27,379.04 " N/A "$26,010.09 " "$106,270.11 " 330104 98 1 Other ear nose mouth & throat procedures I N/A "$4,971.79 " N/A "$4,971.79 " N/A N/A N/A N/A "$4,723.20 " N/A "$4,772.91 " N/A N/A N/A N/A N/A "$6,363.89 " "$4,971.79 " N/A N/A N/A N/A "$5,120.94 " N/A N/A "$6,960.50 " "$18,308.88 " "$4,971.79 " "$6,711.91 " "$6,115.30 " N/A "$5,120.94 " N/A N/A N/A N/A N/A "$4,971.79 " "$16,078.81 " "$10,192.16 " "$4,971.79 " "$4,971.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,971.79 " "$4,971.79 " "$5,717.55 " "$4,971.79 " N/A "$4,723.20 " "$18,308.88 " 330104 98 2 Other ear nose mouth & throat procedures I N/A "$6,951.28 " N/A "$6,951.28 " N/A N/A N/A N/A "$6,603.72 " N/A "$6,673.23 " N/A N/A N/A N/A N/A "$8,897.64 " "$6,951.28 " N/A N/A N/A N/A "$7,159.82 " N/A N/A "$9,731.79 " "$26,079.52 " "$6,951.28 " "$9,384.23 " "$8,550.07 " N/A "$7,159.82 " N/A N/A N/A N/A N/A "$6,951.28 " "$22,902.97 " "$14,250.12 " "$6,951.28 " "$6,951.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,951.28 " "$6,951.28 " "$7,993.97 " "$6,951.28 " N/A "$6,603.72 " "$26,079.52 " 330104 98 3 Other ear nose mouth & throat procedures I N/A "$13,000.11 " N/A "$13,000.11 " N/A N/A N/A N/A "$12,350.11 " N/A "$12,480.11 " N/A N/A N/A N/A N/A "$16,640.15 " "$13,000.11 " N/A N/A N/A N/A "$13,390.12 " N/A N/A "$18,200.16 " "$49,824.64 " "$13,000.11 " "$17,550.15 " "$15,990.14 " N/A "$13,390.12 " N/A N/A N/A N/A N/A "$13,000.11 " "$43,755.87 " "$26,650.23 " "$13,000.11 " "$13,000.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,000.11 " "$13,000.11 " "$14,950.13 " "$13,000.11 " N/A "$12,350.11 " "$49,824.64 " 330104 98 4 Other ear nose mouth & throat procedures I N/A "$28,654.88 " N/A "$28,654.88 " N/A N/A N/A N/A "$27,222.13 " N/A "$27,508.68 " N/A N/A N/A N/A N/A "$36,678.24 " "$28,654.88 " N/A N/A N/A N/A "$29,514.52 " N/A N/A "$40,116.83 " "$111,278.51 " "$28,654.88 " "$38,684.08 " "$35,245.50 " N/A "$29,514.52 " N/A N/A N/A N/A N/A "$28,654.88 " "$97,724.50 " "$58,742.50 " "$28,654.88 " "$28,654.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$28,654.88 " "$28,654.88 " "$32,953.11 " "$28,654.88 " N/A "$27,222.13 " "$111,278.51 " 330104 110 1 Ear nose mouth throat cranial/facial malignancies I N/A "$5,193.17 " N/A "$5,193.17 " N/A N/A N/A N/A "$4,933.51 " N/A "$4,985.44 " N/A N/A N/A N/A N/A "$6,647.25 " "$5,193.17 " N/A N/A N/A N/A "$5,348.96 " N/A N/A "$7,270.43 " "$19,177.93 " "$5,193.17 " "$7,010.78 " "$6,387.60 " N/A "$5,348.96 " N/A N/A N/A N/A N/A "$5,193.17 " "$16,842.01 " "$10,645.99 " "$5,193.17 " "$5,193.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,193.17 " "$5,193.17 " "$5,972.14 " "$5,193.17 " N/A "$4,933.51 " "$19,177.93 " 330104 110 2 Ear nose mouth throat cranial/facial malignancies I N/A "$6,455.38 " N/A "$6,455.38 " N/A N/A N/A N/A "$6,132.62 " N/A "$6,197.17 " N/A N/A N/A N/A N/A "$8,262.89 " "$6,455.38 " N/A N/A N/A N/A "$6,649.05 " N/A N/A "$9,037.54 " "$24,132.85 " "$6,455.38 " "$8,714.77 " "$7,940.12 " N/A "$6,649.05 " N/A N/A N/A N/A N/A "$6,455.38 " "$21,193.41 " "$13,233.54 " "$6,455.38 " "$6,455.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,455.38 " "$6,455.38 " "$7,423.69 " "$6,455.38 " N/A "$6,132.62 " "$24,132.85 " 330104 110 3 Ear nose mouth throat cranial/facial malignancies I N/A "$12,388.42 " N/A "$12,388.42 " N/A N/A N/A N/A "$11,769.00 " N/A "$11,892.88 " N/A N/A N/A N/A N/A "$15,857.18 " "$12,388.42 " N/A N/A N/A N/A "$12,760.07 " N/A N/A "$17,343.79 " "$47,423.39 " "$12,388.42 " "$16,724.37 " "$15,237.75 " N/A "$12,760.07 " N/A N/A N/A N/A N/A "$12,388.42 " "$41,647.10 " "$25,396.26 " "$12,388.42 " "$12,388.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,388.42 " "$12,388.42 " "$14,246.68 " "$12,388.42 " N/A "$11,769.00 " "$47,423.39 " 330104 110 4 Ear nose mouth throat cranial/facial malignancies I N/A "$25,018.77 " N/A "$25,018.77 " N/A N/A N/A N/A "$23,767.83 " N/A "$24,018.01 " N/A N/A N/A N/A N/A "$32,024.02 " "$25,018.77 " N/A N/A N/A N/A "$25,769.33 " N/A N/A "$35,026.27 " "$97,004.70 " "$25,018.77 " "$33,775.33 " "$30,773.08 " N/A "$25,769.33 " N/A N/A N/A N/A N/A "$25,018.77 " "$85,189.28 " "$51,288.47 " "$25,018.77 " "$25,018.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,018.77 " "$25,018.77 " "$28,771.58 " "$25,018.77 " N/A "$23,767.83 " "$97,004.70 " 330104 111 1 Vertigo & other labyrinth disorders I N/A "$3,289.96 " N/A "$3,289.96 " N/A N/A N/A N/A "$3,125.47 " N/A "$3,158.37 " N/A N/A N/A N/A N/A "$4,211.15 " "$3,289.96 " N/A N/A N/A N/A "$3,388.66 " N/A N/A "$4,605.95 " "$11,706.77 " "$3,289.96 " "$4,441.45 " "$4,046.66 " N/A "$3,388.66 " N/A N/A N/A N/A N/A "$3,289.96 " "$10,280.86 " "$6,744.43 " "$3,289.96 " "$3,289.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,289.96 " "$3,289.96 " "$3,783.46 " "$3,289.96 " N/A "$3,125.47 " "$11,706.77 " 330104 111 2 Vertigo & other labyrinth disorders I N/A "$3,997.70 " N/A "$3,997.70 " N/A N/A N/A N/A "$3,797.82 " N/A "$3,837.80 " N/A N/A N/A N/A N/A "$5,117.06 " "$3,997.70 " N/A N/A N/A N/A "$4,117.64 " N/A N/A "$5,596.79 " "$14,485.06 " "$3,997.70 " "$5,396.90 " "$4,917.18 " N/A "$4,117.64 " N/A N/A N/A N/A N/A "$3,997.70 " "$12,720.74 " "$8,195.30 " "$3,997.70 " "$3,997.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,997.70 " "$3,997.70 " "$4,597.36 " "$3,997.70 " N/A "$3,797.82 " "$14,485.06 " 330104 111 3 Vertigo & other labyrinth disorders I N/A "$5,502.42 " N/A "$5,502.42 " N/A N/A N/A N/A "$5,227.30 " N/A "$5,282.32 " N/A N/A N/A N/A N/A "$7,043.10 " "$5,502.42 " N/A N/A N/A N/A "$5,667.49 " N/A N/A "$7,703.39 " "$20,391.92 " "$5,502.42 " "$7,428.27 " "$6,767.98 " N/A "$5,667.49 " N/A N/A N/A N/A N/A "$5,502.42 " "$17,908.14 " "$11,279.96 " "$5,502.42 " "$5,502.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,502.42 " "$5,502.42 " "$6,327.78 " "$5,502.42 " N/A "$5,227.30 " "$20,391.92 " 330104 111 4 Vertigo & other labyrinth disorders I N/A "$5,597.10 " N/A "$5,597.10 " N/A N/A N/A N/A "$5,317.25 " N/A "$5,373.22 " N/A N/A N/A N/A N/A "$7,164.29 " "$5,597.10 " N/A N/A N/A N/A "$5,765.02 " N/A N/A "$7,835.95 " "$20,763.61 " "$5,597.10 " "$7,556.09 " "$6,884.44 " N/A "$5,765.02 " N/A N/A N/A N/A N/A "$5,597.10 " "$18,234.55 " "$11,474.06 " "$5,597.10 " "$5,597.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,597.10 " "$5,597.10 " "$6,436.67 " "$5,597.10 " N/A "$5,317.25 " "$20,763.61 " 330104 113 1 Infections of upper respiratory tract I N/A "$2,951.42 " N/A "$2,951.42 " N/A N/A N/A N/A "$2,803.85 " N/A "$2,833.36 " N/A N/A N/A N/A N/A "$3,777.82 " "$2,951.42 " N/A N/A N/A N/A "$3,039.96 " N/A N/A "$4,131.99 " "$10,377.79 " "$2,951.42 " "$3,984.42 " "$3,630.25 " N/A "$3,039.96 " N/A N/A N/A N/A N/A "$2,951.42 " "$9,113.75 " "$6,050.41 " "$2,951.42 " "$2,951.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,951.42 " "$2,951.42 " "$3,394.13 " "$2,951.42 " N/A "$2,803.85 " "$10,377.79 " 330104 113 2 Infections of upper respiratory tract I N/A "$3,695.94 " N/A "$3,695.94 " N/A N/A N/A N/A "$3,511.15 " N/A "$3,548.11 " N/A N/A N/A N/A N/A "$4,730.81 " "$3,695.94 " N/A N/A N/A N/A "$3,806.82 " N/A N/A "$5,174.32 " "$13,300.48 " "$3,695.94 " "$4,989.53 " "$4,546.01 " N/A "$3,806.82 " N/A N/A N/A N/A N/A "$3,695.94 " "$11,680.44 " "$7,576.69 " "$3,695.94 " "$3,695.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,695.94 " "$3,695.94 " "$4,250.34 " "$3,695.94 " N/A "$3,511.15 " "$13,300.48 " 330104 113 3 Infections of upper respiratory tract I N/A "$5,611.41 " N/A "$5,611.41 " N/A N/A N/A N/A "$5,330.84 " N/A "$5,386.95 " N/A N/A N/A N/A N/A "$7,182.60 " "$5,611.41 " N/A N/A N/A N/A "$5,779.75 " N/A N/A "$7,855.97 " "$20,819.76 " "$5,611.41 " "$7,575.40 " "$6,902.03 " N/A "$5,779.75 " N/A N/A N/A N/A N/A "$5,611.41 " "$18,283.86 " "$11,503.39 " "$5,611.41 " "$5,611.41 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,611.41 " "$5,611.41 " "$6,453.12 " "$5,611.41 " N/A "$5,330.84 " "$20,819.76 " 330104 113 4 Infections of upper respiratory tract I N/A "$14,519.82 " N/A "$14,519.82 " N/A N/A N/A N/A "$13,793.82 " N/A "$13,939.02 " N/A N/A N/A N/A N/A "$18,585.36 " "$14,519.82 " N/A N/A N/A N/A "$14,955.41 " N/A N/A "$20,327.74 " "$55,790.34 " "$14,519.82 " "$19,601.75 " "$17,859.37 " N/A "$14,955.41 " N/A N/A N/A N/A N/A "$14,519.82 " "$48,994.93 " "$29,765.62 " "$14,519.82 " "$14,519.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,519.82 " "$14,519.82 " "$16,697.79 " "$14,519.82 " N/A "$13,793.82 " "$55,790.34 " 330104 114 1 Dental & oral diseases & injuries I N/A "$3,568.56 " N/A "$3,568.56 " N/A N/A N/A N/A "$3,390.14 " N/A "$3,425.82 " N/A N/A N/A N/A N/A "$4,567.76 " "$3,568.56 " N/A N/A N/A N/A "$3,675.62 " N/A N/A "$4,995.99 " "$12,800.44 " "$3,568.56 " "$4,817.56 " "$4,389.33 " N/A "$3,675.62 " N/A N/A N/A N/A N/A "$3,568.56 " "$11,241.31 " "$7,315.56 " "$3,568.56 " "$3,568.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,568.56 " "$3,568.56 " "$4,103.85 " "$3,568.56 " N/A "$3,390.14 " "$12,800.44 " 330104 114 2 Dental & oral diseases & injuries I N/A "$4,431.61 " N/A "$4,431.61 " N/A N/A N/A N/A "$4,210.03 " N/A "$4,254.35 " N/A N/A N/A N/A N/A "$5,672.47 " "$4,431.61 " N/A N/A N/A N/A "$4,564.56 " N/A N/A "$6,204.26 " "$16,188.40 " "$4,431.61 " "$5,982.68 " "$5,450.88 " N/A "$4,564.56 " N/A N/A N/A N/A N/A "$4,431.61 " "$14,216.61 " "$9,084.81 " "$4,431.61 " "$4,431.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,431.61 " "$4,431.61 " "$5,096.36 " "$4,431.61 " N/A "$4,210.03 " "$16,188.40 " 330104 114 3 Dental & oral diseases & injuries I N/A "$8,480.52 " N/A "$8,480.52 " N/A N/A N/A N/A "$8,056.49 " N/A "$8,141.30 " N/A N/A N/A N/A N/A "$10,855.06 " "$8,480.52 " N/A N/A N/A N/A "$8,734.93 " N/A N/A "$11,872.72 " "$32,082.65 " "$8,480.52 " "$11,448.70 " "$10,431.04 " N/A "$8,734.93 " N/A N/A N/A N/A N/A "$8,480.52 " "$28,174.90 " "$17,385.06 " "$8,480.52 " "$8,480.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,480.52 " "$8,480.52 " "$9,752.60 " "$8,480.52 " N/A "$8,056.49 " "$32,082.65 " 330104 114 4 Dental & oral diseases & injuries I N/A "$17,116.45 " N/A "$17,116.45 " N/A N/A N/A N/A "$16,260.63 " N/A "$16,431.80 " N/A N/A N/A N/A N/A "$21,909.06 " "$17,116.45 " N/A N/A N/A N/A "$17,629.95 " N/A N/A "$23,963.04 " "$65,983.62 " "$17,116.45 " "$23,107.21 " "$21,053.24 " N/A "$17,629.95 " N/A N/A N/A N/A N/A "$17,116.45 " "$57,946.65 " "$35,088.73 " "$17,116.45 " "$17,116.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,116.45 " "$17,116.45 " "$19,683.92 " "$17,116.45 " N/A "$16,260.63 " "$65,983.62 " 330104 115 1 Other ear nose mouththroat & cranial/facial diagnoses I N/A "$3,315.85 " N/A "$3,315.85 " N/A N/A N/A N/A "$3,150.06 " N/A "$3,183.21 " N/A N/A N/A N/A N/A "$4,244.29 " "$3,315.85 " N/A N/A N/A N/A "$3,415.32 " N/A N/A "$4,642.19 " "$11,808.38 " "$3,315.85 " "$4,476.40 " "$4,078.49 " N/A "$3,415.32 " N/A N/A N/A N/A N/A "$3,315.85 " "$10,370.09 " "$6,797.49 " "$3,315.85 " "$3,315.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,315.85 " "$3,315.85 " "$3,813.23 " "$3,315.85 " N/A "$3,150.06 " "$11,808.38 " 330104 115 2 Other ear nose mouththroat & cranial/facial diagnoses I N/A "$4,404.37 " N/A "$4,404.37 " N/A N/A N/A N/A "$4,184.15 " N/A "$4,228.19 " N/A N/A N/A N/A N/A "$5,637.59 " "$4,404.37 " N/A N/A N/A N/A "$4,536.50 " N/A N/A "$6,166.11 " "$16,081.44 " "$4,404.37 " "$5,945.89 " "$5,417.37 " N/A "$4,536.50 " N/A N/A N/A N/A N/A "$4,404.37 " "$14,122.68 " "$9,028.95 " "$4,404.37 " "$4,404.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,404.37 " "$4,404.37 " "$5,065.02 " "$4,404.37 " N/A "$4,184.15 " "$16,081.44 " 330104 115 3 Other ear nose mouththroat & cranial/facial diagnoses I N/A "$7,071.85 " N/A "$7,071.85 " N/A N/A N/A N/A "$6,718.26 " N/A "$6,788.97 " N/A N/A N/A N/A N/A "$9,051.97 " "$7,071.85 " N/A N/A N/A N/A "$7,284.00 " N/A N/A "$9,900.59 " "$26,552.82 " "$7,071.85 " "$9,546.99 " "$8,698.37 " N/A "$7,284.00 " N/A N/A N/A N/A N/A "$7,071.85 " "$23,318.62 " "$14,497.29 " "$7,071.85 " "$7,071.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,071.85 " "$7,071.85 " "$8,132.62 " "$7,071.85 " N/A "$6,718.26 " "$26,552.82 " 330104 115 4 Other ear nose mouththroat & cranial/facial diagnoses I N/A "$18,166.83 " N/A "$18,166.83 " N/A N/A N/A N/A "$17,258.48 " N/A "$17,440.15 " N/A N/A N/A N/A N/A "$23,253.54 " "$18,166.83 " N/A N/A N/A N/A "$18,711.83 " N/A N/A "$25,433.56 " "$70,106.93 " "$18,166.83 " "$24,525.22 " "$22,345.20 " N/A "$18,711.83 " N/A N/A N/A N/A N/A "$18,166.83 " "$61,567.73 " "$37,241.99 " "$18,166.83 " "$18,166.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,166.83 " "$18,166.83 " "$20,891.85 " "$18,166.83 " N/A "$17,258.48 " "$70,106.93 " 330104 120 1 Major respiratory & chest procedures I N/A "$12,110.50 " N/A "$12,110.50 " N/A N/A N/A N/A "$11,504.97 " N/A "$11,626.08 " N/A N/A N/A N/A N/A "$15,501.44 " "$12,110.50 " N/A N/A N/A N/A "$12,473.81 " N/A N/A "$16,954.70 " "$46,332.40 " "$12,110.50 " "$16,349.17 " "$14,895.91 " N/A "$12,473.81 " N/A N/A N/A N/A N/A "$12,110.50 " "$40,688.99 " "$24,826.52 " "$12,110.50 " "$12,110.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,110.50 " "$12,110.50 " "$13,927.07 " "$12,110.50 " N/A "$11,504.97 " "$46,332.40 " 330104 120 2 Major respiratory & chest procedures I N/A "$14,688.07 " N/A "$14,688.07 " N/A N/A N/A N/A "$13,953.66 " N/A "$14,100.54 " N/A N/A N/A N/A N/A "$18,800.72 " "$14,688.07 " N/A N/A N/A N/A "$15,128.71 " N/A N/A "$20,563.29 " "$56,450.81 " "$14,688.07 " "$19,828.89 " "$18,066.32 " N/A "$15,128.71 " N/A N/A N/A N/A N/A "$14,688.07 " "$49,574.96 " "$30,110.53 " "$14,688.07 " "$14,688.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,688.07 " "$14,688.07 " "$16,891.28 " "$14,688.07 " N/A "$13,953.66 " "$56,450.81 " 330104 120 3 Major respiratory & chest procedures I N/A "$23,224.55 " N/A "$23,224.55 " N/A N/A N/A N/A "$22,063.32 " N/A "$22,295.57 " N/A N/A N/A N/A N/A "$29,727.42 " "$23,224.55 " N/A N/A N/A N/A "$23,921.29 " N/A N/A "$32,514.37 " "$89,961.38 " "$23,224.55 " "$31,353.14 " "$28,566.20 " N/A "$23,921.29 " N/A N/A N/A N/A N/A "$23,224.55 " "$79,003.86 " "$47,610.33 " "$23,224.55 " "$23,224.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,224.55 " "$23,224.55 " "$26,708.23 " "$23,224.55 " N/A "$22,063.32 " "$89,961.38 " 330104 120 4 Major respiratory & chest procedures I N/A "$41,796.79 " N/A "$41,796.79 " N/A N/A N/A N/A "$39,706.95 " N/A "$40,124.92 " N/A N/A N/A N/A N/A "$53,499.89 " "$41,796.79 " N/A N/A N/A N/A "$43,050.69 " N/A N/A "$58,515.50 " "$162,867.99 " "$41,796.79 " "$56,425.66 " "$51,410.05 " N/A "$43,050.69 " N/A N/A N/A N/A N/A "$41,796.79 " "$143,030.26 " "$85,683.41 " "$41,796.79 " "$41,796.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,796.79 " "$41,796.79 " "$48,066.30 " "$41,796.79 " N/A "$39,706.95 " "$162,867.99 " 330104 121 1 Other respiratory & chest procedures I N/A "$8,541.14 " N/A "$8,541.14 " N/A N/A N/A N/A "$8,114.09 " N/A "$8,199.50 " N/A N/A N/A N/A N/A "$10,932.66 " "$8,541.14 " N/A N/A N/A N/A "$8,797.38 " N/A N/A "$11,957.60 " "$32,320.64 " "$8,541.14 " "$11,530.54 " "$10,505.60 " N/A "$8,797.38 " N/A N/A N/A N/A N/A "$8,541.14 " "$28,383.90 " "$17,509.34 " "$8,541.14 " "$8,541.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,541.14 " "$8,541.14 " "$9,822.31 " "$8,541.14 " N/A "$8,114.09 " "$32,320.64 " 330104 121 2 Other respiratory & chest procedures I N/A "$11,393.22 " N/A "$11,393.22 " N/A N/A N/A N/A "$10,823.56 " N/A "$10,937.49 " N/A N/A N/A N/A N/A "$14,583.32 " "$11,393.22 " N/A N/A N/A N/A "$11,735.02 " N/A N/A "$15,950.51 " "$43,516.68 " "$11,393.22 " "$15,380.85 " "$14,013.66 " N/A "$11,735.02 " N/A N/A N/A N/A N/A "$11,393.22 " "$38,216.23 " "$23,356.10 " "$11,393.22 " "$11,393.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,393.22 " "$11,393.22 " "$13,102.21 " "$11,393.22 " N/A "$10,823.56 " "$43,516.68 " 330104 121 3 Other respiratory & chest procedures I N/A "$19,677.67 " N/A "$19,677.67 " N/A N/A N/A N/A "$18,693.79 " N/A "$18,890.57 " N/A N/A N/A N/A N/A "$25,187.42 " "$19,677.67 " N/A N/A N/A N/A "$20,268.00 " N/A N/A "$27,548.74 " "$76,037.86 " "$19,677.67 " "$26,564.86 " "$24,203.54 " N/A "$20,268.00 " N/A N/A N/A N/A N/A "$19,677.67 " "$66,776.26 " "$40,339.23 " "$19,677.67 " "$19,677.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,677.67 " "$19,677.67 " "$22,629.32 " "$19,677.67 " N/A "$18,693.79 " "$76,037.86 " 330104 121 4 Other respiratory & chest procedures I N/A "$41,567.23 " N/A "$41,567.23 " N/A N/A N/A N/A "$39,488.87 " N/A "$39,904.54 " N/A N/A N/A N/A N/A "$53,206.06 " "$41,567.23 " N/A N/A N/A N/A "$42,814.25 " N/A N/A "$58,194.12 " "$161,966.85 " "$41,567.23 " "$56,115.76 " "$51,127.69 " N/A "$42,814.25 " N/A N/A N/A N/A N/A "$41,567.23 " "$142,238.88 " "$85,212.82 " "$41,567.23 " "$41,567.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,567.23 " "$41,567.23 " "$47,802.32 " "$41,567.23 " N/A "$39,488.87 " "$161,966.85 " 330104 130 1 Respiratory system diagnosis w ventilator support 96+ hours I N/A "$23,673.44 " N/A "$23,673.44 " N/A N/A N/A N/A "$22,489.77 " N/A "$22,726.51 " N/A N/A N/A N/A N/A "$30,302.01 " "$23,673.44 " N/A N/A N/A N/A "$24,383.65 " N/A N/A "$33,142.82 " "$91,723.55 " "$23,673.44 " "$31,959.15 " "$29,118.34 " N/A "$24,383.65 " N/A N/A N/A N/A N/A "$23,673.44 " "$80,551.39 " "$48,530.56 " "$23,673.44 " "$23,673.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,673.44 " "$23,673.44 " "$27,224.46 " "$23,673.44 " N/A "$22,489.77 " "$91,723.55 " 330104 130 2 Respiratory system diagnosis w ventilator support 96+ hours I N/A "$23,673.44 " N/A "$23,673.44 " N/A N/A N/A N/A "$22,489.77 " N/A "$22,726.51 " N/A N/A N/A N/A N/A "$30,302.01 " "$23,673.44 " N/A N/A N/A N/A "$24,383.65 " N/A N/A "$33,142.82 " "$91,723.55 " "$23,673.44 " "$31,959.15 " "$29,118.34 " N/A "$24,383.65 " N/A N/A N/A N/A N/A "$23,673.44 " "$80,551.39 " "$48,530.56 " "$23,673.44 " "$23,673.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,673.44 " "$23,673.44 " "$27,224.46 " "$23,673.44 " N/A "$22,489.77 " "$91,723.55 " 330104 130 3 Respiratory system diagnosis w ventilator support 96+ hours I N/A "$29,457.98 " N/A "$29,457.98 " N/A N/A N/A N/A "$27,985.08 " N/A "$28,279.66 " N/A N/A N/A N/A N/A "$37,706.22 " "$29,457.98 " N/A N/A N/A N/A "$30,341.72 " N/A N/A "$41,241.18 " "$114,431.16 " "$29,457.98 " "$39,768.28 " "$36,233.32 " N/A "$30,341.72 " N/A N/A N/A N/A N/A "$29,457.98 " "$100,493.15 " "$60,388.87 " "$29,457.98 " "$29,457.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$29,457.98 " "$29,457.98 " "$33,876.68 " "$29,457.98 " N/A "$27,985.08 " "$114,431.16 " 330104 130 4 Respiratory system diagnosis w ventilator support 96+ hours I N/A "$41,674.18 " N/A "$41,674.18 " N/A N/A N/A N/A "$39,590.47 " N/A "$40,007.21 " N/A N/A N/A N/A N/A "$53,342.94 " "$41,674.18 " N/A N/A N/A N/A "$42,924.40 " N/A N/A "$58,343.85 " "$162,386.67 " "$41,674.18 " "$56,260.14 " "$51,259.24 " N/A "$42,924.40 " N/A N/A N/A N/A N/A "$41,674.18 " "$142,607.56 " "$85,432.06 " "$41,674.18 " "$41,674.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,674.18 " "$41,674.18 " "$47,925.30 " "$41,674.18 " N/A "$39,590.47 " "$162,386.67 " 330104 131 1 Cystic fibrosis - pulmonary disease I N/A "$9,708.00 " N/A "$9,708.00 " N/A N/A N/A N/A "$9,222.60 " N/A "$9,319.68 " N/A N/A N/A N/A N/A "$12,426.23 " "$9,708.00 " N/A N/A N/A N/A "$9,999.23 " N/A N/A "$13,591.19 " "$36,901.20 " "$9,708.00 " "$13,105.79 " "$11,940.83 " N/A "$9,999.23 " N/A N/A N/A N/A N/A "$9,708.00 " "$32,406.54 " "$19,901.39 " "$9,708.00 " "$9,708.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,708.00 " "$9,708.00 " "$11,164.19 " "$9,708.00 " N/A "$9,222.60 " "$36,901.20 " 330104 131 2 Cystic fibrosis - pulmonary disease I N/A "$12,090.75 " N/A "$12,090.75 " N/A N/A N/A N/A "$11,486.21 " N/A "$11,607.12 " N/A N/A N/A N/A N/A "$15,476.15 " "$12,090.75 " N/A N/A N/A N/A "$12,453.47 " N/A N/A "$16,927.04 " "$46,254.85 " "$12,090.75 " "$16,322.51 " "$14,871.62 " N/A "$12,453.47 " N/A N/A N/A N/A N/A "$12,090.75 " "$40,620.89 " "$24,786.03 " "$12,090.75 " "$12,090.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,090.75 " "$12,090.75 " "$13,904.36 " "$12,090.75 " N/A "$11,486.21 " "$46,254.85 " 330104 131 3 Cystic fibrosis - pulmonary disease I N/A "$17,700.90 " N/A "$17,700.90 " N/A N/A N/A N/A "$16,815.86 " N/A "$16,992.87 " N/A N/A N/A N/A N/A "$22,657.16 " "$17,700.90 " N/A N/A N/A N/A "$18,231.93 " N/A N/A "$24,781.26 " "$68,277.92 " "$17,700.90 " "$23,896.22 " "$21,772.11 " N/A "$18,231.93 " N/A N/A N/A N/A N/A "$17,700.90 " "$59,961.49 " "$36,286.85 " "$17,700.90 " "$17,700.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,700.90 " "$17,700.90 " "$20,356.04 " "$17,700.90 " N/A "$16,815.86 " "$68,277.92 " 330104 131 4 Cystic fibrosis - pulmonary disease I N/A "$18,927.70 " N/A "$18,927.70 " N/A N/A N/A N/A "$17,981.31 " N/A "$18,170.59 " N/A N/A N/A N/A N/A "$24,227.45 " "$18,927.70 " N/A N/A N/A N/A "$19,495.53 " N/A N/A "$26,498.78 " "$73,093.79 " "$18,927.70 " "$25,552.39 " "$23,281.07 " N/A "$19,495.53 " N/A N/A N/A N/A N/A "$18,927.70 " "$64,190.78 " "$38,801.78 " "$18,927.70 " "$18,927.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,927.70 " "$18,927.70 " "$21,766.85 " "$18,927.70 " N/A "$17,981.31 " "$73,093.79 " 330104 132 1 BPD & oth chronic respiratory diseases arising in perinatal period I N/A "$4,328.07 " N/A "$4,328.07 " N/A N/A N/A N/A "$4,111.67 " N/A "$4,154.95 " N/A N/A N/A N/A N/A "$5,539.94 " "$4,328.07 " N/A N/A N/A N/A "$4,457.92 " N/A N/A "$6,059.30 " "$15,781.95 " "$4,328.07 " "$5,842.90 " "$5,323.53 " N/A "$4,457.92 " N/A N/A N/A N/A N/A "$4,328.07 " "$13,859.67 " "$8,872.55 " "$4,328.07 " "$4,328.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,328.07 " "$4,328.07 " "$4,977.29 " "$4,328.07 " N/A "$4,111.67 " "$15,781.95 " 330104 132 2 BPD & oth chronic respiratory diseases arising in perinatal period I N/A "$5,650.24 " N/A "$5,650.24 " N/A N/A N/A N/A "$5,367.72 " N/A "$5,424.23 " N/A N/A N/A N/A N/A "$7,232.30 " "$5,650.24 " N/A N/A N/A N/A "$5,819.74 " N/A N/A "$7,910.33 " "$20,972.18 " "$5,650.24 " "$7,627.82 " "$6,949.79 " N/A "$5,819.74 " N/A N/A N/A N/A N/A "$5,650.24 " "$18,417.72 " "$11,582.98 " "$5,650.24 " "$5,650.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,650.24 " "$5,650.24 " "$6,497.77 " "$5,650.24 " N/A "$5,367.72 " "$20,972.18 " 330104 132 3 BPD & oth chronic respiratory diseases arising in perinatal period I N/A "$9,283.62 " N/A "$9,283.62 " N/A N/A N/A N/A "$8,819.44 " N/A "$8,912.28 " N/A N/A N/A N/A N/A "$11,883.04 " "$9,283.62 " N/A N/A N/A N/A "$9,562.13 " N/A N/A "$12,997.07 " "$35,235.30 " "$9,283.62 " "$12,532.89 " "$11,418.86 " N/A "$9,562.13 " N/A N/A N/A N/A N/A "$9,283.62 " "$30,943.55 " "$19,031.43 " "$9,283.62 " "$9,283.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,283.62 " "$9,283.62 " "$10,676.17 " "$9,283.62 " N/A "$8,819.44 " "$35,235.30 " 330104 132 4 BPD & oth chronic respiratory diseases arising in perinatal period I N/A "$16,661.43 " N/A "$16,661.43 " N/A N/A N/A N/A "$15,828.36 " N/A "$15,994.97 " N/A N/A N/A N/A N/A "$21,326.63 " "$16,661.43 " N/A N/A N/A N/A "$17,161.27 " N/A N/A "$23,326.00 " "$64,197.39 " "$16,661.43 " "$22,492.93 " "$20,493.56 " N/A "$17,161.27 " N/A N/A N/A N/A N/A "$16,661.43 " "$56,377.99 " "$34,155.93 " "$16,661.43 " "$16,661.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,661.43 " "$16,661.43 " "$19,160.64 " "$16,661.43 " N/A "$15,828.36 " "$64,197.39 " 330104 133 1 Respiratory Failure I N/A "$6,584.81 " N/A "$6,584.81 " N/A N/A N/A N/A "$6,255.57 " N/A "$6,321.42 " N/A N/A N/A N/A N/A "$8,428.55 " "$6,584.81 " N/A N/A N/A N/A "$6,782.35 " N/A N/A "$9,218.73 " "$24,640.91 " "$6,584.81 " "$8,889.49 " "$8,099.31 " N/A "$6,782.35 " N/A N/A N/A N/A N/A "$6,584.81 " "$21,639.58 " "$13,498.86 " "$6,584.81 " "$6,584.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,584.81 " "$6,584.81 " "$7,572.53 " "$6,584.81 " N/A "$6,255.57 " "$24,640.91 " 330104 133 2 Respiratory Failure I N/A "$6,597.75 " N/A "$6,597.75 " N/A N/A N/A N/A "$6,267.86 " N/A "$6,333.84 " N/A N/A N/A N/A N/A "$8,445.12 " "$6,597.75 " N/A N/A N/A N/A "$6,795.68 " N/A N/A "$9,236.85 " "$24,691.72 " "$6,597.75 " "$8,906.96 " "$8,115.23 " N/A "$6,795.68 " N/A N/A N/A N/A N/A "$6,597.75 " "$21,684.20 " "$13,525.39 " "$6,597.75 " "$6,597.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,597.75 " "$6,597.75 " "$7,587.41 " "$6,597.75 " N/A "$6,267.86 " "$24,691.72 " 330104 133 3 Respiratory Failure I N/A "$9,618.08 " N/A "$9,618.08 " N/A N/A N/A N/A "$9,137.18 " N/A "$9,233.36 " N/A N/A N/A N/A N/A "$12,311.14 " "$9,618.08 " N/A N/A N/A N/A "$9,906.62 " N/A N/A "$13,465.31 " "$36,548.23 " "$9,618.08 " "$12,984.41 " "$11,830.24 " N/A "$9,906.62 " N/A N/A N/A N/A N/A "$9,618.08 " "$32,096.56 " "$19,717.06 " "$9,618.08 " "$9,618.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,618.08 " "$9,618.08 " "$11,060.79 " "$9,618.08 " N/A "$9,137.18 " "$36,548.23 " 330104 133 4 Respiratory Failure I N/A "$14,047.76 " N/A "$14,047.76 " N/A N/A N/A N/A "$13,345.37 " N/A "$13,485.85 " N/A N/A N/A N/A N/A "$17,981.13 " "$14,047.76 " N/A N/A N/A N/A "$14,469.19 " N/A N/A "$19,666.87 " "$53,937.25 " "$14,047.76 " "$18,964.48 " "$17,278.75 " N/A "$14,469.19 " N/A N/A N/A N/A N/A "$14,047.76 " "$47,367.56 " "$28,797.91 " "$14,047.76 " "$14,047.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,047.76 " "$14,047.76 " "$16,154.93 " "$14,047.76 " N/A "$13,345.37 " "$53,937.25 " 330104 134 1 Pulmonary embolism I N/A "$5,108.02 " N/A "$5,108.02 " N/A N/A N/A N/A "$4,852.62 " N/A "$4,903.70 " N/A N/A N/A N/A N/A "$6,538.27 " "$5,108.02 " N/A N/A N/A N/A "$5,261.26 " N/A N/A "$7,151.23 " "$18,843.68 " "$5,108.02 " "$6,895.83 " "$6,282.86 " N/A "$5,261.26 " N/A N/A N/A N/A N/A "$5,108.02 " "$16,548.47 " "$10,471.44 " "$5,108.02 " "$5,108.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,108.02 " "$5,108.02 " "$5,874.22 " "$5,108.02 " N/A "$4,852.62 " "$18,843.68 " 330104 134 2 Pulmonary embolism I N/A "$6,677.45 " N/A "$6,677.45 " N/A N/A N/A N/A "$6,343.58 " N/A "$6,410.35 " N/A N/A N/A N/A N/A "$8,547.13 " "$6,677.45 " N/A N/A N/A N/A "$6,877.77 " N/A N/A "$9,348.43 " "$25,004.57 " "$6,677.45 " "$9,014.55 " "$8,213.26 " N/A "$6,877.77 " N/A N/A N/A N/A N/A "$6,677.45 " "$21,958.95 " "$13,688.77 " "$6,677.45 " "$6,677.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,677.45 " "$6,677.45 " "$7,679.06 " "$6,677.45 " N/A "$6,343.58 " "$25,004.57 " 330104 134 3 Pulmonary embolism I N/A "$10,589.44 " N/A "$10,589.44 " N/A N/A N/A N/A "$10,059.96 " N/A "$10,165.86 " N/A N/A N/A N/A N/A "$13,554.48 " "$10,589.44 " N/A N/A N/A N/A "$10,907.12 " N/A N/A "$14,825.21 " "$40,361.36 " "$10,589.44 " "$14,295.74 " "$13,025.01 " N/A "$10,907.12 " N/A N/A N/A N/A N/A "$10,589.44 " "$35,445.24 " "$21,708.34 " "$10,589.44 " "$10,589.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,589.44 " "$10,589.44 " "$12,177.85 " "$10,589.44 " N/A "$10,059.96 " "$40,361.36 " 330104 134 4 Pulmonary embolism I N/A "$17,721.34 " N/A "$17,721.34 " N/A N/A N/A N/A "$16,835.27 " N/A "$17,012.48 " N/A N/A N/A N/A N/A "$22,683.31 " "$17,721.34 " N/A N/A N/A N/A "$18,252.98 " N/A N/A "$24,809.87 " "$68,358.14 " "$17,721.34 " "$23,923.81 " "$21,797.25 " N/A "$18,252.98 " N/A N/A N/A N/A N/A "$17,721.34 " "$60,031.94 " "$36,328.74 " "$17,721.34 " "$17,721.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,721.34 " "$17,721.34 " "$20,379.54 " "$17,721.34 " N/A "$16,835.27 " "$68,358.14 " 330104 135 1 Major chest & respiratory trauma I N/A "$3,833.54 " N/A "$3,833.54 " N/A N/A N/A N/A "$3,641.86 " N/A "$3,680.20 " N/A N/A N/A N/A N/A "$4,906.93 " "$3,833.54 " N/A N/A N/A N/A "$3,948.55 " N/A N/A "$5,366.96 " "$13,840.62 " "$3,833.54 " "$5,175.28 " "$4,715.26 " N/A "$3,948.55 " N/A N/A N/A N/A N/A "$3,833.54 " "$12,154.80 " "$7,858.76 " "$3,833.54 " "$3,833.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,833.54 " "$3,833.54 " "$4,408.57 " "$3,833.54 " N/A "$3,641.86 " "$13,840.62 " 330104 135 2 Major chest & respiratory trauma I N/A "$5,218.37 " N/A "$5,218.37 " N/A N/A N/A N/A "$4,957.45 " N/A "$5,009.64 " N/A N/A N/A N/A N/A "$6,679.51 " "$5,218.37 " N/A N/A N/A N/A "$5,374.92 " N/A N/A "$7,305.72 " "$19,276.87 " "$5,218.37 " "$7,044.80 " "$6,418.60 " N/A "$5,374.92 " N/A N/A N/A N/A N/A "$5,218.37 " "$16,928.89 " "$10,697.66 " "$5,218.37 " "$5,218.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,218.37 " "$5,218.37 " "$6,001.13 " "$5,218.37 " N/A "$4,957.45 " "$19,276.87 " 330104 135 3 Major chest & respiratory trauma I N/A "$8,663.75 " N/A "$8,663.75 " N/A N/A N/A N/A "$8,230.57 " N/A "$8,317.20 " N/A N/A N/A N/A N/A "$11,089.60 " "$8,663.75 " N/A N/A N/A N/A "$8,923.67 " N/A N/A "$12,129.26 " "$32,801.96 " "$8,663.75 " "$11,696.07 " "$10,656.42 " N/A "$8,923.67 " N/A N/A N/A N/A N/A "$8,663.75 " "$28,806.60 " "$17,760.70 " "$8,663.75 " "$8,663.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,663.75 " "$8,663.75 " "$9,963.32 " "$8,663.75 " N/A "$8,230.57 " "$32,801.96 " 330104 135 4 Major chest & respiratory trauma I N/A "$12,675.87 " N/A "$12,675.87 " N/A N/A N/A N/A "$12,042.08 " N/A "$12,168.84 " N/A N/A N/A N/A N/A "$16,225.12 " "$12,675.87 " N/A N/A N/A N/A "$13,056.15 " N/A N/A "$17,746.22 " "$48,551.82 " "$12,675.87 " "$17,112.43 " "$15,591.33 " N/A "$13,056.15 " N/A N/A N/A N/A N/A "$12,675.87 " "$42,638.08 " "$25,985.54 " "$12,675.87 " "$12,675.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,675.87 " "$12,675.87 " "$14,577.26 " "$12,675.87 " N/A "$12,042.08 " "$48,551.82 " 330104 136 1 Respiratory malignancy I N/A "$4,183.67 " N/A "$4,183.67 " N/A N/A N/A N/A "$3,974.48 " N/A "$4,016.32 " N/A N/A N/A N/A N/A "$5,355.09 " "$4,183.67 " N/A N/A N/A N/A "$4,309.18 " N/A N/A "$5,857.13 " "$15,215.06 " "$4,183.67 " "$5,647.95 " "$5,145.91 " N/A "$4,309.18 " N/A N/A N/A N/A N/A "$4,183.67 " "$13,361.83 " "$8,576.51 " "$4,183.67 " "$4,183.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,183.67 " "$4,183.67 " "$4,811.22 " "$4,183.67 " N/A "$3,974.48 " "$15,215.06 " 330104 136 2 Respiratory malignancy I N/A "$6,464.92 " N/A "$6,464.92 " N/A N/A N/A N/A "$6,141.67 " N/A "$6,206.32 " N/A N/A N/A N/A N/A "$8,275.10 " "$6,464.92 " N/A N/A N/A N/A "$6,658.87 " N/A N/A "$9,050.89 " "$24,170.29 " "$6,464.92 " "$8,727.64 " "$7,951.85 " N/A "$6,658.87 " N/A N/A N/A N/A N/A "$6,464.92 " "$21,226.28 " "$13,253.09 " "$6,464.92 " "$6,464.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,464.92 " "$6,464.92 " "$7,434.66 " "$6,464.92 " N/A "$6,141.67 " "$24,170.29 " 330104 136 3 Respiratory malignancy I N/A "$10,932.07 " N/A "$10,932.07 " N/A N/A N/A N/A "$10,385.46 " N/A "$10,494.78 " N/A N/A N/A N/A N/A "$13,993.05 " "$10,932.07 " N/A N/A N/A N/A "$11,260.03 " N/A N/A "$15,304.89 " "$41,706.38 " "$10,932.07 " "$14,758.29 " "$13,446.44 " N/A "$11,260.03 " N/A N/A N/A N/A N/A "$10,932.07 " "$36,626.44 " "$22,410.74 " "$10,932.07 " "$10,932.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,932.07 " "$10,932.07 " "$12,571.88 " "$10,932.07 " N/A "$10,385.46 " "$41,706.38 " 330104 136 4 Respiratory malignancy I N/A "$15,931.21 " N/A "$15,931.21 " N/A N/A N/A N/A "$15,134.65 " N/A "$15,293.96 " N/A N/A N/A N/A N/A "$20,391.95 " "$15,931.21 " N/A N/A N/A N/A "$16,409.15 " N/A N/A "$22,303.69 " "$61,330.86 " "$15,931.21 " "$21,507.13 " "$19,595.39 " N/A "$16,409.15 " N/A N/A N/A N/A N/A "$15,931.21 " "$53,860.61 " "$32,658.98 " "$15,931.21 " "$15,931.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,931.21 " "$15,931.21 " "$18,320.89 " "$15,931.21 " N/A "$15,134.65 " "$61,330.86 " 330104 137 1 Major respiratory infections & inflammations I N/A "$5,047.40 " N/A "$5,047.40 " N/A N/A N/A N/A "$4,795.03 " N/A "$4,845.50 " N/A N/A N/A N/A N/A "$6,460.67 " "$5,047.40 " N/A N/A N/A N/A "$5,198.82 " N/A N/A "$7,066.35 " "$18,605.69 " "$5,047.40 " "$6,813.98 " "$6,208.30 " N/A "$5,198.82 " N/A N/A N/A N/A N/A "$5,047.40 " "$16,339.47 " "$10,347.16 " "$5,047.40 " "$5,047.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,047.40 " "$5,047.40 " "$5,804.50 " "$5,047.40 " N/A "$4,795.03 " "$18,605.69 " 330104 137 2 Major respiratory infections & inflammations I N/A "$7,329.33 " N/A "$7,329.33 " N/A N/A N/A N/A "$6,962.87 " N/A "$7,036.16 " N/A N/A N/A N/A N/A "$9,381.54 " "$7,329.33 " N/A N/A N/A N/A "$7,549.21 " N/A N/A "$10,261.06 " "$27,563.59 " "$7,329.33 " "$9,894.60 " "$9,015.08 " N/A "$7,549.21 " N/A N/A N/A N/A N/A "$7,329.33 " "$24,206.28 " "$15,025.13 " "$7,329.33 " "$7,329.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,329.33 " "$7,329.33 " "$8,428.73 " "$7,329.33 " N/A "$6,962.87 " "$27,563.59 " 330104 137 3 Major respiratory infections & inflammations I N/A "$11,729.72 " N/A "$11,729.72 " N/A N/A N/A N/A "$11,143.24 " N/A "$11,260.53 " N/A N/A N/A N/A N/A "$15,014.04 " "$11,729.72 " N/A N/A N/A N/A "$12,081.61 " N/A N/A "$16,421.61 " "$44,837.63 " "$11,729.72 " "$15,835.13 " "$14,427.56 " N/A "$12,081.61 " N/A N/A N/A N/A N/A "$11,729.72 " "$39,376.29 " "$24,045.93 " "$11,729.72 " "$11,729.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,729.72 " "$11,729.72 " "$13,489.18 " "$11,729.72 " N/A "$11,143.24 " "$44,837.63 " 330104 137 4 Major respiratory infections & inflammations I N/A "$18,100.75 " N/A "$18,100.75 " N/A N/A N/A N/A "$17,195.71 " N/A "$17,376.72 " N/A N/A N/A N/A N/A "$23,168.96 " "$18,100.75 " N/A N/A N/A N/A "$18,643.77 " N/A N/A "$25,341.05 " "$69,847.55 " "$18,100.75 " "$24,436.02 " "$22,263.93 " N/A "$18,643.77 " N/A N/A N/A N/A N/A "$18,100.75 " "$61,339.94 " "$37,106.54 " "$18,100.75 " "$18,100.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,100.75 " "$18,100.75 " "$20,815.87 " "$18,100.75 " N/A "$17,195.71 " "$69,847.55 " 330104 138 1 Bronchiolitis & RSV pneumonia I N/A "$3,629.87 " N/A "$3,629.87 " N/A N/A N/A N/A "$3,448.38 " N/A "$3,484.68 " N/A N/A N/A N/A N/A "$4,646.23 " "$3,629.87 " N/A N/A N/A N/A "$3,738.77 " N/A N/A "$5,081.82 " "$13,041.10 " "$3,629.87 " "$4,900.33 " "$4,464.74 " N/A "$3,738.77 " N/A N/A N/A N/A N/A "$3,629.87 " "$11,452.66 " "$7,441.23 " "$3,629.87 " "$3,629.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,629.87 " "$3,629.87 " "$4,174.35 " "$3,629.87 " N/A "$3,448.38 " "$13,041.10 " 330104 138 2 Bronchiolitis & RSV pneumonia I N/A "$4,601.23 " N/A "$4,601.23 " N/A N/A N/A N/A "$4,371.16 " N/A "$4,417.18 " N/A N/A N/A N/A N/A "$5,889.57 " "$4,601.23 " N/A N/A N/A N/A "$4,739.26 " N/A N/A "$6,441.72 " "$16,854.22 " "$4,601.23 " "$6,211.66 " "$5,659.51 " N/A "$4,739.26 " N/A N/A N/A N/A N/A "$4,601.23 " "$14,801.33 " "$9,432.51 " "$4,601.23 " "$4,601.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,601.23 " "$4,601.23 " "$5,291.41 " "$4,601.23 " N/A "$4,371.16 " "$16,854.22 " 330104 138 3 Bronchiolitis & RSV pneumonia I N/A "$9,604.46 " N/A "$9,604.46 " N/A N/A N/A N/A "$9,124.23 " N/A "$9,220.28 " N/A N/A N/A N/A N/A "$12,293.70 " "$9,604.46 " N/A N/A N/A N/A "$9,892.59 " N/A N/A "$13,446.24 " "$36,494.75 " "$9,604.46 " "$12,966.02 " "$11,813.48 " N/A "$9,892.59 " N/A N/A N/A N/A N/A "$9,604.46 " "$32,049.60 " "$19,689.14 " "$9,604.46 " "$9,604.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,604.46 " "$9,604.46 " "$11,045.12 " "$9,604.46 " N/A "$9,124.23 " "$36,494.75 " 330104 138 4 Bronchiolitis & RSV pneumonia I N/A "$20,904.47 " N/A "$20,904.47 " N/A N/A N/A N/A "$19,859.25 " N/A "$20,068.29 " N/A N/A N/A N/A N/A "$26,757.72 " "$20,904.47 " N/A N/A N/A N/A "$21,531.60 " N/A N/A "$29,266.26 " "$80,853.74 " "$20,904.47 " "$28,221.03 " "$25,712.50 " N/A "$21,531.60 " N/A N/A N/A N/A N/A "$20,904.47 " "$71,005.55 " "$42,854.16 " "$20,904.47 " "$20,904.47 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,904.47 " "$20,904.47 " "$24,040.14 " "$20,904.47 " N/A "$19,859.25 " "$80,853.74 " 330104 139 1 Other pneumonia I N/A "$3,806.98 " N/A "$3,806.98 " N/A N/A N/A N/A "$3,616.63 " N/A "$3,654.70 " N/A N/A N/A N/A N/A "$4,872.93 " "$3,806.98 " N/A N/A N/A N/A "$3,921.19 " N/A N/A "$5,329.77 " "$13,736.34 " "$3,806.98 " "$5,139.42 " "$4,682.58 " N/A "$3,921.19 " N/A N/A N/A N/A N/A "$3,806.98 " "$12,063.22 " "$7,804.30 " "$3,806.98 " "$3,806.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,806.98 " "$3,806.98 " "$4,378.02 " "$3,806.98 " N/A "$3,616.63 " "$13,736.34 " 330104 139 2 Other pneumonia I N/A "$4,928.19 " N/A "$4,928.19 " N/A N/A N/A N/A "$4,681.78 " N/A "$4,731.06 " N/A N/A N/A N/A N/A "$6,308.08 " "$4,928.19 " N/A N/A N/A N/A "$5,076.04 " N/A N/A "$6,899.47 " "$18,137.74 " "$4,928.19 " "$6,653.06 " "$6,061.67 " N/A "$5,076.04 " N/A N/A N/A N/A N/A "$4,928.19 " "$15,928.52 " "$10,102.79 " "$4,928.19 " "$4,928.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,928.19 " "$4,928.19 " "$5,667.42 " "$4,928.19 " N/A "$4,681.78 " "$18,137.74 " 330104 139 3 Other pneumonia I N/A "$8,060.23 " N/A "$8,060.23 " N/A N/A N/A N/A "$7,657.22 " N/A "$7,737.82 " N/A N/A N/A N/A N/A "$10,317.10 " "$8,060.23 " N/A N/A N/A N/A "$8,302.04 " N/A N/A "$11,284.33 " "$30,432.79 " "$8,060.23 " "$10,881.31 " "$9,914.09 " N/A "$8,302.04 " N/A N/A N/A N/A N/A "$8,060.23 " "$26,726.00 " "$16,523.48 " "$8,060.23 " "$8,060.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,060.23 " "$8,060.23 " "$9,269.27 " "$8,060.23 " N/A "$7,657.22 " "$30,432.79 " 330104 139 4 Other pneumonia I N/A "$15,087.92 " N/A "$15,087.92 " N/A N/A N/A N/A "$14,333.52 " N/A "$14,484.40 " N/A N/A N/A N/A N/A "$19,312.53 " "$15,087.92 " N/A N/A N/A N/A "$15,540.55 " N/A N/A "$21,123.08 " "$58,020.45 " "$15,087.92 " "$20,368.69 " "$18,558.14 " N/A "$15,540.55 " N/A N/A N/A N/A N/A "$15,087.92 " "$50,953.41 " "$30,930.23 " "$15,087.92 " "$15,087.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,087.92 " "$15,087.92 " "$17,351.10 " "$15,087.92 " N/A "$14,333.52 " "$58,020.45 " 330104 140 1 Chronic obstructive pulmonary disease I N/A "$4,225.22 " N/A "$4,225.22 " N/A N/A N/A N/A "$4,013.96 " N/A "$4,056.21 " N/A N/A N/A N/A N/A "$5,408.28 " "$4,225.22 " N/A N/A N/A N/A "$4,351.97 " N/A N/A "$5,915.30 " "$15,378.17 " "$4,225.22 " "$5,704.04 " "$5,197.02 " N/A "$4,351.97 " N/A N/A N/A N/A N/A "$4,225.22 " "$13,505.07 " "$8,661.70 " "$4,225.22 " "$4,225.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,225.22 " "$4,225.22 " "$4,859.00 " "$4,225.22 " N/A "$4,013.96 " "$15,378.17 " 330104 140 2 Chronic obstructive pulmonary disease I N/A "$5,225.86 " N/A "$5,225.86 " N/A N/A N/A N/A "$4,964.57 " N/A "$5,016.83 " N/A N/A N/A N/A N/A "$6,689.11 " "$5,225.86 " N/A N/A N/A N/A "$5,382.64 " N/A N/A "$7,316.21 " "$19,306.28 " "$5,225.86 " "$7,054.92 " "$6,427.81 " N/A "$5,382.64 " N/A N/A N/A N/A N/A "$5,225.86 " "$16,954.73 " "$10,713.02 " "$5,225.86 " "$5,225.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,225.86 " "$5,225.86 " "$6,009.74 " "$5,225.86 " N/A "$4,964.57 " "$19,306.28 " 330104 140 3 Chronic obstructive pulmonary disease I N/A "$7,203.31 " N/A "$7,203.31 " N/A N/A N/A N/A "$6,843.15 " N/A "$6,915.18 " N/A N/A N/A N/A N/A "$9,220.24 " "$7,203.31 " N/A N/A N/A N/A "$7,419.41 " N/A N/A "$10,084.64 " "$27,068.90 " "$7,203.31 " "$9,724.47 " "$8,860.08 " N/A "$7,419.41 " N/A N/A N/A N/A N/A "$7,203.31 " "$23,771.84 " "$14,766.79 " "$7,203.31 " "$7,203.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,203.31 " "$7,203.31 " "$8,283.81 " "$7,203.31 " N/A "$6,843.15 " "$27,068.90 " 330104 140 4 Chronic obstructive pulmonary disease I N/A "$13,729.65 " N/A "$13,729.65 " N/A N/A N/A N/A "$13,043.17 " N/A "$13,180.47 " N/A N/A N/A N/A N/A "$17,573.95 " "$13,729.65 " N/A N/A N/A N/A "$14,141.54 " N/A N/A "$19,221.51 " "$52,688.50 " "$13,729.65 " "$18,535.03 " "$16,887.47 " N/A "$14,141.54 " N/A N/A N/A N/A N/A "$13,729.65 " "$46,270.90 " "$28,145.79 " "$13,729.65 " "$13,729.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,729.65 " "$13,729.65 " "$15,789.10 " "$13,729.65 " N/A "$13,043.17 " "$52,688.50 " 330104 141 1 Asthma I N/A "$3,533.82 " N/A "$3,533.82 " N/A N/A N/A N/A "$3,357.13 " N/A "$3,392.47 " N/A N/A N/A N/A N/A "$4,523.30 " "$3,533.82 " N/A N/A N/A N/A "$3,639.84 " N/A N/A "$4,947.35 " "$12,664.06 " "$3,533.82 " "$4,770.66 " "$4,346.60 " N/A "$3,639.84 " N/A N/A N/A N/A N/A "$3,533.82 " "$11,121.55 " "$7,244.34 " "$3,533.82 " "$3,533.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,533.82 " "$3,533.82 " "$4,063.90 " "$3,533.82 " N/A "$3,357.13 " "$12,664.06 " 330104 141 2 Asthma I N/A "$4,512.67 " N/A "$4,512.67 " N/A N/A N/A N/A "$4,287.04 " N/A "$4,332.17 " N/A N/A N/A N/A N/A "$5,776.22 " "$4,512.67 " N/A N/A N/A N/A "$4,648.05 " N/A N/A "$6,317.74 " "$16,506.60 " "$4,512.67 " "$6,092.11 " "$5,550.59 " N/A "$4,648.05 " N/A N/A N/A N/A N/A "$4,512.67 " "$14,496.06 " "$9,250.98 " "$4,512.67 " "$4,512.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,512.67 " "$4,512.67 " "$5,189.57 " "$4,512.67 " N/A "$4,287.04 " "$16,506.60 " 330104 141 3 Asthma I N/A "$6,695.16 " N/A "$6,695.16 " N/A N/A N/A N/A "$6,360.40 " N/A "$6,427.35 " N/A N/A N/A N/A N/A "$8,569.80 " "$6,695.16 " N/A N/A N/A N/A "$6,896.01 " N/A N/A "$9,373.22 " "$25,074.10 " "$6,695.16 " "$9,038.46 " "$8,235.04 " N/A "$6,896.01 " N/A N/A N/A N/A N/A "$6,695.16 " "$22,020.01 " "$13,725.07 " "$6,695.16 " "$6,695.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,695.16 " "$6,695.16 " "$7,699.43 " "$6,695.16 " N/A "$6,360.40 " "$25,074.10 " 330104 141 4 Asthma I N/A "$11,560.11 " N/A "$11,560.11 " N/A N/A N/A N/A "$10,982.10 " N/A "$11,097.71 " N/A N/A N/A N/A N/A "$14,796.94 " "$11,560.11 " N/A N/A N/A N/A "$11,906.91 " N/A N/A "$16,184.15 " "$44,171.81 " "$11,560.11 " "$15,606.15 " "$14,218.94 " N/A "$11,906.91 " N/A N/A N/A N/A N/A "$11,560.11 " "$38,791.57 " "$23,698.23 " "$11,560.11 " "$11,560.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,560.11 " "$11,560.11 " "$13,294.13 " "$11,560.11 " N/A "$10,982.10 " "$44,171.81 " 330104 142 1 Interstitial & alveolar lung diseases I N/A "$4,851.90 " N/A "$4,851.90 " N/A N/A N/A N/A "$4,609.30 " N/A "$4,657.82 " N/A N/A N/A N/A N/A "$6,210.43 " "$4,851.90 " N/A N/A N/A N/A "$4,997.46 " N/A N/A "$6,792.66 " "$17,838.25 " "$4,851.90 " "$6,550.06 " "$5,967.84 " N/A "$4,997.46 " N/A N/A N/A N/A N/A "$4,851.90 " "$15,665.51 " "$9,946.39 " "$4,851.90 " "$4,851.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,851.90 " "$4,851.90 " "$5,579.68 " "$4,851.90 " N/A "$4,609.30 " "$17,838.25 " 330104 142 2 Interstitial & alveolar lung diseases I N/A "$6,159.75 " N/A "$6,159.75 " N/A N/A N/A N/A "$5,851.77 " N/A "$5,913.36 " N/A N/A N/A N/A N/A "$7,884.49 " "$6,159.75 " N/A N/A N/A N/A "$6,344.55 " N/A N/A "$8,623.66 " "$22,972.33 " "$6,159.75 " "$8,315.67 " "$7,576.50 " N/A "$6,344.55 " N/A N/A N/A N/A N/A "$6,159.75 " "$20,174.25 " "$12,627.50 " "$6,159.75 " "$6,159.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,159.75 " "$6,159.75 " "$7,083.72 " "$6,159.75 " N/A "$5,851.77 " "$22,972.33 " 330104 142 3 Interstitial & alveolar lung diseases I N/A "$9,372.86 " N/A "$9,372.86 " N/A N/A N/A N/A "$8,904.21 " N/A "$8,997.94 " N/A N/A N/A N/A N/A "$11,997.26 " "$9,372.86 " N/A N/A N/A N/A "$9,654.04 " N/A N/A "$13,122.00 " "$35,585.59 " "$9,372.86 " "$12,653.36 " "$11,528.61 " N/A "$9,654.04 " N/A N/A N/A N/A N/A "$9,372.86 " "$31,251.18 " "$19,214.36 " "$9,372.86 " "$9,372.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,372.86 " "$9,372.86 " "$10,778.79 " "$9,372.86 " N/A "$8,904.21 " "$35,585.59 " 330104 142 4 Interstitial & alveolar lung diseases I N/A "$19,255.34 " N/A "$19,255.34 " N/A N/A N/A N/A "$18,292.58 " N/A "$18,485.13 " N/A N/A N/A N/A N/A "$24,646.84 " "$19,255.34 " N/A N/A N/A N/A "$19,833.00 " N/A N/A "$26,957.48 " "$74,379.98 " "$19,255.34 " "$25,994.71 " "$23,684.07 " N/A "$19,833.00 " N/A N/A N/A N/A N/A "$19,255.34 " "$65,320.31 " "$39,473.45 " "$19,255.34 " "$19,255.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,255.34 " "$19,255.34 " "$22,143.65 " "$19,255.34 " N/A "$18,292.58 " "$74,379.98 " 330104 143 1 Other respiratory diagnoses except signs symptoms & minor diagnoses I N/A "$3,925.50 " N/A "$3,925.50 " N/A N/A N/A N/A "$3,729.23 " N/A "$3,768.48 " N/A N/A N/A N/A N/A "$5,024.64 " "$3,925.50 " N/A N/A N/A N/A "$4,043.27 " N/A N/A "$5,495.70 " "$14,201.61 " "$3,925.50 " "$5,299.43 " "$4,828.37 " N/A "$4,043.27 " N/A N/A N/A N/A N/A "$3,925.50 " "$12,471.82 " "$8,047.28 " "$3,925.50 " "$3,925.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,925.50 " "$3,925.50 " "$4,514.33 " "$3,925.50 " N/A "$3,729.23 " "$14,201.61 " 330104 143 2 Other respiratory diagnoses except signs symptoms & minor diagnoses I N/A "$5,477.90 " N/A "$5,477.90 " N/A N/A N/A N/A "$5,204.00 " N/A "$5,258.78 " N/A N/A N/A N/A N/A "$7,011.71 " "$5,477.90 " N/A N/A N/A N/A "$5,642.24 " N/A N/A "$7,669.06 " "$20,295.66 " "$5,477.90 " "$7,395.16 " "$6,737.81 " N/A "$5,642.24 " N/A N/A N/A N/A N/A "$5,477.90 " "$17,823.60 " "$11,229.69 " "$5,477.90 " "$5,477.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,477.90 " "$5,477.90 " "$6,299.58 " "$5,477.90 " N/A "$5,204.00 " "$20,295.66 " 330104 143 3 Other respiratory diagnoses except signs symptoms & minor diagnoses I N/A "$9,045.89 " N/A "$9,045.89 " N/A N/A N/A N/A "$8,593.60 " N/A "$8,684.06 " N/A N/A N/A N/A N/A "$11,578.74 " "$9,045.89 " N/A N/A N/A N/A "$9,317.27 " N/A N/A "$12,664.25 " "$34,302.07 " "$9,045.89 " "$12,211.96 " "$11,126.45 " N/A "$9,317.27 " N/A N/A N/A N/A N/A "$9,045.89 " "$30,123.99 " "$18,544.08 " "$9,045.89 " "$9,045.89 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,045.89 " "$9,045.89 " "$10,402.78 " "$9,045.89 " N/A "$8,593.60 " "$34,302.07 " 330104 143 4 Other respiratory diagnoses except signs symptoms & minor diagnoses I N/A "$14,324.32 " N/A "$14,324.32 " N/A N/A N/A N/A "$13,608.10 " N/A "$13,751.35 " N/A N/A N/A N/A N/A "$18,335.13 " "$14,324.32 " N/A N/A N/A N/A "$14,754.05 " N/A N/A "$20,054.05 " "$55,022.90 " "$14,324.32 " "$19,337.83 " "$17,618.91 " N/A "$14,754.05 " N/A N/A N/A N/A N/A "$14,324.32 " "$48,320.97 " "$29,364.85 " "$14,324.32 " "$14,324.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,324.32 " "$14,324.32 " "$16,472.97 " "$14,324.32 " N/A "$13,608.10 " "$55,022.90 " 330104 144 1 Respiratory signs symptoms & minor diagnoses I N/A "$3,391.46 " N/A "$3,391.46 " N/A N/A N/A N/A "$3,221.89 " N/A "$3,255.80 " N/A N/A N/A N/A N/A "$4,341.07 " "$3,391.46 " N/A N/A N/A N/A "$3,493.20 " N/A N/A "$4,748.04 " "$12,105.20 " "$3,391.46 " "$4,578.47 " "$4,171.49 " N/A "$3,493.20 " N/A N/A N/A N/A N/A "$3,391.46 " "$10,630.75 " "$6,952.49 " "$3,391.46 " "$3,391.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,391.46 " "$3,391.46 " "$3,900.18 " "$3,391.46 " N/A "$3,221.89 " "$12,105.20 " 330104 144 2 Respiratory signs symptoms & minor diagnoses I N/A "$4,182.98 " N/A "$4,182.98 " N/A N/A N/A N/A "$3,973.84 " N/A "$4,015.67 " N/A N/A N/A N/A N/A "$5,354.22 " "$4,182.98 " N/A N/A N/A N/A "$4,308.47 " N/A N/A "$5,856.18 " "$15,212.39 " "$4,182.98 " "$5,647.03 " "$5,145.07 " N/A "$4,308.47 " N/A N/A N/A N/A N/A "$4,182.98 " "$13,359.48 " "$8,575.12 " "$4,182.98 " "$4,182.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,182.98 " "$4,182.98 " "$4,810.43 " "$4,182.98 " N/A "$3,973.84 " "$15,212.39 " 330104 144 3 Respiratory signs symptoms & minor diagnoses I N/A "$6,194.49 " N/A "$6,194.49 " N/A N/A N/A N/A "$5,884.77 " N/A "$5,946.71 " N/A N/A N/A N/A N/A "$7,928.95 " "$6,194.49 " N/A N/A N/A N/A "$6,380.33 " N/A N/A "$8,672.29 " "$23,108.71 " "$6,194.49 " "$8,362.57 " "$7,619.23 " N/A "$6,380.33 " N/A N/A N/A N/A N/A "$6,194.49 " "$20,294.01 " "$12,698.71 " "$6,194.49 " "$6,194.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,194.49 " "$6,194.49 " "$7,123.67 " "$6,194.49 " N/A "$5,884.77 " "$23,108.71 " 330104 144 4 Respiratory signs symptoms & minor diagnoses I N/A "$11,880.26 " N/A "$11,880.26 " N/A N/A N/A N/A "$11,286.25 " N/A "$11,405.05 " N/A N/A N/A N/A N/A "$15,206.74 " "$11,880.26 " N/A N/A N/A N/A "$12,236.67 " N/A N/A "$16,632.37 " "$45,428.59 " "$11,880.26 " "$16,038.35 " "$14,612.72 " N/A "$12,236.67 " N/A N/A N/A N/A N/A "$11,880.26 " "$39,895.27 " "$24,354.54 " "$11,880.26 " "$11,880.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,880.26 " "$11,880.26 " "$13,662.30 " "$11,880.26 " N/A "$11,286.25 " "$45,428.59 " 330104 160 1 Major cardiothoracic repair of heart anomaly I N/A "$21,738.91 " N/A "$21,738.91 " N/A N/A N/A N/A "$20,651.96 " N/A "$20,869.35 " N/A N/A N/A N/A N/A "$27,825.80 " "$21,738.91 " N/A N/A N/A N/A "$22,391.08 " N/A N/A "$30,434.47 " "$84,129.39 " "$21,738.91 " "$29,347.53 " "$26,738.86 " N/A "$22,391.08 " N/A N/A N/A N/A N/A "$21,738.91 " "$73,882.21 " "$44,564.76 " "$21,738.91 " "$21,738.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,738.91 " "$21,738.91 " "$24,999.74 " "$21,738.91 " N/A "$20,651.96 " "$84,129.39 " 330104 160 2 Major cardiothoracic repair of heart anomaly I N/A "$23,452.74 " N/A "$23,452.74 " N/A N/A N/A N/A "$22,280.11 " N/A "$22,514.63 " N/A N/A N/A N/A N/A "$30,019.51 " "$23,452.74 " N/A N/A N/A N/A "$24,156.33 " N/A N/A "$32,833.84 " "$90,857.17 " "$23,452.74 " "$31,661.20 " "$28,846.88 " N/A "$24,156.33 " N/A N/A N/A N/A N/A "$23,452.74 " "$79,790.54 " "$48,078.13 " "$23,452.74 " "$23,452.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,452.74 " "$23,452.74 " "$26,970.66 " "$23,452.74 " N/A "$22,280.11 " "$90,857.17 " 330104 160 3 Major cardiothoracic repair of heart anomaly I N/A "$32,868.63 " N/A "$32,868.63 " N/A N/A N/A N/A "$31,225.19 " N/A "$31,553.88 " N/A N/A N/A N/A N/A "$42,071.84 " "$32,868.63 " N/A N/A N/A N/A "$33,854.68 " N/A N/A "$46,016.08 " "$127,819.87 " "$32,868.63 " "$44,372.65 " "$40,428.41 " N/A "$33,854.68 " N/A N/A N/A N/A N/A "$32,868.63 " "$112,251.09 " "$67,380.68 " "$32,868.63 " "$32,868.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$32,868.63 " "$32,868.63 " "$37,798.92 " "$32,868.63 " N/A "$31,225.19 " "$127,819.87 " 330104 160 4 Major cardiothoracic repair of heart anomaly I N/A "$68,043.14 " N/A "$68,043.14 " N/A N/A N/A N/A "$64,640.98 " N/A "$65,321.42 " N/A N/A N/A N/A N/A "$87,095.22 " "$68,043.14 " N/A N/A N/A N/A "$70,084.44 " N/A N/A "$95,260.40 " "$265,899.89 " "$68,043.14 " "$91,858.24 " "$83,693.06 " N/A "$70,084.44 " N/A N/A N/A N/A N/A "$68,043.14 " "$233,512.60 " "$139,488.44 " "$68,043.14 " "$68,043.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$68,043.14 " "$68,043.14 " "$78,249.61 " "$68,043.14 " N/A "$64,640.98 " "$265,899.89 " 330104 161 1 Cardiac defibrillator & heart assist implant I N/A "$27,652.19 " N/A "$27,652.19 " N/A N/A N/A N/A "$26,269.58 " N/A "$26,546.10 " N/A N/A N/A N/A N/A "$35,394.80 " "$27,652.19 " N/A N/A N/A N/A "$28,481.75 " N/A N/A "$38,713.06 " "$107,342.38 " "$27,652.19 " "$37,330.45 " "$34,012.19 " N/A "$28,481.75 " N/A N/A N/A N/A N/A "$27,652.19 " "$94,267.81 " "$56,686.99 " "$27,652.19 " "$27,652.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,652.19 " "$27,652.19 " "$31,800.02 " "$27,652.19 " N/A "$26,269.58 " "$107,342.38 " 330104 161 2 Cardiac defibrillator & heart assist implant I N/A "$42,047.46 " N/A "$42,047.46 " N/A N/A N/A N/A "$39,945.09 " N/A "$40,365.56 " N/A N/A N/A N/A N/A "$53,820.75 " "$42,047.46 " N/A N/A N/A N/A "$43,308.88 " N/A N/A "$58,866.44 " "$163,852.02 " "$42,047.46 " "$56,764.07 " "$51,718.37 " N/A "$43,308.88 " N/A N/A N/A N/A N/A "$42,047.46 " "$143,894.43 " "$86,197.29 " "$42,047.46 " "$42,047.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,047.46 " "$42,047.46 " "$48,354.58 " "$42,047.46 " N/A "$39,945.09 " "$163,852.02 " 330104 161 3 Cardiac defibrillator & heart assist implant I N/A "$67,332.68 " N/A "$67,332.68 " N/A N/A N/A N/A "$63,966.04 " N/A "$64,639.37 " N/A N/A N/A N/A N/A "$86,185.82 " "$67,332.68 " N/A N/A N/A N/A "$69,352.66 " N/A N/A "$94,265.75 " "$263,110.90 " "$67,332.68 " "$90,899.11 " "$82,819.19 " N/A "$69,352.66 " N/A N/A N/A N/A N/A "$67,332.68 " "$231,063.33 " "$138,031.98 " "$67,332.68 " "$67,332.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$67,332.68 " "$67,332.68 " "$77,432.58 " "$67,332.68 " N/A "$63,966.04 " "$263,110.90 " 330104 161 4 Cardiac defibrillator & heart assist implant I N/A "$157,528.42 " N/A "$157,528.42 " N/A N/A N/A N/A "$149,652.00 " N/A "$151,227.28 " N/A N/A N/A N/A N/A "$201,636.38 " "$157,528.42 " N/A N/A N/A N/A "$162,254.27 " N/A N/A "$220,539.79 " "$617,180.59 " "$157,528.42 " "$212,663.37 " "$193,759.96 " N/A "$162,254.27 " N/A N/A N/A N/A N/A "$157,528.42 " "$542,006.43 " "$322,933.26 " "$157,528.42 " "$157,528.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$157,528.42 " "$157,528.42 " "$181,157.68 " "$157,528.42 " N/A "$149,652.00 " "$617,180.59 " 330104 162 1 Cardiac valve procedures w AMI or complex PDX I N/A "$23,890.74 " N/A "$23,890.74 " N/A N/A N/A N/A "$22,696.20 " N/A "$22,935.11 " N/A N/A N/A N/A N/A "$30,580.15 " "$23,890.74 " N/A N/A N/A N/A "$24,607.46 " N/A N/A "$33,447.04 " "$92,576.55 " "$23,890.74 " "$32,252.50 " "$29,385.61 " N/A "$24,607.46 " N/A N/A N/A N/A N/A "$23,890.74 " "$81,300.49 " "$48,976.02 " "$23,890.74 " "$23,890.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,890.74 " "$23,890.74 " "$27,474.35 " "$23,890.74 " N/A "$22,696.20 " "$92,576.55 " 330104 162 2 Cardiac valve procedures w AMI or complex PDX I N/A "$30,838.72 " N/A "$30,838.72 " N/A N/A N/A N/A "$29,296.79 " N/A "$29,605.18 " N/A N/A N/A N/A N/A "$39,473.57 " "$30,838.72 " N/A N/A N/A N/A "$31,763.89 " N/A N/A "$43,174.21 " "$119,851.35 " "$30,838.72 " "$41,632.28 " "$37,931.63 " N/A "$31,763.89 " N/A N/A N/A N/A N/A "$30,838.72 " "$105,253.15 " "$63,219.39 " "$30,838.72 " "$30,838.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$30,838.72 " "$30,838.72 " "$35,464.53 " "$30,838.72 " N/A "$29,296.79 " "$119,851.35 " 330104 162 3 Cardiac valve procedures w AMI or complex PDX I N/A "$39,384.75 " N/A "$39,384.75 " N/A N/A N/A N/A "$37,415.51 " N/A "$37,809.36 " N/A N/A N/A N/A N/A "$50,412.48 " "$39,384.75 " N/A N/A N/A N/A "$40,566.29 " N/A N/A "$55,138.64 " "$153,399.36 " "$39,384.75 " "$53,169.41 " "$48,443.24 " N/A "$40,566.29 " N/A N/A N/A N/A N/A "$39,384.75 " "$134,714.93 " "$80,738.73 " "$39,384.75 " "$39,384.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$39,384.75 " "$39,384.75 " "$45,292.46 " "$39,384.75 " N/A "$37,415.51 " "$153,399.36 " 330104 162 4 Cardiac valve procedures w AMI or complex PDX I N/A "$64,234.01 " N/A "$64,234.01 " N/A N/A N/A N/A "$61,022.31 " N/A "$61,664.65 " N/A N/A N/A N/A N/A "$82,219.53 " "$64,234.01 " N/A N/A N/A N/A "$66,161.03 " N/A N/A "$89,927.61 " "$250,946.88 " "$64,234.01 " "$86,715.91 " "$79,007.83 " N/A "$66,161.03 " N/A N/A N/A N/A N/A "$64,234.01 " "$220,380.91 " "$131,679.72 " "$64,234.01 " "$64,234.01 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$64,234.01 " "$64,234.01 " "$73,869.11 " "$64,234.01 " N/A "$61,022.31 " "$250,946.88 " 330104 163 1 Cardiac valve procedures w/o AMI or complex PDX I N/A "$20,911.28 " N/A "$20,911.28 " N/A N/A N/A N/A "$19,865.72 " N/A "$20,074.83 " N/A N/A N/A N/A N/A "$26,766.44 " "$20,911.28 " N/A N/A N/A N/A "$21,538.62 " N/A N/A "$29,275.79 " "$80,880.48 " "$20,911.28 " "$28,230.23 " "$25,720.87 " N/A "$21,538.62 " N/A N/A N/A N/A N/A "$20,911.28 " "$71,029.03 " "$42,868.12 " "$20,911.28 " "$20,911.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,911.28 " "$20,911.28 " "$24,047.97 " "$20,911.28 " N/A "$19,865.72 " "$80,880.48 " 330104 163 2 Cardiac valve procedures w/o AMI or complex PDX I N/A "$25,511.94 " N/A "$25,511.94 " N/A N/A N/A N/A "$24,236.34 " N/A "$24,491.46 " N/A N/A N/A N/A N/A "$32,655.28 " "$25,511.94 " N/A N/A N/A N/A "$26,277.29 " N/A N/A "$35,716.71 " "$98,940.67 " "$25,511.94 " "$34,441.11 " "$31,379.68 " N/A "$26,277.29 " N/A N/A N/A N/A N/A "$25,511.94 " "$86,889.45 " "$52,299.47 " "$25,511.94 " "$25,511.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,511.94 " "$25,511.94 " "$29,338.73 " "$25,511.94 " N/A "$24,236.34 " "$98,940.67 " 330104 163 3 Cardiac valve procedures w/o AMI or complex PDX I N/A "$31,271.27 " N/A "$31,271.27 " N/A N/A N/A N/A "$29,707.71 " N/A "$30,020.42 " N/A N/A N/A N/A N/A "$40,027.23 " "$31,271.27 " N/A N/A N/A N/A "$32,209.41 " N/A N/A "$43,779.78 " "$121,549.34 " "$31,271.27 " "$42,216.22 " "$38,463.66 " N/A "$32,209.41 " N/A N/A N/A N/A N/A "$31,271.27 " "$106,744.32 " "$64,106.11 " "$31,271.27 " "$31,271.27 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$31,271.27 " "$31,271.27 " "$35,961.96 " "$31,271.27 " N/A "$29,707.71 " "$121,549.34 " 330104 163 4 Cardiac valve procedures w/o AMI or complex PDX I N/A "$48,310.18 " N/A "$48,310.18 " N/A N/A N/A N/A "$45,894.67 " N/A "$46,377.77 " N/A N/A N/A N/A N/A "$61,837.03 " "$48,310.18 " N/A N/A N/A N/A "$49,759.49 " N/A N/A "$67,634.26 " "$188,436.78 " "$48,310.18 " "$65,218.75 " "$59,421.52 " N/A "$49,759.49 " N/A N/A N/A N/A N/A "$48,310.18 " "$165,484.70 " "$99,035.87 " "$48,310.18 " "$48,310.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$48,310.18 " "$48,310.18 " "$55,556.71 " "$48,310.18 " N/A "$45,894.67 " "$188,436.78 " 330104 165 1 Coronary bypass w AMI or complex PDX I N/A "$27,101.80 " N/A "$27,101.80 " N/A N/A N/A N/A "$25,746.71 " N/A "$26,017.73 " N/A N/A N/A N/A N/A "$34,690.30 " "$27,101.80 " N/A N/A N/A N/A "$27,914.85 " N/A N/A "$37,942.52 " "$105,181.79 " "$27,101.80 " "$36,587.43 " "$33,335.21 " N/A "$27,914.85 " N/A N/A N/A N/A N/A "$27,101.80 " "$92,370.38 " "$55,558.69 " "$27,101.80 " "$27,101.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,101.80 " "$27,101.80 " "$31,167.07 " "$27,101.80 " N/A "$25,746.71 " "$105,181.79 " 330104 165 2 Coronary bypass w AMI or complex PDX I N/A "$27,193.76 " N/A "$27,193.76 " N/A N/A N/A N/A "$25,834.07 " N/A "$26,106.01 " N/A N/A N/A N/A N/A "$34,808.01 " "$27,193.76 " N/A N/A N/A N/A "$28,009.57 " N/A N/A "$38,071.26 " "$105,542.78 " "$27,193.76 " "$36,711.57 " "$33,448.32 " N/A "$28,009.57 " N/A N/A N/A N/A N/A "$27,193.76 " "$92,687.40 " "$55,747.20 " "$27,193.76 " "$27,193.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,193.76 " "$27,193.76 " "$31,272.82 " "$27,193.76 " N/A "$25,834.07 " "$105,542.78 " 330104 165 3 Coronary bypass w AMI or complex PDX I N/A "$33,422.42 " N/A "$33,422.42 " N/A N/A N/A N/A "$31,751.30 " N/A "$32,085.52 " N/A N/A N/A N/A N/A "$42,780.70 " "$33,422.42 " N/A N/A N/A N/A "$34,425.09 " N/A N/A "$46,791.39 " "$129,993.84 " "$33,422.42 " "$45,120.27 " "$41,109.58 " N/A "$34,425.09 " N/A N/A N/A N/A N/A "$33,422.42 " "$114,160.26 " "$68,515.96 " "$33,422.42 " "$33,422.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$33,422.42 " "$33,422.42 " "$38,435.78 " "$33,422.42 " N/A "$31,751.30 " "$129,993.84 " 330104 165 4 Coronary bypass w AMI or complex PDX I N/A "$48,511.81 " N/A "$48,511.81 " N/A N/A N/A N/A "$46,086.22 " N/A "$46,571.34 " N/A N/A N/A N/A N/A "$62,095.12 " "$48,511.81 " N/A N/A N/A N/A "$49,967.16 " N/A N/A "$67,916.53 " "$189,228.28 " "$48,511.81 " "$65,490.94 " "$59,669.53 " N/A "$49,967.16 " N/A N/A N/A N/A N/A "$48,511.81 " "$166,179.80 " "$99,449.21 " "$48,511.81 " "$48,511.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$48,511.81 " "$48,511.81 " "$55,788.58 " "$48,511.81 " N/A "$46,086.22 " "$189,228.28 " 330104 166 1 Coronary bypass w/o AMI or complex PDX I N/A "$20,768.23 " N/A "$20,768.23 " N/A N/A N/A N/A "$19,729.82 " N/A "$19,937.50 " N/A N/A N/A N/A N/A "$26,583.34 " "$20,768.23 " N/A N/A N/A N/A "$21,391.28 " N/A N/A "$29,075.53 " "$80,318.94 " "$20,768.23 " "$28,037.12 " "$25,544.93 " N/A "$21,391.28 " N/A N/A N/A N/A N/A "$20,768.23 " "$70,535.89 " "$42,574.88 " "$20,768.23 " "$20,768.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,768.23 " "$20,768.23 " "$23,883.47 " "$20,768.23 " N/A "$19,729.82 " "$80,318.94 " 330104 166 2 Coronary bypass w/o AMI or complex PDX I N/A "$22,524.98 " N/A "$22,524.98 " N/A N/A N/A N/A "$21,398.73 " N/A "$21,623.98 " N/A N/A N/A N/A N/A "$28,831.98 " "$22,524.98 " N/A N/A N/A N/A "$23,200.73 " N/A N/A "$31,534.98 " "$87,215.18 " "$22,524.98 " "$30,408.73 " "$27,705.73 " N/A "$23,200.73 " N/A N/A N/A N/A N/A "$22,524.98 " "$76,592.15 " "$46,176.22 " "$22,524.98 " "$22,524.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,524.98 " "$22,524.98 " "$25,903.73 " "$22,524.98 " N/A "$21,398.73 " "$87,215.18 " 330104 166 3 Coronary bypass w/o AMI or complex PDX I N/A "$27,662.41 " N/A "$27,662.41 " N/A N/A N/A N/A "$26,279.29 " N/A "$26,555.91 " N/A N/A N/A N/A N/A "$35,407.88 " "$27,662.41 " N/A N/A N/A N/A "$28,492.28 " N/A N/A "$38,727.37 " "$107,382.49 " "$27,662.41 " "$37,344.25 " "$34,024.76 " N/A "$28,492.28 " N/A N/A N/A N/A N/A "$27,662.41 " "$94,303.03 " "$56,707.93 " "$27,662.41 " "$27,662.41 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,662.41 " "$27,662.41 " "$31,811.77 " "$27,662.41 " N/A "$26,279.29 " "$107,382.49 " 330104 166 4 Coronary bypass w/o AMI or complex PDX I N/A "$42,753.16 " N/A "$42,753.16 " N/A N/A N/A N/A "$40,615.50 " N/A "$41,043.03 " N/A N/A N/A N/A N/A "$54,724.04 " "$42,753.16 " N/A N/A N/A N/A "$44,035.75 " N/A N/A "$59,854.42 " "$166,622.29 " "$42,753.16 " "$57,716.76 " "$52,586.38 " N/A "$44,035.75 " N/A N/A N/A N/A N/A "$42,753.16 " "$146,327.27 " "$87,643.97 " "$42,753.16 " "$42,753.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,753.16 " "$42,753.16 " "$49,166.13 " "$42,753.16 " N/A "$40,615.50 " "$166,622.29 " 330104 167 1 Other cardiothoracic & thoracic vascular procedures I N/A "$16,831.04 " N/A "$16,831.04 " N/A N/A N/A N/A "$15,989.49 " N/A "$16,157.80 " N/A N/A N/A N/A N/A "$21,543.73 " "$16,831.04 " N/A N/A N/A N/A "$17,335.97 " N/A N/A "$23,563.46 " "$64,863.22 " "$16,831.04 " "$22,721.91 " "$20,702.18 " N/A "$17,335.97 " N/A N/A N/A N/A N/A "$16,831.04 " "$56,962.71 " "$34,503.64 " "$16,831.04 " "$16,831.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,831.04 " "$16,831.04 " "$19,355.70 " "$16,831.04 " N/A "$15,989.49 " "$64,863.22 " 330104 167 2 Other cardiothoracic & thoracic vascular procedures I N/A "$19,651.11 " N/A "$19,651.11 " N/A N/A N/A N/A "$18,668.55 " N/A "$18,865.06 " N/A N/A N/A N/A N/A "$25,153.42 " "$19,651.11 " N/A N/A N/A N/A "$20,240.64 " N/A N/A "$27,511.55 " "$75,933.58 " "$19,651.11 " "$26,528.99 " "$24,170.86 " N/A "$20,240.64 " N/A N/A N/A N/A N/A "$19,651.11 " "$66,684.68 " "$40,284.77 " "$19,651.11 " "$19,651.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,651.11 " "$19,651.11 " "$22,598.77 " "$19,651.11 " N/A "$18,668.55 " "$75,933.58 " 330104 167 3 Other cardiothoracic & thoracic vascular procedures I N/A "$25,383.19 " N/A "$25,383.19 " N/A N/A N/A N/A "$24,114.03 " N/A "$24,367.87 " N/A N/A N/A N/A N/A "$32,490.49 " "$25,383.19 " N/A N/A N/A N/A "$26,144.69 " N/A N/A "$35,536.47 " "$98,435.29 " "$25,383.19 " "$34,267.31 " "$31,221.33 " N/A "$26,144.69 " N/A N/A N/A N/A N/A "$25,383.19 " "$86,445.62 " "$52,035.55 " "$25,383.19 " "$25,383.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,383.19 " "$25,383.19 " "$29,190.67 " "$25,383.19 " N/A "$24,114.03 " "$98,435.29 " 330104 167 4 Other cardiothoracic & thoracic vascular procedures I N/A "$45,477.86 " N/A "$45,477.86 " N/A N/A N/A N/A "$43,203.96 " N/A "$43,658.74 " N/A N/A N/A N/A N/A "$58,211.66 " "$45,477.86 " N/A N/A N/A N/A "$46,842.19 " N/A N/A "$63,669.00 " "$177,318.29 " "$45,477.86 " "$61,395.11 " "$55,937.76 " N/A "$46,842.19 " N/A N/A N/A N/A N/A "$45,477.86 " "$155,720.47 " "$93,229.61 " "$45,477.86 " "$45,477.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$45,477.86 " "$45,477.86 " "$52,299.54 " "$45,477.86 " N/A "$43,203.96 " "$177,318.29 " 330104 169 1 Major abdominal vascular procedures I N/A "$12,455.17 " N/A "$12,455.17 " N/A N/A N/A N/A "$11,832.42 " N/A "$11,956.97 " N/A N/A N/A N/A N/A "$15,942.62 " "$12,455.17 " N/A N/A N/A N/A "$12,828.83 " N/A N/A "$17,437.24 " "$47,685.44 " "$12,455.17 " "$16,814.48 " "$15,319.86 " N/A "$12,828.83 " N/A N/A N/A N/A N/A "$12,455.17 " "$41,877.23 " "$25,533.11 " "$12,455.17 " "$12,455.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,455.17 " "$12,455.17 " "$14,323.45 " "$12,455.17 " N/A "$11,832.42 " "$47,685.44 " 330104 169 2 Major abdominal vascular procedures I N/A "$15,895.79 " N/A "$15,895.79 " N/A N/A N/A N/A "$15,101.00 " N/A "$15,259.96 " N/A N/A N/A N/A N/A "$20,346.61 " "$15,895.79 " N/A N/A N/A N/A "$16,372.66 " N/A N/A "$22,254.10 " "$61,191.82 " "$15,895.79 " "$21,459.31 " "$19,551.82 " N/A "$16,372.66 " N/A N/A N/A N/A N/A "$15,895.79 " "$53,738.50 " "$32,586.37 " "$15,895.79 " "$15,895.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,895.79 " "$15,895.79 " "$18,280.16 " "$15,895.79 " N/A "$15,101.00 " "$61,191.82 " 330104 169 3 Major abdominal vascular procedures I N/A "$25,616.16 " N/A "$25,616.16 " N/A N/A N/A N/A "$24,335.35 " N/A "$24,591.51 " N/A N/A N/A N/A N/A "$32,788.68 " "$25,616.16 " N/A N/A N/A N/A "$26,384.64 " N/A N/A "$35,862.62 " "$99,349.80 " "$25,616.16 " "$34,581.81 " "$31,507.87 " N/A "$26,384.64 " N/A N/A N/A N/A N/A "$25,616.16 " "$87,248.74 " "$52,513.12 " "$25,616.16 " "$25,616.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,616.16 " "$25,616.16 " "$29,458.58 " "$25,616.16 " N/A "$24,335.35 " "$99,349.80 " 330104 169 4 Major abdominal vascular procedures I N/A "$49,235.90 " N/A "$49,235.90 " N/A N/A N/A N/A "$46,774.10 " N/A "$47,266.46 " N/A N/A N/A N/A N/A "$63,021.95 " "$49,235.90 " N/A N/A N/A N/A "$50,712.98 " N/A N/A "$68,930.26 " "$192,070.75 " "$49,235.90 " "$66,468.46 " "$60,560.16 " N/A "$50,712.98 " N/A N/A N/A N/A N/A "$49,235.90 " "$168,676.04 " "$100,933.59 " "$49,235.90 " "$49,235.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$49,235.90 " "$49,235.90 " "$56,621.28 " "$49,235.90 " N/A "$46,774.10 " "$192,070.75 " 330104 170 1 Permanent cardiac pacemaker implant w AMI heart failure or shock I N/A "$18,737.65 " N/A "$18,737.65 " N/A N/A N/A N/A "$17,800.77 " N/A "$17,988.14 " N/A N/A N/A N/A N/A "$23,984.19 " "$18,737.65 " N/A N/A N/A N/A "$19,299.78 " N/A N/A "$26,232.71 " "$72,347.74 " "$18,737.65 " "$25,295.83 " "$23,047.31 " N/A "$19,299.78 " N/A N/A N/A N/A N/A "$18,737.65 " "$63,535.60 " "$38,412.18 " "$18,737.65 " "$18,737.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,737.65 " "$18,737.65 " "$21,548.30 " "$18,737.65 " N/A "$17,800.77 " "$72,347.74 " 330104 170 2 Permanent cardiac pacemaker implant w AMI heart failure or shock I N/A "$18,940.64 " N/A "$18,940.64 " N/A N/A N/A N/A "$17,993.61 " N/A "$18,183.02 " N/A N/A N/A N/A N/A "$24,244.02 " "$18,940.64 " N/A N/A N/A N/A "$19,508.86 " N/A N/A "$26,516.90 " "$73,144.60 " "$18,940.64 " "$25,569.87 " "$23,296.99 " N/A "$19,508.86 " N/A N/A N/A N/A N/A "$18,940.64 " "$64,235.40 " "$38,828.31 " "$18,940.64 " "$18,940.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,940.64 " "$18,940.64 " "$21,781.74 " "$18,940.64 " N/A "$17,993.61 " "$73,144.60 " 330104 170 3 Permanent cardiac pacemaker implant w AMI heart failure or shock I N/A "$24,850.52 " N/A "$24,850.52 " N/A N/A N/A N/A "$23,607.99 " N/A "$23,856.49 " N/A N/A N/A N/A N/A "$31,808.66 " "$24,850.52 " N/A N/A N/A N/A "$25,596.03 " N/A N/A "$34,790.72 " "$96,344.22 " "$24,850.52 " "$33,548.20 " "$30,566.13 " N/A "$25,596.03 " N/A N/A N/A N/A N/A "$24,850.52 " "$84,609.25 " "$50,943.56 " "$24,850.52 " "$24,850.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,850.52 " "$24,850.52 " "$28,578.09 " "$24,850.52 " N/A "$23,607.99 " "$96,344.22 " 330104 170 4 Permanent cardiac pacemaker implant w AMI heart failure or shock I N/A "$33,089.33 " N/A "$33,089.33 " N/A N/A N/A N/A "$31,434.86 " N/A "$31,765.75 " N/A N/A N/A N/A N/A "$42,354.34 " "$33,089.33 " N/A N/A N/A N/A "$34,082.01 " N/A N/A "$46,325.06 " "$128,686.25 " "$33,089.33 " "$44,670.59 " "$40,699.87 " N/A "$34,082.01 " N/A N/A N/A N/A N/A "$33,089.33 " "$113,011.94 " "$67,833.12 " "$33,089.33 " "$33,089.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$33,089.33 " "$33,089.33 " "$38,052.73 " "$33,089.33 " N/A "$31,434.86 " "$128,686.25 " 330104 171 1 Perm cardiac pacemaker implant w/o AMI heart failure or shock I N/A "$12,158.86 " N/A "$12,158.86 " N/A N/A N/A N/A "$11,550.92 " N/A "$11,672.51 " N/A N/A N/A N/A N/A "$15,563.34 " "$12,158.86 " N/A N/A N/A N/A "$12,523.63 " N/A N/A "$17,022.41 " "$46,522.25 " "$12,158.86 " "$16,414.46 " "$14,955.40 " N/A "$12,523.63 " N/A N/A N/A N/A N/A "$12,158.86 " "$40,855.72 " "$24,925.67 " "$12,158.86 " "$12,158.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,158.86 " "$12,158.86 " "$13,982.69 " "$12,158.86 " N/A "$11,550.92 " "$46,522.25 " 330104 171 2 Perm cardiac pacemaker implant w/o AMI heart failure or shock I N/A "$14,912.17 " N/A "$14,912.17 " N/A N/A N/A N/A "$14,166.56 " N/A "$14,315.69 " N/A N/A N/A N/A N/A "$19,087.58 " "$14,912.17 " N/A N/A N/A N/A "$15,359.54 " N/A N/A "$20,877.04 " "$57,330.56 " "$14,912.17 " "$20,131.43 " "$18,341.97 " N/A "$15,359.54 " N/A N/A N/A N/A N/A "$14,912.17 " "$50,347.55 " "$30,569.95 " "$14,912.17 " "$14,912.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,912.17 " "$14,912.17 " "$17,149.00 " "$14,912.17 " N/A "$14,166.56 " "$57,330.56 " 330104 171 3 Perm cardiac pacemaker implant w/o AMI heart failure or shock I N/A "$20,660.61 " N/A "$20,660.61 " N/A N/A N/A N/A "$19,627.58 " N/A "$19,834.18 " N/A N/A N/A N/A N/A "$26,445.58 " "$20,660.61 " N/A N/A N/A N/A "$21,280.43 " N/A N/A "$28,924.85 " "$79,896.45 " "$20,660.61 " "$27,891.82 " "$25,412.55 " N/A "$21,280.43 " N/A N/A N/A N/A N/A "$20,660.61 " "$70,164.86 " "$42,354.25 " "$20,660.61 " "$20,660.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,660.61 " "$20,660.61 " "$23,759.70 " "$20,660.61 " N/A "$19,627.58 " "$79,896.45 " 330104 171 4 Perm cardiac pacemaker implant w/o AMI heart failure or shock I N/A "$40,931.69 " N/A "$40,931.69 " N/A N/A N/A N/A "$38,885.11 " N/A "$39,294.43 " N/A N/A N/A N/A N/A "$52,392.57 " "$40,931.69 " N/A N/A N/A N/A "$42,159.65 " N/A N/A "$57,304.37 " "$159,472.01 " "$40,931.69 " "$55,257.79 " "$50,345.98 " N/A "$42,159.65 " N/A N/A N/A N/A N/A "$40,931.69 " "$140,047.92 " "$83,909.97 " "$40,931.69 " "$40,931.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$40,931.69 " "$40,931.69 " "$47,071.45 " "$40,931.69 " N/A "$38,885.11 " "$159,472.01 " 330104 174 1 Percutaneous coronary intervention w AMI I N/A "$12,330.52 " N/A "$12,330.52 " N/A N/A N/A N/A "$11,713.99 " N/A "$11,837.30 " N/A N/A N/A N/A N/A "$15,783.06 " "$12,330.52 " N/A N/A N/A N/A "$12,700.43 " N/A N/A "$17,262.73 " "$47,196.10 " "$12,330.52 " "$16,646.20 " "$15,166.54 " N/A "$12,700.43 " N/A N/A N/A N/A N/A "$12,330.52 " "$41,447.49 " "$25,277.56 " "$12,330.52 " "$12,330.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,330.52 " "$12,330.52 " "$14,180.10 " "$12,330.52 " N/A "$11,713.99 " "$47,196.10 " 330104 174 2 Percutaneous coronary intervention w AMI I N/A "$13,538.24 " N/A "$13,538.24 " N/A N/A N/A N/A "$12,861.33 " N/A "$12,996.71 " N/A N/A N/A N/A N/A "$17,328.95 " "$13,538.24 " N/A N/A N/A N/A "$13,944.39 " N/A N/A "$18,953.54 " "$51,937.10 " "$13,538.24 " "$18,276.63 " "$16,652.04 " N/A "$13,944.39 " N/A N/A N/A N/A N/A "$13,538.24 " "$45,611.03 " "$27,753.40 " "$13,538.24 " "$13,538.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,538.24 " "$13,538.24 " "$15,568.98 " "$13,538.24 " N/A "$12,861.33 " "$51,937.10 " 330104 174 3 Percutaneous coronary intervention w AMI I N/A "$17,380.75 " N/A "$17,380.75 " N/A N/A N/A N/A "$16,511.71 " N/A "$16,685.52 " N/A N/A N/A N/A N/A "$22,247.36 " "$17,380.75 " N/A N/A N/A N/A "$17,902.17 " N/A N/A "$24,333.05 " "$67,021.14 " "$17,380.75 " "$23,464.01 " "$21,378.32 " N/A "$17,902.17 " N/A N/A N/A N/A N/A "$17,380.75 " "$58,857.79 " "$35,630.54 " "$17,380.75 " "$17,380.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,380.75 " "$17,380.75 " "$19,987.86 " "$17,380.75 " N/A "$16,511.71 " "$67,021.14 " 330104 174 4 Percutaneous coronary intervention w AMI I N/A "$26,388.61 " N/A "$26,388.61 " N/A N/A N/A N/A "$25,069.18 " N/A "$25,333.06 " N/A N/A N/A N/A N/A "$33,777.42 " "$26,388.61 " N/A N/A N/A N/A "$27,180.27 " N/A N/A "$36,944.05 " "$102,382.11 " "$26,388.61 " "$35,624.62 " "$32,457.99 " N/A "$27,180.27 " N/A N/A N/A N/A N/A "$26,388.61 " "$89,911.71 " "$54,096.65 " "$26,388.61 " "$26,388.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,388.61 " "$26,388.61 " "$30,346.90 " "$26,388.61 " N/A "$25,069.18 " "$102,382.11 " 330104 175 1 Percutaneous coronary intervention w/o AMI I N/A "$10,357.84 " N/A "$10,357.84 " N/A N/A N/A N/A "$9,839.94 " N/A "$9,943.52 " N/A N/A N/A N/A N/A "$13,258.03 " "$10,357.84 " N/A N/A N/A N/A "$10,668.57 " N/A N/A "$14,500.97 " "$39,452.20 " "$10,357.84 " "$13,983.08 " "$12,740.14 " N/A "$10,668.57 " N/A N/A N/A N/A N/A "$10,357.84 " "$34,646.82 " "$21,233.56 " "$10,357.84 " "$10,357.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,357.84 " "$10,357.84 " "$11,911.51 " "$10,357.84 " N/A "$9,839.94 " "$39,452.20 " 330104 175 2 Percutaneous coronary intervention w/o AMI I N/A "$11,711.33 " N/A "$11,711.33 " N/A N/A N/A N/A "$11,125.76 " N/A "$11,242.88 " N/A N/A N/A N/A N/A "$14,990.50 " "$11,711.33 " N/A N/A N/A N/A "$12,062.67 " N/A N/A "$16,395.86 " "$44,765.43 " "$11,711.33 " "$15,810.30 " "$14,404.94 " N/A "$12,062.67 " N/A N/A N/A N/A N/A "$11,711.33 " "$39,312.89 " "$24,008.23 " "$11,711.33 " "$11,711.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,711.33 " "$11,711.33 " "$13,468.03 " "$11,711.33 " N/A "$11,125.76 " "$44,765.43 " 330104 175 3 Percutaneous coronary intervention w/o AMI I N/A "$16,781.32 " N/A "$16,781.32 " N/A N/A N/A N/A "$15,942.25 " N/A "$16,110.06 " N/A N/A N/A N/A N/A "$21,480.08 " "$16,781.32 " N/A N/A N/A N/A "$17,284.76 " N/A N/A "$23,493.84 " "$64,668.02 " "$16,781.32 " "$22,654.78 " "$20,641.02 " N/A "$17,284.76 " N/A N/A N/A N/A N/A "$16,781.32 " "$56,791.29 " "$34,401.70 " "$16,781.32 " "$16,781.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,781.32 " "$16,781.32 " "$19,298.51 " "$16,781.32 " N/A "$15,942.25 " "$64,668.02 " 330104 175 4 Percutaneous coronary intervention w/o AMI I N/A "$33,758.24 " N/A "$33,758.24 " N/A N/A N/A N/A "$32,070.33 " N/A "$32,407.91 " N/A N/A N/A N/A N/A "$43,210.55 " "$33,758.24 " N/A N/A N/A N/A "$34,770.99 " N/A N/A "$47,261.54 " "$131,312.12 " "$33,758.24 " "$45,573.62 " "$41,522.64 " N/A "$34,770.99 " N/A N/A N/A N/A N/A "$33,758.24 " "$115,317.97 " "$69,204.39 " "$33,758.24 " "$33,758.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$33,758.24 " "$33,758.24 " "$38,821.98 " "$33,758.24 " N/A "$32,070.33 " "$131,312.12 " 330104 176 1 Cardiac pacemaker & defibrillator device replacement I N/A "$10,068.34 " N/A "$10,068.34 " N/A N/A N/A N/A "$9,564.92 " N/A "$9,665.60 " N/A N/A N/A N/A N/A "$12,887.47 " "$10,068.34 " N/A N/A N/A N/A "$10,370.39 " N/A N/A "$14,095.67 " "$38,315.75 " "$10,068.34 " "$13,592.25 " "$12,384.05 " N/A "$10,370.39 " N/A N/A N/A N/A N/A "$10,068.34 " "$33,648.79 " "$20,640.09 " "$10,068.34 " "$10,068.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,068.34 " "$10,068.34 " "$11,578.59 " "$10,068.34 " N/A "$9,564.92 " "$38,315.75 " 330104 176 2 Cardiac pacemaker & defibrillator device replacement I N/A "$18,293.52 " N/A "$18,293.52 " N/A N/A N/A N/A "$17,378.85 " N/A "$17,561.78 " N/A N/A N/A N/A N/A "$23,415.71 " "$18,293.52 " N/A N/A N/A N/A "$18,842.33 " N/A N/A "$25,610.93 " "$70,604.30 " "$18,293.52 " "$24,696.26 " "$22,501.04 " N/A "$18,842.33 " N/A N/A N/A N/A N/A "$18,293.52 " "$62,004.51 " "$37,501.73 " "$18,293.52 " "$18,293.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,293.52 " "$18,293.52 " "$21,037.55 " "$18,293.52 " N/A "$17,378.85 " "$70,604.30 " 330104 176 3 Cardiac pacemaker & defibrillator device replacement I N/A "$23,226.59 " N/A "$23,226.59 " N/A N/A N/A N/A "$22,065.26 " N/A "$22,297.53 " N/A N/A N/A N/A N/A "$29,730.04 " "$23,226.59 " N/A N/A N/A N/A "$23,923.39 " N/A N/A "$32,517.23 " "$89,969.40 " "$23,226.59 " "$31,355.90 " "$28,568.71 " N/A "$23,923.39 " N/A N/A N/A N/A N/A "$23,226.59 " "$79,010.90 " "$47,614.52 " "$23,226.59 " "$23,226.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,226.59 " "$23,226.59 " "$26,710.58 " "$23,226.59 " N/A "$22,065.26 " "$89,969.40 " 330104 176 4 Cardiac pacemaker & defibrillator device replacement I N/A "$24,496.99 " N/A "$24,496.99 " N/A N/A N/A N/A "$23,272.14 " N/A "$23,517.11 " N/A N/A N/A N/A N/A "$31,356.14 " "$24,496.99 " N/A N/A N/A N/A "$25,231.89 " N/A N/A "$34,295.78 " "$94,956.41 " "$24,496.99 " "$33,070.93 " "$30,131.29 " N/A "$25,231.89 " N/A N/A N/A N/A N/A "$24,496.99 " "$83,390.48 " "$50,218.82 " "$24,496.99 " "$24,496.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,496.99 " "$24,496.99 " "$28,171.53 " "$24,496.99 " N/A "$23,272.14 " "$94,956.41 " 330104 177 1 Cardiac pacemaker & defibrillator revision except device replacement I N/A "$9,804.72 " N/A "$9,804.72 " N/A N/A N/A N/A "$9,314.49 " N/A "$9,412.53 " N/A N/A N/A N/A N/A "$12,550.04 " "$9,804.72 " N/A N/A N/A N/A "$10,098.86 " N/A N/A "$13,726.61 " "$37,280.91 " "$9,804.72 " "$13,236.37 " "$12,059.81 " N/A "$10,098.86 " N/A N/A N/A N/A N/A "$9,804.72 " "$32,740.00 " "$20,099.68 " "$9,804.72 " "$9,804.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,804.72 " "$9,804.72 " "$11,275.43 " "$9,804.72 " N/A "$9,314.49 " "$37,280.91 " 330104 177 2 Cardiac pacemaker & defibrillator revision except device replacement I N/A "$12,209.27 " N/A "$12,209.27 " N/A N/A N/A N/A "$11,598.81 " N/A "$11,720.90 " N/A N/A N/A N/A N/A "$15,627.87 " "$12,209.27 " N/A N/A N/A N/A "$12,575.55 " N/A N/A "$17,092.98 " "$46,720.13 " "$12,209.27 " "$16,482.51 " "$15,017.40 " N/A "$12,575.55 " N/A N/A N/A N/A N/A "$12,209.27 " "$41,029.50 " "$25,029.00 " "$12,209.27 " "$12,209.27 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,209.27 " "$12,209.27 " "$14,040.66 " "$12,209.27 " N/A "$11,598.81 " "$46,720.13 " 330104 177 3 Cardiac pacemaker & defibrillator revision except device replacement I N/A "$18,567.36 " N/A "$18,567.36 " N/A N/A N/A N/A "$17,638.99 " N/A "$17,824.66 " N/A N/A N/A N/A N/A "$23,766.22 " "$18,567.36 " N/A N/A N/A N/A "$19,124.38 " N/A N/A "$25,994.30 " "$71,679.24 " "$18,567.36 " "$25,065.93 " "$22,837.85 " N/A "$19,124.38 " N/A N/A N/A N/A N/A "$18,567.36 " "$62,948.53 " "$38,063.08 " "$18,567.36 " "$18,567.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,567.36 " "$18,567.36 " "$21,352.46 " "$18,567.36 " N/A "$17,638.99 " "$71,679.24 " 330104 177 4 Cardiac pacemaker & defibrillator revision except device replacement I N/A "$43,457.49 " N/A "$43,457.49 " N/A N/A N/A N/A "$41,284.62 " N/A "$41,719.19 " N/A N/A N/A N/A N/A "$55,625.59 " "$43,457.49 " N/A N/A N/A N/A "$44,761.22 " N/A N/A "$60,840.49 " "$169,387.20 " "$43,457.49 " "$58,667.61 " "$53,452.71 " N/A "$44,761.22 " N/A N/A N/A N/A N/A "$43,457.49 " "$148,755.41 " "$89,087.86 " "$43,457.49 " "$43,457.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,457.49 " "$43,457.49 " "$49,976.12 " "$43,457.49 " N/A "$41,284.62 " "$169,387.20 " 330104 180 1 Other circulatory system procedures I N/A "$8,066.36 " N/A "$8,066.36 " N/A N/A N/A N/A "$7,663.05 " N/A "$7,743.71 " N/A N/A N/A N/A N/A "$10,324.94 " "$8,066.36 " N/A N/A N/A N/A "$8,308.35 " N/A N/A "$11,292.91 " "$30,456.86 " "$8,066.36 " "$10,889.59 " "$9,921.63 " N/A "$8,308.35 " N/A N/A N/A N/A N/A "$8,066.36 " "$26,747.14 " "$16,536.04 " "$8,066.36 " "$8,066.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,066.36 " "$8,066.36 " "$9,276.32 " "$8,066.36 " N/A "$7,663.05 " "$30,456.86 " 330104 180 2 Other circulatory system procedures I N/A "$11,521.28 " N/A "$11,521.28 " N/A N/A N/A N/A "$10,945.22 " N/A "$11,060.43 " N/A N/A N/A N/A N/A "$14,747.24 " "$11,521.28 " N/A N/A N/A N/A "$11,866.92 " N/A N/A "$16,129.80 " "$44,019.39 " "$11,521.28 " "$15,553.73 " "$14,171.18 " N/A "$11,866.92 " N/A N/A N/A N/A N/A "$11,521.28 " "$38,657.71 " "$23,618.63 " "$11,521.28 " "$11,521.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,521.28 " "$11,521.28 " "$13,249.48 " "$11,521.28 " N/A "$10,945.22 " "$44,019.39 " 330104 180 3 Other circulatory system procedures I N/A "$16,788.81 " N/A "$16,788.81 " N/A N/A N/A N/A "$15,949.37 " N/A "$16,117.26 " N/A N/A N/A N/A N/A "$21,489.68 " "$16,788.81 " N/A N/A N/A N/A "$17,292.47 " N/A N/A "$23,504.33 " "$64,697.43 " "$16,788.81 " "$22,664.89 " "$20,650.24 " N/A "$17,292.47 " N/A N/A N/A N/A N/A "$16,788.81 " "$56,817.12 " "$34,417.06 " "$16,788.81 " "$16,788.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,788.81 " "$16,788.81 " "$19,307.13 " "$16,788.81 " N/A "$15,949.37 " "$64,697.43 " 330104 180 4 Other circulatory system procedures I N/A "$33,134.28 " N/A "$33,134.28 " N/A N/A N/A N/A "$31,477.57 " N/A "$31,808.91 " N/A N/A N/A N/A N/A "$42,411.88 " "$33,134.28 " N/A N/A N/A N/A "$34,128.31 " N/A N/A "$46,388.00 " "$128,862.73 " "$33,134.28 " "$44,731.28 " "$40,755.17 " N/A "$34,128.31 " N/A N/A N/A N/A N/A "$33,134.28 " "$113,166.93 " "$67,925.28 " "$33,134.28 " "$33,134.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$33,134.28 " "$33,134.28 " "$38,104.43 " "$33,134.28 " N/A "$31,477.57 " "$128,862.73 " 330104 181 1 Lower extremity arterial procedures # I N/A "$10,082.64 " N/A "$10,082.64 " N/A N/A N/A N/A "$9,578.51 " N/A "$9,679.34 " N/A N/A N/A N/A N/A "$12,905.78 " "$10,082.64 " N/A N/A N/A N/A "$10,385.12 " N/A N/A "$14,115.70 " "$38,371.90 " "$10,082.64 " "$13,611.57 " "$12,401.65 " N/A "$10,385.12 " N/A N/A N/A N/A N/A "$10,082.64 " "$33,698.11 " "$20,669.41 " "$10,082.64 " "$10,082.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,082.64 " "$10,082.64 " "$11,595.04 " "$10,082.64 " N/A "$9,578.51 " "$38,371.90 " 330104 181 2 Lower extremity arterial procedures # I N/A "$15,822.90 " N/A "$15,822.90 " N/A N/A N/A N/A "$15,031.76 " N/A "$15,189.99 " N/A N/A N/A N/A N/A "$20,253.32 " "$15,822.90 " N/A N/A N/A N/A "$16,297.59 " N/A N/A "$22,152.06 " "$60,905.70 " "$15,822.90 " "$21,360.92 " "$19,462.17 " N/A "$16,297.59 " N/A N/A N/A N/A N/A "$15,822.90 " "$53,487.23 " "$32,436.95 " "$15,822.90 " "$15,822.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,822.90 " "$15,822.90 " "$18,196.34 " "$15,822.90 " N/A "$15,031.76 " "$60,905.70 " 330104 181 3 Lower extremity arterial procedures # I N/A "$28,169.88 " N/A "$28,169.88 " N/A N/A N/A N/A "$26,761.39 " N/A "$27,043.09 " N/A N/A N/A N/A N/A "$36,057.45 " "$28,169.88 " N/A N/A N/A N/A "$29,014.98 " N/A N/A "$39,437.83 " "$109,374.62 " "$28,169.88 " "$38,029.34 " "$34,648.95 " N/A "$29,014.98 " N/A N/A N/A N/A N/A "$28,169.88 " "$96,052.51 " "$57,748.26 " "$28,169.88 " "$28,169.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$28,169.88 " "$28,169.88 " "$32,395.36 " "$28,169.88 " N/A "$26,761.39 " "$109,374.62 " 330104 181 4 Lower extremity arterial procedures # I N/A "$45,377.72 " N/A "$45,377.72 " N/A N/A N/A N/A "$43,108.84 " N/A "$43,562.61 " N/A N/A N/A N/A N/A "$58,083.49 " "$45,377.72 " N/A N/A N/A N/A "$46,739.06 " N/A N/A "$63,528.81 " "$176,925.21 " "$45,377.72 " "$61,259.93 " "$55,814.60 " N/A "$46,739.06 " N/A N/A N/A N/A N/A "$45,377.72 " "$155,375.27 " "$93,024.33 " "$45,377.72 " "$45,377.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$45,377.72 " "$45,377.72 " "$52,184.38 " "$45,377.72 " N/A "$43,108.84 " "$176,925.21 " 330104 182 1 Other peripheral vascular procedures # I N/A "$10,528.13 " N/A "$10,528.13 " N/A N/A N/A N/A "$10,001.72 " N/A "$10,107.00 " N/A N/A N/A N/A N/A "$13,476.01 " "$10,528.13 " N/A N/A N/A N/A "$10,843.97 " N/A N/A "$14,739.38 " "$40,120.70 " "$10,528.13 " "$14,212.98 " "$12,949.60 " N/A "$10,843.97 " N/A N/A N/A N/A N/A "$10,528.13 " "$35,233.89 " "$21,582.67 " "$10,528.13 " "$10,528.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,528.13 " "$10,528.13 " "$12,107.35 " "$10,528.13 " N/A "$10,001.72 " "$40,120.70 " 330104 182 2 Other peripheral vascular procedures # I N/A "$14,735.07 " N/A "$14,735.07 " N/A N/A N/A N/A "$13,998.31 " N/A "$14,145.66 " N/A N/A N/A N/A N/A "$18,860.89 " "$14,735.07 " N/A N/A N/A N/A "$15,177.12 " N/A N/A "$20,629.09 " "$56,635.32 " "$14,735.07 " "$19,892.34 " "$18,124.13 " N/A "$15,177.12 " N/A N/A N/A N/A N/A "$14,735.07 " "$49,736.99 " "$30,206.89 " "$14,735.07 " "$14,735.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,735.07 " "$14,735.07 " "$16,945.33 " "$14,735.07 " N/A "$13,998.31 " "$56,635.32 " 330104 182 3 Other peripheral vascular procedures # I N/A "$22,268.86 " N/A "$22,268.86 " N/A N/A N/A N/A "$21,155.42 " N/A "$21,378.11 " N/A N/A N/A N/A N/A "$28,504.14 " "$22,268.86 " N/A N/A N/A N/A "$22,936.93 " N/A N/A "$31,176.41 " "$86,209.76 " "$22,268.86 " "$30,062.96 " "$27,390.70 " N/A "$22,936.93 " N/A N/A N/A N/A N/A "$22,268.86 " "$75,709.19 " "$45,651.17 " "$22,268.86 " "$22,268.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,268.86 " "$22,268.86 " "$25,609.19 " "$22,268.86 " N/A "$21,155.42 " "$86,209.76 " 330104 182 4 Other peripheral vascular procedures # I N/A "$43,031.08 " N/A "$43,031.08 " N/A N/A N/A N/A "$40,879.52 " N/A "$41,309.83 " N/A N/A N/A N/A N/A "$55,079.78 " "$43,031.08 " N/A N/A N/A N/A "$44,322.01 " N/A N/A "$60,243.51 " "$167,713.28 " "$43,031.08 " "$58,091.95 " "$52,928.22 " N/A "$44,322.01 " N/A N/A N/A N/A N/A "$43,031.08 " "$147,285.38 " "$88,213.71 " "$43,031.08 " "$43,031.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,031.08 " "$43,031.08 " "$49,485.74 " "$43,031.08 " N/A "$40,879.52 " "$167,713.28 " 330104 190 1 Acute myocardial infarction I N/A "$5,319.18 " N/A "$5,319.18 " N/A N/A N/A N/A "$5,053.23 " N/A "$5,106.42 " N/A N/A N/A N/A N/A "$6,808.56 " "$5,319.18 " N/A N/A N/A N/A "$5,478.76 " N/A N/A "$7,446.86 " "$19,672.62 " "$5,319.18 " "$7,180.90 " "$6,542.60 " N/A "$5,478.76 " N/A N/A N/A N/A N/A "$5,319.18 " "$17,276.44 " "$10,904.33 " "$5,319.18 " "$5,319.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,319.18 " "$5,319.18 " "$6,117.06 " "$5,319.18 " N/A "$5,053.23 " "$19,672.62 " 330104 190 2 Acute myocardial infarction I N/A "$6,835.48 " N/A "$6,835.48 " N/A N/A N/A N/A "$6,493.71 " N/A "$6,562.06 " N/A N/A N/A N/A N/A "$8,749.41 " "$6,835.48 " N/A N/A N/A N/A "$7,040.54 " N/A N/A "$9,569.67 " "$25,624.94 " "$6,835.48 " "$9,227.90 " "$8,407.64 " N/A "$7,040.54 " N/A N/A N/A N/A N/A "$6,835.48 " "$22,503.76 " "$14,012.73 " "$6,835.48 " "$6,835.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,835.48 " "$6,835.48 " "$7,860.80 " "$6,835.48 " N/A "$6,493.71 " "$25,624.94 " 330104 190 3 Acute myocardial infarction I N/A "$10,190.27 " N/A "$10,190.27 " N/A N/A N/A N/A "$9,680.75 " N/A "$9,782.66 " N/A N/A N/A N/A N/A "$13,043.54 " "$10,190.27 " N/A N/A N/A N/A "$10,495.97 " N/A N/A "$14,266.37 " "$38,794.39 " "$10,190.27 " "$13,756.86 " "$12,534.03 " N/A "$10,495.97 " N/A N/A N/A N/A N/A "$10,190.27 " "$34,069.14 " "$20,890.05 " "$10,190.27 " "$10,190.27 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,190.27 " "$10,190.27 " "$11,718.81 " "$10,190.27 " N/A "$9,680.75 " "$38,794.39 " 330104 190 4 Acute myocardial infarction I N/A "$19,470.60 " N/A "$19,470.60 " N/A N/A N/A N/A "$18,497.07 " N/A "$18,691.77 " N/A N/A N/A N/A N/A "$24,922.36 " "$19,470.60 " N/A N/A N/A N/A "$20,054.71 " N/A N/A "$27,258.83 " "$75,224.97 " "$19,470.60 " "$26,285.30 " "$23,948.83 " N/A "$20,054.71 " N/A N/A N/A N/A N/A "$19,470.60 " "$66,062.38 " "$39,914.72 " "$19,470.60 " "$19,470.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,470.60 " "$19,470.60 " "$22,391.18 " "$19,470.60 " N/A "$18,497.07 " "$75,224.97 " 330104 191 1 Cardiac catheterization for coronary artery disease I N/A "$5,191.80 " N/A "$5,191.80 " N/A N/A N/A N/A "$4,932.21 " N/A "$4,984.13 " N/A N/A N/A N/A N/A "$6,645.51 " "$5,191.80 " N/A N/A N/A N/A "$5,347.56 " N/A N/A "$7,268.53 " "$19,172.58 " "$5,191.80 " "$7,008.94 " "$6,385.92 " N/A "$5,347.56 " N/A N/A N/A N/A N/A "$5,191.80 " "$16,837.31 " "$10,643.20 " "$5,191.80 " "$5,191.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,191.80 " "$5,191.80 " "$5,970.58 " "$5,191.80 " N/A "$4,932.21 " "$19,172.58 " 330104 191 2 Cardiac catheterization for coronary artery disease I N/A "$6,276.24 " N/A "$6,276.24 " N/A N/A N/A N/A "$5,962.42 " N/A "$6,025.19 " N/A N/A N/A N/A N/A "$8,033.58 " "$6,276.24 " N/A N/A N/A N/A "$6,464.52 " N/A N/A "$8,786.73 " "$23,429.59 " "$6,276.24 " "$8,472.92 " "$7,719.77 " N/A "$6,464.52 " N/A N/A N/A N/A N/A "$6,276.24 " "$20,575.80 " "$12,866.28 " "$6,276.24 " "$6,276.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,276.24 " "$6,276.24 " "$7,217.67 " "$6,276.24 " N/A "$5,962.42 " "$23,429.59 " 330104 191 3 Cardiac catheterization for coronary artery disease I N/A "$10,026.10 " N/A "$10,026.10 " N/A N/A N/A N/A "$9,524.80 " N/A "$9,625.06 " N/A N/A N/A N/A N/A "$12,833.41 " "$10,026.10 " N/A N/A N/A N/A "$10,326.89 " N/A N/A "$14,036.55 " "$38,149.96 " "$10,026.10 " "$13,535.24 " "$12,332.11 " N/A "$10,326.89 " N/A N/A N/A N/A N/A "$10,026.10 " "$33,503.20 " "$20,553.51 " "$10,026.10 " "$10,026.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,026.10 " "$10,026.10 " "$11,530.02 " "$10,026.10 " N/A "$9,524.80 " "$38,149.96 " 330104 191 4 Cardiac catheterization for coronary artery disease I N/A "$18,341.89 " N/A "$18,341.89 " N/A N/A N/A N/A "$17,424.79 " N/A "$17,608.21 " N/A N/A N/A N/A N/A "$23,477.62 " "$18,341.89 " N/A N/A N/A N/A "$18,892.14 " N/A N/A "$25,678.64 " "$70,794.15 " "$18,341.89 " "$24,761.55 " "$22,560.52 " N/A "$18,892.14 " N/A N/A N/A N/A N/A "$18,341.89 " "$62,171.24 " "$37,600.87 " "$18,341.89 " "$18,341.89 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,341.89 " "$18,341.89 " "$21,093.17 " "$18,341.89 " N/A "$17,424.79 " "$70,794.15 " 330104 192 1 Cardiac catheterization for other non-coronary conditions I N/A "$5,199.30 " N/A "$5,199.30 " N/A N/A N/A N/A "$4,939.33 " N/A "$4,991.33 " N/A N/A N/A N/A N/A "$6,655.10 " "$5,199.30 " N/A N/A N/A N/A "$5,355.28 " N/A N/A "$7,279.02 " "$19,201.99 " "$5,199.30 " "$7,019.05 " "$6,395.14 " N/A "$5,355.28 " N/A N/A N/A N/A N/A "$5,199.30 " "$16,863.14 " "$10,658.56 " "$5,199.30 " "$5,199.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,199.30 " "$5,199.30 " "$5,979.19 " "$5,199.30 " N/A "$4,939.33 " "$19,201.99 " 330104 192 2 Cardiac catheterization for other non-coronary conditions I N/A "$7,251.68 " N/A "$7,251.68 " N/A N/A N/A N/A "$6,889.09 " N/A "$6,961.61 " N/A N/A N/A N/A N/A "$9,282.15 " "$7,251.68 " N/A N/A N/A N/A "$7,469.23 " N/A N/A "$10,152.35 " "$27,258.76 " "$7,251.68 " "$9,789.77 " "$8,919.56 " N/A "$7,469.23 " N/A N/A N/A N/A N/A "$7,251.68 " "$23,938.57 " "$14,865.94 " "$7,251.68 " "$7,251.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,251.68 " "$7,251.68 " "$8,339.43 " "$7,251.68 " N/A "$6,889.09 " "$27,258.76 " 330104 192 3 Cardiac catheterization for other non-coronary conditions I N/A "$12,704.48 " N/A "$12,704.48 " N/A N/A N/A N/A "$12,069.26 " N/A "$12,196.30 " N/A N/A N/A N/A N/A "$16,261.74 " "$12,704.48 " N/A N/A N/A N/A "$13,085.62 " N/A N/A "$17,786.28 " "$48,664.13 " "$12,704.48 " "$17,151.05 " "$15,626.52 " N/A "$13,085.62 " N/A N/A N/A N/A N/A "$12,704.48 " "$42,736.71 " "$26,044.19 " "$12,704.48 " "$12,704.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,704.48 " "$12,704.48 " "$14,610.16 " "$12,704.48 " N/A "$12,069.26 " "$48,664.13 " 330104 192 4 Cardiac catheterization for other non-coronary conditions I N/A "$28,353.80 " N/A "$28,353.80 " N/A N/A N/A N/A "$26,936.11 " N/A "$27,219.65 " N/A N/A N/A N/A N/A "$36,292.86 " "$28,353.80 " N/A N/A N/A N/A "$29,204.41 " N/A N/A "$39,695.32 " "$110,096.60 " "$28,353.80 " "$38,277.63 " "$34,875.17 " N/A "$29,204.41 " N/A N/A N/A N/A N/A "$28,353.80 " "$96,686.56 " "$58,125.29 " "$28,353.80 " "$28,353.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$28,353.80 " "$28,353.80 " "$32,606.87 " "$28,353.80 " N/A "$26,936.11 " "$110,096.60 " 330104 193 1 Acute & subacute endocarditis I N/A "$7,336.14 " N/A "$7,336.14 " N/A N/A N/A N/A "$6,969.34 " N/A "$7,042.70 " N/A N/A N/A N/A N/A "$9,390.26 " "$7,336.14 " N/A N/A N/A N/A "$7,556.23 " N/A N/A "$10,270.60 " "$27,590.33 " "$7,336.14 " "$9,903.79 " "$9,023.46 " N/A "$7,556.23 " N/A N/A N/A N/A N/A "$7,336.14 " "$24,229.76 " "$15,039.09 " "$7,336.14 " "$7,336.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,336.14 " "$7,336.14 " "$8,436.57 " "$7,336.14 " N/A "$6,969.34 " "$27,590.33 " 330104 193 2 Acute & subacute endocarditis I N/A "$9,695.05 " N/A "$9,695.05 " N/A N/A N/A N/A "$9,210.30 " N/A "$9,307.25 " N/A N/A N/A N/A N/A "$12,409.67 " "$9,695.05 " N/A N/A N/A N/A "$9,985.90 " N/A N/A "$13,573.07 " "$36,850.39 " "$9,695.05 " "$13,088.32 " "$11,924.91 " N/A "$9,985.90 " N/A N/A N/A N/A N/A "$9,695.05 " "$32,361.92 " "$19,874.86 " "$9,695.05 " "$9,695.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,695.05 " "$9,695.05 " "$11,149.31 " "$9,695.05 " N/A "$9,210.30 " "$36,850.39 " 330104 193 3 Acute & subacute endocarditis I N/A "$14,974.84 " N/A "$14,974.84 " N/A N/A N/A N/A "$14,226.10 " N/A "$14,375.85 " N/A N/A N/A N/A N/A "$19,167.80 " "$14,974.84 " N/A N/A N/A N/A "$15,424.09 " N/A N/A "$20,964.78 " "$57,576.57 " "$14,974.84 " "$20,216.03 " "$18,419.05 " N/A "$15,424.09 " N/A N/A N/A N/A N/A "$14,974.84 " "$50,563.60 " "$30,698.42 " "$14,974.84 " "$14,974.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,974.84 " "$14,974.84 " "$17,221.07 " "$14,974.84 " N/A "$14,226.10 " "$57,576.57 " 330104 193 4 Acute & subacute endocarditis I N/A "$30,716.79 " N/A "$30,716.79 " N/A N/A N/A N/A "$29,180.95 " N/A "$29,488.12 " N/A N/A N/A N/A N/A "$39,317.50 " "$30,716.79 " N/A N/A N/A N/A "$31,638.30 " N/A N/A "$43,003.51 " "$119,372.71 " "$30,716.79 " "$41,467.67 " "$37,781.66 " N/A "$31,638.30 " N/A N/A N/A N/A N/A "$30,716.79 " "$104,832.81 " "$62,969.43 " "$30,716.79 " "$30,716.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$30,716.79 " "$30,716.79 " "$35,324.31 " "$30,716.79 " N/A "$29,180.95 " "$119,372.71 " 330104 194 1 Heart failure I N/A "$4,189.12 " N/A "$4,189.12 " N/A N/A N/A N/A "$3,979.66 " N/A "$4,021.55 " N/A N/A N/A N/A N/A "$5,362.07 " "$4,189.12 " N/A N/A N/A N/A "$4,314.79 " N/A N/A "$5,864.76 " "$15,236.45 " "$4,189.12 " "$5,655.31 " "$5,152.61 " N/A "$4,314.79 " N/A N/A N/A N/A N/A "$4,189.12 " "$13,380.61 " "$8,587.69 " "$4,189.12 " "$4,189.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,189.12 " "$4,189.12 " "$4,817.48 " "$4,189.12 " N/A "$3,979.66 " "$15,236.45 " 330104 194 2 Heart failure I N/A "$5,697.24 " N/A "$5,697.24 " N/A N/A N/A N/A "$5,412.37 " N/A "$5,469.35 " N/A N/A N/A N/A N/A "$7,292.46 " "$5,697.24 " N/A N/A N/A N/A "$5,868.15 " N/A N/A "$7,976.13 " "$21,156.69 " "$5,697.24 " "$7,691.27 " "$7,007.60 " N/A "$5,868.15 " N/A N/A N/A N/A N/A "$5,697.24 " "$18,579.75 " "$11,679.34 " "$5,697.24 " "$5,697.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,697.24 " "$5,697.24 " "$6,551.82 " "$5,697.24 " N/A "$5,412.37 " "$21,156.69 " 330104 194 3 Heart failure I N/A "$9,120.14 " N/A "$9,120.14 " N/A N/A N/A N/A "$8,664.13 " N/A "$8,755.34 " N/A N/A N/A N/A N/A "$11,673.78 " "$9,120.14 " N/A N/A N/A N/A "$9,393.75 " N/A N/A "$12,768.20 " "$34,593.54 " "$9,120.14 " "$12,312.19 " "$11,217.77 " N/A "$9,393.75 " N/A N/A N/A N/A N/A "$9,120.14 " "$30,379.96 " "$18,696.29 " "$9,120.14 " "$9,120.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,120.14 " "$9,120.14 " "$10,488.16 " "$9,120.14 " N/A "$8,664.13 " "$34,593.54 " 330104 194 4 Heart failure I N/A "$19,982.84 " N/A "$19,982.84 " N/A N/A N/A N/A "$18,983.70 " N/A "$19,183.53 " N/A N/A N/A N/A N/A "$25,578.03 " "$19,982.84 " N/A N/A N/A N/A "$20,582.32 " N/A N/A "$27,975.97 " "$77,235.82 " "$19,982.84 " "$26,976.83 " "$24,578.89 " N/A "$20,582.32 " N/A N/A N/A N/A N/A "$19,982.84 " "$67,828.30 " "$40,964.82 " "$19,982.84 " "$19,982.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,982.84 " "$19,982.84 " "$22,980.26 " "$19,982.84 " N/A "$18,983.70 " "$77,235.82 " 330104 196 1 Cardiac arrest and shock I N/A "$4,297.42 " N/A "$4,297.42 " N/A N/A N/A N/A "$4,082.55 " N/A "$4,125.53 " N/A N/A N/A N/A N/A "$5,500.70 " "$4,297.42 " N/A N/A N/A N/A "$4,426.34 " N/A N/A "$6,016.39 " "$15,661.62 " "$4,297.42 " "$5,801.52 " "$5,285.83 " N/A "$4,426.34 " N/A N/A N/A N/A N/A "$4,297.42 " "$13,753.99 " "$8,809.72 " "$4,297.42 " "$4,297.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,297.42 " "$4,297.42 " "$4,942.04 " "$4,297.42 " N/A "$4,082.55 " "$15,661.62 " 330104 196 2 Cardiac arrest and shock I N/A "$4,612.81 " N/A "$4,612.81 " N/A N/A N/A N/A "$4,382.17 " N/A "$4,428.29 " N/A N/A N/A N/A N/A "$5,904.39 " "$4,612.81 " N/A N/A N/A N/A "$4,751.19 " N/A N/A "$6,457.93 " "$16,899.68 " "$4,612.81 " "$6,227.29 " "$5,673.75 " N/A "$4,751.19 " N/A N/A N/A N/A N/A "$4,612.81 " "$14,841.26 " "$9,456.25 " "$4,612.81 " "$4,612.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,612.81 " "$4,612.81 " "$5,304.73 " "$4,612.81 " N/A "$4,382.17 " "$16,899.68 " 330104 196 3 Cardiac arrest and shock I N/A "$5,086.22 " N/A "$5,086.22 " N/A N/A N/A N/A "$4,831.91 " N/A "$4,882.77 " N/A N/A N/A N/A N/A "$6,510.36 " "$5,086.22 " N/A N/A N/A N/A "$5,238.81 " N/A N/A "$7,120.71 " "$18,758.11 " "$5,086.22 " "$6,866.40 " "$6,256.05 " N/A "$5,238.81 " N/A N/A N/A N/A N/A "$5,086.22 " "$16,473.32 " "$10,426.76 " "$5,086.22 " "$5,086.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,086.22 " "$5,086.22 " "$5,849.16 " "$5,086.22 " N/A "$4,831.91 " "$18,758.11 " 330104 196 4 Cardiac arrest and shock I N/A "$14,549.79 " N/A "$14,549.79 " N/A N/A N/A N/A "$13,822.30 " N/A "$13,967.80 " N/A N/A N/A N/A N/A "$18,623.73 " "$14,549.79 " N/A N/A N/A N/A "$14,986.28 " N/A N/A "$20,369.70 " "$55,907.99 " "$14,549.79 " "$19,642.21 " "$17,896.24 " N/A "$14,986.28 " N/A N/A N/A N/A N/A "$14,549.79 " "$49,098.26 " "$29,827.06 " "$14,549.79 " "$14,549.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,549.79 " "$14,549.79 " "$16,732.25 " "$14,549.79 " N/A "$13,822.30 " "$55,907.99 " 330104 197 1 Peripheral & other vascular disorders I N/A "$4,299.47 " N/A "$4,299.47 " N/A N/A N/A N/A "$4,084.49 " N/A "$4,127.49 " N/A N/A N/A N/A N/A "$5,503.32 " "$4,299.47 " N/A N/A N/A N/A "$4,428.45 " N/A N/A "$6,019.25 " "$15,669.64 " "$4,299.47 " "$5,804.28 " "$5,288.34 " N/A "$4,428.45 " N/A N/A N/A N/A N/A "$4,299.47 " "$13,761.04 " "$8,813.90 " "$4,299.47 " "$4,299.47 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,299.47 " "$4,299.47 " "$4,944.39 " "$4,299.47 " N/A "$4,084.49 " "$15,669.64 " 330104 197 2 Peripheral & other vascular disorders I N/A "$5,704.73 " N/A "$5,704.73 " N/A N/A N/A N/A "$5,419.49 " N/A "$5,476.54 " N/A N/A N/A N/A N/A "$7,302.05 " "$5,704.73 " N/A N/A N/A N/A "$5,875.87 " N/A N/A "$7,986.62 " "$21,186.10 " "$5,704.73 " "$7,701.38 " "$7,016.82 " N/A "$5,875.87 " N/A N/A N/A N/A N/A "$5,704.73 " "$18,605.58 " "$11,694.70 " "$5,704.73 " "$5,704.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,704.73 " "$5,704.73 " "$6,560.44 " "$5,704.73 " N/A "$5,419.49 " "$21,186.10 " 330104 197 3 Peripheral & other vascular disorders I N/A "$8,351.78 " N/A "$8,351.78 " N/A N/A N/A N/A "$7,934.19 " N/A "$8,017.70 " N/A N/A N/A N/A N/A "$10,690.27 " "$8,351.78 " N/A N/A N/A N/A "$8,602.33 " N/A N/A "$11,692.49 " "$31,577.27 " "$8,351.78 " "$11,274.90 " "$10,272.68 " N/A "$8,602.33 " N/A N/A N/A N/A N/A "$8,351.78 " "$27,731.07 " "$17,121.14 " "$8,351.78 " "$8,351.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,351.78 " "$8,351.78 " "$9,604.54 " "$8,351.78 " N/A "$7,934.19 " "$31,577.27 " 330104 197 4 Peripheral & other vascular disorders I N/A "$19,815.95 " N/A "$19,815.95 " N/A N/A N/A N/A "$18,825.15 " N/A "$19,023.31 " N/A N/A N/A N/A N/A "$25,364.42 " "$19,815.95 " N/A N/A N/A N/A "$20,410.43 " N/A N/A "$27,742.33 " "$76,580.69 " "$19,815.95 " "$26,751.53 " "$24,373.62 " N/A "$20,410.43 " N/A N/A N/A N/A N/A "$19,815.95 " "$67,252.96 " "$40,622.70 " "$19,815.95 " "$19,815.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,815.95 " "$19,815.95 " "$22,788.34 " "$19,815.95 " N/A "$18,825.15 " "$76,580.69 " 330104 198 1 Angina pectoris & coronary atherosclerosis I N/A "$3,089.02 " N/A "$3,089.02 " N/A N/A N/A N/A "$2,934.57 " N/A "$2,965.46 " N/A N/A N/A N/A N/A "$3,953.94 " "$3,089.02 " N/A N/A N/A N/A "$3,181.69 " N/A N/A "$4,324.62 " "$10,917.94 " "$3,089.02 " "$4,170.17 " "$3,799.49 " N/A "$3,181.69 " N/A N/A N/A N/A N/A "$3,089.02 " "$9,588.11 " "$6,332.49 " "$3,089.02 " "$3,089.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,089.02 " "$3,089.02 " "$3,552.37 " "$3,089.02 " N/A "$2,934.57 " "$10,917.94 " 330104 198 2 Angina pectoris & coronary atherosclerosis I N/A "$3,947.30 " N/A "$3,947.30 " N/A N/A N/A N/A "$3,749.93 " N/A "$3,789.41 " N/A N/A N/A N/A N/A "$5,052.54 " "$3,947.30 " N/A N/A N/A N/A "$4,065.72 " N/A N/A "$5,526.22 " "$14,287.18 " "$3,947.30 " "$5,328.85 " "$4,855.18 " N/A "$4,065.72 " N/A N/A N/A N/A N/A "$3,947.30 " "$12,546.97 " "$8,091.96 " "$3,947.30 " "$3,947.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,947.30 " "$3,947.30 " "$4,539.39 " "$3,947.30 " N/A "$3,749.93 " "$14,287.18 " 330104 198 3 Angina pectoris & coronary atherosclerosis I N/A "$5,877.75 " N/A "$5,877.75 " N/A N/A N/A N/A "$5,583.86 " N/A "$5,642.64 " N/A N/A N/A N/A N/A "$7,523.52 " "$5,877.75 " N/A N/A N/A N/A "$6,054.08 " N/A N/A "$8,228.85 " "$21,865.30 " "$5,877.75 " "$7,934.96 " "$7,229.63 " N/A "$6,054.08 " N/A N/A N/A N/A N/A "$5,877.75 " "$19,202.05 " "$12,049.38 " "$5,877.75 " "$5,877.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,877.75 " "$5,877.75 " "$6,759.41 " "$5,877.75 " N/A "$5,583.86 " "$21,865.30 " 330104 198 4 Angina pectoris & coronary atherosclerosis I N/A "$16,796.98 " N/A "$16,796.98 " N/A N/A N/A N/A "$15,957.13 " N/A "$16,125.10 " N/A N/A N/A N/A N/A "$21,500.14 " "$16,796.98 " N/A N/A N/A N/A "$17,300.89 " N/A N/A "$23,515.78 " "$64,729.52 " "$16,796.98 " "$22,675.93 " "$20,660.29 " N/A "$17,300.89 " N/A N/A N/A N/A N/A "$16,796.98 " "$56,845.30 " "$34,433.82 " "$16,796.98 " "$16,796.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,796.98 " "$16,796.98 " "$19,316.53 " "$16,796.98 " N/A "$15,957.13 " "$64,729.52 " 330104 199 1 Hypertension I N/A "$3,390.10 " N/A "$3,390.10 " N/A N/A N/A N/A "$3,220.59 " N/A "$3,254.49 " N/A N/A N/A N/A N/A "$4,339.32 " "$3,390.10 " N/A N/A N/A N/A "$3,491.80 " N/A N/A "$4,746.14 " "$12,099.85 " "$3,390.10 " "$4,576.63 " "$4,169.82 " N/A "$3,491.80 " N/A N/A N/A N/A N/A "$3,390.10 " "$10,626.06 " "$6,949.70 " "$3,390.10 " "$3,390.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,390.10 " "$3,390.10 " "$3,898.61 " "$3,390.10 " N/A "$3,220.59 " "$12,099.85 " 330104 199 2 Hypertension I N/A "$4,343.06 " N/A "$4,343.06 " N/A N/A N/A N/A "$4,125.91 " N/A "$4,169.34 " N/A N/A N/A N/A N/A "$5,559.12 " "$4,343.06 " N/A N/A N/A N/A "$4,473.35 " N/A N/A "$6,080.28 " "$15,840.78 " "$4,343.06 " "$5,863.13 " "$5,341.96 " N/A "$4,473.35 " N/A N/A N/A N/A N/A "$4,343.06 " "$13,911.33 " "$8,903.27 " "$4,343.06 " "$4,343.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,343.06 " "$4,343.06 " "$4,994.52 " "$4,343.06 " N/A "$4,125.91 " "$15,840.78 " 330104 199 3 Hypertension I N/A "$6,655.65 " N/A "$6,655.65 " N/A N/A N/A N/A "$6,322.87 " N/A "$6,389.42 " N/A N/A N/A N/A N/A "$8,519.23 " "$6,655.65 " N/A N/A N/A N/A "$6,855.32 " N/A N/A "$9,317.91 " "$24,919.01 " "$6,655.65 " "$8,985.13 " "$8,186.45 " N/A "$6,855.32 " N/A N/A N/A N/A N/A "$6,655.65 " "$21,883.81 " "$13,644.08 " "$6,655.65 " "$6,655.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,655.65 " "$6,655.65 " "$7,654.00 " "$6,655.65 " N/A "$6,322.87 " "$24,919.01 " 330104 199 4 Hypertension I N/A "$17,039.48 " N/A "$17,039.48 " N/A N/A N/A N/A "$16,187.51 " N/A "$16,357.90 " N/A N/A N/A N/A N/A "$21,810.54 " "$17,039.48 " N/A N/A N/A N/A "$17,550.67 " N/A N/A "$23,855.27 " "$65,681.46 " "$17,039.48 " "$23,003.30 " "$20,958.56 " N/A "$17,550.67 " N/A N/A N/A N/A N/A "$17,039.48 " "$57,681.29 " "$34,930.94 " "$17,039.48 " "$17,039.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,039.48 " "$17,039.48 " "$19,595.40 " "$17,039.48 " N/A "$16,187.51 " "$65,681.46 " 330104 200 1 Cardiac structural & valvular disorders I N/A "$3,763.38 " N/A "$3,763.38 " N/A N/A N/A N/A "$3,575.21 " N/A "$3,612.85 " N/A N/A N/A N/A N/A "$4,817.13 " "$3,763.38 " N/A N/A N/A N/A "$3,876.28 " N/A N/A "$5,268.73 " "$13,565.20 " "$3,763.38 " "$5,080.56 " "$4,628.96 " N/A "$3,876.28 " N/A N/A N/A N/A N/A "$3,763.38 " "$11,912.93 " "$7,714.93 " "$3,763.38 " "$3,763.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,763.38 " "$3,763.38 " "$4,327.89 " "$3,763.38 " N/A "$3,575.21 " "$13,565.20 " 330104 200 2 Cardiac structural & valvular disorders I N/A "$5,048.76 " N/A "$5,048.76 " N/A N/A N/A N/A "$4,796.32 " N/A "$4,846.81 " N/A N/A N/A N/A N/A "$6,462.41 " "$5,048.76 " N/A N/A N/A N/A "$5,200.22 " N/A N/A "$7,068.26 " "$18,611.04 " "$5,048.76 " "$6,815.82 " "$6,209.97 " N/A "$5,200.22 " N/A N/A N/A N/A N/A "$5,048.76 " "$16,344.17 " "$10,349.95 " "$5,048.76 " "$5,048.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,048.76 " "$5,048.76 " "$5,806.07 " "$5,048.76 " N/A "$4,796.32 " "$18,611.04 " 330104 200 3 Cardiac structural & valvular disorders I N/A "$8,833.37 " N/A "$8,833.37 " N/A N/A N/A N/A "$8,391.70 " N/A "$8,480.03 " N/A N/A N/A N/A N/A "$11,306.71 " "$8,833.37 " N/A N/A N/A N/A "$9,098.37 " N/A N/A "$12,366.71 " "$33,467.78 " "$8,833.37 " "$11,925.04 " "$10,865.04 " N/A "$9,098.37 " N/A N/A N/A N/A N/A "$8,833.37 " "$29,391.32 " "$18,108.40 " "$8,833.37 " "$8,833.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,833.37 " "$8,833.37 " "$10,158.37 " "$8,833.37 " N/A "$8,391.70 " "$33,467.78 " 330104 200 4 Cardiac structural & valvular disorders I N/A "$27,142.67 " N/A "$27,142.67 " N/A N/A N/A N/A "$25,785.54 " N/A "$26,056.96 " N/A N/A N/A N/A N/A "$34,742.62 " "$27,142.67 " N/A N/A N/A N/A "$27,956.95 " N/A N/A "$37,999.74 " "$105,342.23 " "$27,142.67 " "$36,642.60 " "$33,385.48 " N/A "$27,956.95 " N/A N/A N/A N/A N/A "$27,142.67 " "$92,511.28 " "$55,642.47 " "$27,142.67 " "$27,142.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,142.67 " "$27,142.67 " "$31,214.07 " "$27,142.67 " N/A "$25,785.54 " "$105,342.23 " 330104 201 1 Cardiac arrhythmia & conduction disorders I N/A "$3,253.86 " N/A "$3,253.86 " N/A N/A N/A N/A "$3,091.17 " N/A "$3,123.71 " N/A N/A N/A N/A N/A "$4,164.94 " "$3,253.86 " N/A N/A N/A N/A "$3,351.48 " N/A N/A "$4,555.41 " "$11,565.05 " "$3,253.86 " "$4,392.71 " "$4,002.25 " N/A "$3,351.48 " N/A N/A N/A N/A N/A "$3,253.86 " "$10,156.40 " "$6,670.42 " "$3,253.86 " "$3,253.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,253.86 " "$3,253.86 " "$3,741.94 " "$3,253.86 " N/A "$3,091.17 " "$11,565.05 " 330104 201 2 Cardiac arrhythmia & conduction disorders I N/A "$4,563.08 " N/A "$4,563.08 " N/A N/A N/A N/A "$4,334.93 " N/A "$4,380.56 " N/A N/A N/A N/A N/A "$5,840.74 " "$4,563.08 " N/A N/A N/A N/A "$4,699.97 " N/A N/A "$6,388.31 " "$16,704.48 " "$4,563.08 " "$6,160.16 " "$5,612.59 " N/A "$4,699.97 " N/A N/A N/A N/A N/A "$4,563.08 " "$14,669.83 " "$9,354.31 " "$4,563.08 " "$4,563.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,563.08 " "$4,563.08 " "$5,247.54 " "$4,563.08 " N/A "$4,334.93 " "$16,704.48 " 330104 201 3 Cardiac arrhythmia & conduction disorders I N/A "$7,697.85 " N/A "$7,697.85 " N/A N/A N/A N/A "$7,312.96 " N/A "$7,389.93 " N/A N/A N/A N/A N/A "$9,853.24 " "$7,697.85 " N/A N/A N/A N/A "$7,928.78 " N/A N/A "$10,776.99 " "$29,010.23 " "$7,697.85 " "$10,392.09 " "$9,468.35 " N/A "$7,928.78 " N/A N/A N/A N/A N/A "$7,697.85 " "$25,476.71 " "$15,780.59 " "$7,697.85 " "$7,697.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,697.85 " "$7,697.85 " "$8,852.52 " "$7,697.85 " N/A "$7,312.96 " "$29,010.23 " 330104 201 4 Cardiac arrhythmia & conduction disorders I N/A "$17,609.62 " N/A "$17,609.62 " N/A N/A N/A N/A "$16,729.14 " N/A "$16,905.24 " N/A N/A N/A N/A N/A "$22,540.32 " "$17,609.62 " N/A N/A N/A N/A "$18,137.91 " N/A N/A "$24,653.47 " "$67,919.60 " "$17,609.62 " "$23,772.99 " "$21,659.84 " N/A "$18,137.91 " N/A N/A N/A N/A N/A "$17,609.62 " "$59,646.82 " "$36,099.73 " "$17,609.62 " "$17,609.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,609.62 " "$17,609.62 " "$20,251.07 " "$17,609.62 " N/A "$16,729.14 " "$67,919.60 " 330104 203 1 Chest pain I N/A "$2,990.25 " N/A "$2,990.25 " N/A N/A N/A N/A "$2,840.73 " N/A "$2,870.64 " N/A N/A N/A N/A N/A "$3,827.52 " "$2,990.25 " N/A N/A N/A N/A "$3,079.95 " N/A N/A "$4,186.35 " "$10,530.21 " "$2,990.25 " "$4,036.83 " "$3,678.00 " N/A "$3,079.95 " N/A N/A N/A N/A N/A "$2,990.25 " "$9,247.61 " "$6,130.01 " "$2,990.25 " "$2,990.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,990.25 " "$2,990.25 " "$3,438.78 " "$2,990.25 " N/A "$2,840.73 " "$10,530.21 " 330104 203 2 Chest pain I N/A "$3,654.39 " N/A "$3,654.39 " N/A N/A N/A N/A "$3,471.67 " N/A "$3,508.22 " N/A N/A N/A N/A N/A "$4,677.62 " "$3,654.39 " N/A N/A N/A N/A "$3,764.02 " N/A N/A "$5,116.15 " "$13,137.36 " "$3,654.39 " "$4,933.43 " "$4,494.90 " N/A "$3,764.02 " N/A N/A N/A N/A N/A "$3,654.39 " "$11,537.20 " "$7,491.51 " "$3,654.39 " "$3,654.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,654.39 " "$3,654.39 " "$4,202.55 " "$3,654.39 " N/A "$3,471.67 " "$13,137.36 " 330104 203 3 Chest pain I N/A "$5,116.19 " N/A "$5,116.19 " N/A N/A N/A N/A "$4,860.38 " N/A "$4,911.55 " N/A N/A N/A N/A N/A "$6,548.73 " "$5,116.19 " N/A N/A N/A N/A "$5,269.68 " N/A N/A "$7,162.67 " "$18,875.77 " "$5,116.19 " "$6,906.86 " "$6,292.92 " N/A "$5,269.68 " N/A N/A N/A N/A N/A "$5,116.19 " "$16,576.65 " "$10,488.20 " "$5,116.19 " "$5,116.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,116.19 " "$5,116.19 " "$5,883.62 " "$5,116.19 " N/A "$4,860.38 " "$18,875.77 " 330104 203 4 Chest pain I N/A "$16,350.81 " N/A "$16,350.81 " N/A N/A N/A N/A "$15,533.27 " N/A "$15,696.78 " N/A N/A N/A N/A N/A "$20,929.04 " "$16,350.81 " N/A N/A N/A N/A "$16,841.34 " N/A N/A "$22,891.14 " "$62,978.05 " "$16,350.81 " "$22,073.60 " "$20,111.50 " N/A "$16,841.34 " N/A N/A N/A N/A N/A "$16,350.81 " "$55,307.16 " "$33,519.17 " "$16,350.81 " "$16,350.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,350.81 " "$16,350.81 " "$18,803.44 " "$16,350.81 " N/A "$15,533.27 " "$62,978.05 " 330104 204 1 Syncope & collapse I N/A "$3,443.23 " N/A "$3,443.23 " N/A N/A N/A N/A "$3,271.07 " N/A "$3,305.50 " N/A N/A N/A N/A N/A "$4,407.33 " "$3,443.23 " N/A N/A N/A N/A "$3,546.53 " N/A N/A "$4,820.52 " "$12,308.42 " "$3,443.23 " "$4,648.36 " "$4,235.17 " N/A "$3,546.53 " N/A N/A N/A N/A N/A "$3,443.23 " "$10,809.22 " "$7,058.62 " "$3,443.23 " "$3,443.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,443.23 " "$3,443.23 " "$3,959.71 " "$3,443.23 " N/A "$3,271.07 " "$12,308.42 " 330104 204 2 Syncope & collapse I N/A "$4,224.54 " N/A "$4,224.54 " N/A N/A N/A N/A "$4,013.31 " N/A "$4,055.55 " N/A N/A N/A N/A N/A "$5,407.41 " "$4,224.54 " N/A N/A N/A N/A "$4,351.27 " N/A N/A "$5,914.35 " "$15,375.50 " "$4,224.54 " "$5,703.12 " "$5,196.18 " N/A "$4,351.27 " N/A N/A N/A N/A N/A "$4,224.54 " "$13,502.72 " "$8,660.30 " "$4,224.54 " "$4,224.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,224.54 " "$4,224.54 " "$4,858.22 " "$4,224.54 " N/A "$4,013.31 " "$15,375.50 " 330104 204 3 Syncope & collapse I N/A "$6,161.80 " N/A "$6,161.80 " N/A N/A N/A N/A "$5,853.71 " N/A "$5,915.33 " N/A N/A N/A N/A N/A "$7,887.10 " "$6,161.80 " N/A N/A N/A N/A "$6,346.65 " N/A N/A "$8,626.52 " "$22,980.36 " "$6,161.80 " "$8,318.43 " "$7,579.01 " N/A "$6,346.65 " N/A N/A N/A N/A N/A "$6,161.80 " "$20,181.29 " "$12,631.69 " "$6,161.80 " "$6,161.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,161.80 " "$6,161.80 " "$7,086.07 " "$6,161.80 " N/A "$5,853.71 " "$22,980.36 " 330104 204 4 Syncope & collapse I N/A "$14,753.46 " N/A "$14,753.46 " N/A N/A N/A N/A "$14,015.79 " N/A "$14,163.32 " N/A N/A N/A N/A N/A "$18,884.43 " "$14,753.46 " N/A N/A N/A N/A "$15,196.06 " N/A N/A "$20,654.84 " "$56,707.52 " "$14,753.46 " "$19,917.17 " "$18,146.75 " N/A "$15,196.06 " N/A N/A N/A N/A N/A "$14,753.46 " "$49,800.40 " "$30,244.59 " "$14,753.46 " "$14,753.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,753.46 " "$14,753.46 " "$16,966.48 " "$14,753.46 " N/A "$14,015.79 " "$56,707.52 " 330104 205 1 Cardiomyopathy I N/A "$4,310.36 " N/A "$4,310.36 " N/A N/A N/A N/A "$4,094.85 " N/A "$4,137.95 " N/A N/A N/A N/A N/A "$5,517.27 " "$4,310.36 " N/A N/A N/A N/A "$4,439.68 " N/A N/A "$6,034.51 " "$15,712.42 " "$4,310.36 " "$5,818.99 " "$5,301.75 " N/A "$4,439.68 " N/A N/A N/A N/A N/A "$4,310.36 " "$13,798.61 " "$8,836.25 " "$4,310.36 " "$4,310.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,310.36 " "$4,310.36 " "$4,956.92 " "$4,310.36 " N/A "$4,094.85 " "$15,712.42 " 330104 205 2 Cardiomyopathy I N/A "$5,391.39 " N/A "$5,391.39 " N/A N/A N/A N/A "$5,121.82 " N/A "$5,175.73 " N/A N/A N/A N/A N/A "$6,900.98 " "$5,391.39 " N/A N/A N/A N/A "$5,553.13 " N/A N/A "$7,547.94 " "$19,956.06 " "$5,391.39 " "$7,278.38 " "$6,631.41 " N/A "$5,553.13 " N/A N/A N/A N/A N/A "$5,391.39 " "$17,525.36 " "$11,052.35 " "$5,391.39 " "$5,391.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,391.39 " "$5,391.39 " "$6,200.10 " "$5,391.39 " N/A "$5,121.82 " "$19,956.06 " 330104 205 3 Cardiomyopathy I N/A "$10,207.98 " N/A "$10,207.98 " N/A N/A N/A N/A "$9,697.58 " N/A "$9,799.66 " N/A N/A N/A N/A N/A "$13,066.21 " "$10,207.98 " N/A N/A N/A N/A "$10,514.22 " N/A N/A "$14,291.17 " "$38,863.92 " "$10,207.98 " "$13,780.77 " "$12,555.81 " N/A "$10,514.22 " N/A N/A N/A N/A N/A "$10,207.98 " "$34,130.19 " "$20,926.35 " "$10,207.98 " "$10,207.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,207.98 " "$10,207.98 " "$11,739.17 " "$10,207.98 " N/A "$9,697.58 " "$38,863.92 " 330104 205 4 Cardiomyopathy I N/A "$12,378.88 " N/A "$12,378.88 " N/A N/A N/A N/A "$11,759.94 " N/A "$11,883.73 " N/A N/A N/A N/A N/A "$15,844.97 " "$12,378.88 " N/A N/A N/A N/A "$12,750.25 " N/A N/A "$17,330.44 " "$47,385.95 " "$12,378.88 " "$16,711.49 " "$15,226.03 " N/A "$12,750.25 " N/A N/A N/A N/A N/A "$12,378.88 " "$41,614.22 " "$25,376.71 " "$12,378.88 " "$12,378.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,378.88 " "$12,378.88 " "$14,235.71 " "$12,378.88 " N/A "$11,759.94 " "$47,385.95 " 330104 206 1 Malfunctionreactioncomplication of cardiac/vasc device or procedure I N/A "$4,052.88 " N/A "$4,052.88 " N/A N/A N/A N/A "$3,850.24 " N/A "$3,890.76 " N/A N/A N/A N/A N/A "$5,187.69 " "$4,052.88 " N/A N/A N/A N/A "$4,174.47 " N/A N/A "$5,674.03 " "$14,701.65 " "$4,052.88 " "$5,471.39 " "$4,985.04 " N/A "$4,174.47 " N/A N/A N/A N/A N/A "$4,052.88 " "$12,910.95 " "$8,308.40 " "$4,052.88 " "$4,052.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,052.88 " "$4,052.88 " "$4,660.81 " "$4,052.88 " N/A "$3,850.24 " "$14,701.65 " 330104 206 2 Malfunctionreactioncomplication of cardiac/vasc device or procedure I N/A "$5,264.69 " N/A "$5,264.69 " N/A N/A N/A N/A "$5,001.46 " N/A "$5,054.10 " N/A N/A N/A N/A N/A "$6,738.80 " "$5,264.69 " N/A N/A N/A N/A "$5,422.63 " N/A N/A "$7,370.57 " "$19,458.70 " "$5,264.69 " "$7,107.33 " "$6,475.57 " N/A "$5,422.63 " N/A N/A N/A N/A N/A "$5,264.69 " "$17,088.58 " "$10,792.62 " "$5,264.69 " "$5,264.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,264.69 " "$5,264.69 " "$6,054.39 " "$5,264.69 " N/A "$5,001.46 " "$19,458.70 " 330104 206 3 Malfunctionreactioncomplication of cardiac/vasc device or procedure I N/A "$8,782.96 " N/A "$8,782.96 " N/A N/A N/A N/A "$8,343.81 " N/A "$8,431.64 " N/A N/A N/A N/A N/A "$11,242.19 " "$8,782.96 " N/A N/A N/A N/A "$9,046.45 " N/A N/A "$12,296.14 " "$33,269.91 " "$8,782.96 " "$11,857.00 " "$10,803.04 " N/A "$9,046.45 " N/A N/A N/A N/A N/A "$8,782.96 " "$29,217.55 " "$18,005.07 " "$8,782.96 " "$8,782.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,782.96 " "$8,782.96 " "$10,100.40 " "$8,782.96 " N/A "$8,343.81 " "$33,269.91 " 330104 206 4 Malfunctionreactioncomplication of cardiac/vasc device or procedure I N/A "$23,498.38 " N/A "$23,498.38 " N/A N/A N/A N/A "$22,323.46 " N/A "$22,558.45 " N/A N/A N/A N/A N/A "$30,077.93 " "$23,498.38 " N/A N/A N/A N/A "$24,203.33 " N/A N/A "$32,897.74 " "$91,036.33 " "$23,498.38 " "$31,722.82 " "$28,903.01 " N/A "$24,203.33 " N/A N/A N/A N/A N/A "$23,498.38 " "$79,947.87 " "$48,171.68 " "$23,498.38 " "$23,498.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,498.38 " "$23,498.38 " "$27,023.14 " "$23,498.38 " N/A "$22,323.46 " "$91,036.33 " 330104 207 1 Other circulatory system diagnoses I N/A "$3,638.04 " N/A "$3,638.04 " N/A N/A N/A N/A "$3,456.14 " N/A "$3,492.52 " N/A N/A N/A N/A N/A "$4,656.70 " "$3,638.04 " N/A N/A N/A N/A "$3,747.19 " N/A N/A "$5,093.26 " "$13,073.19 " "$3,638.04 " "$4,911.36 " "$4,474.79 " N/A "$3,747.19 " N/A N/A N/A N/A N/A "$3,638.04 " "$11,480.84 " "$7,457.99 " "$3,638.04 " "$3,638.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,638.04 " "$3,638.04 " "$4,183.75 " "$3,638.04 " N/A "$3,456.14 " "$13,073.19 " 330104 207 2 Other circulatory system diagnoses I N/A "$5,192.49 " N/A "$5,192.49 " N/A N/A N/A N/A "$4,932.86 " N/A "$4,984.79 " N/A N/A N/A N/A N/A "$6,646.38 " "$5,192.49 " N/A N/A N/A N/A "$5,348.26 " N/A N/A "$7,269.48 " "$19,175.25 " "$5,192.49 " "$7,009.86 " "$6,386.76 " N/A "$5,348.26 " N/A N/A N/A N/A N/A "$5,192.49 " "$16,839.66 " "$10,644.60 " "$5,192.49 " "$5,192.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,192.49 " "$5,192.49 " "$5,971.36 " "$5,192.49 " N/A "$4,932.86 " "$19,175.25 " 330104 207 3 Other circulatory system diagnoses I N/A "$8,501.63 " N/A "$8,501.63 " N/A N/A N/A N/A "$8,076.55 " N/A "$8,161.57 " N/A N/A N/A N/A N/A "$10,882.09 " "$8,501.63 " N/A N/A N/A N/A "$8,756.68 " N/A N/A "$11,902.29 " "$32,165.55 " "$8,501.63 " "$11,477.21 " "$10,457.01 " N/A "$8,756.68 " N/A N/A N/A N/A N/A "$8,501.63 " "$28,247.70 " "$17,428.35 " "$8,501.63 " "$8,501.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,501.63 " "$8,501.63 " "$9,776.88 " "$8,501.63 " N/A "$8,076.55 " "$32,165.55 " 330104 207 4 Other circulatory system diagnoses I N/A "$17,521.07 " N/A "$17,521.07 " N/A N/A N/A N/A "$16,645.02 " N/A "$16,820.23 " N/A N/A N/A N/A N/A "$22,426.97 " "$17,521.07 " N/A N/A N/A N/A "$18,046.70 " N/A N/A "$24,529.50 " "$67,571.98 " "$17,521.07 " "$23,653.45 " "$21,550.92 " N/A "$18,046.70 " N/A N/A N/A N/A N/A "$17,521.07 " "$59,341.54 " "$35,918.20 " "$17,521.07 " "$17,521.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,521.07 " "$17,521.07 " "$20,149.23 " "$17,521.07 " N/A "$16,645.02 " "$67,571.98 " 330104 220 1 Major stomach esophageal & duodenal procedures I N/A "$8,199.87 " N/A "$8,199.87 " N/A N/A N/A N/A "$7,789.88 " N/A "$7,871.88 " N/A N/A N/A N/A N/A "$10,495.84 " "$8,199.87 " N/A N/A N/A N/A "$8,445.87 " N/A N/A "$11,479.82 " "$30,980.96 " "$8,199.87 " "$11,069.83 " "$10,085.84 " N/A "$8,445.87 " N/A N/A N/A N/A N/A "$8,199.87 " "$27,207.40 " "$16,809.74 " "$8,199.87 " "$8,199.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,199.87 " "$8,199.87 " "$9,429.85 " "$8,199.87 " N/A "$7,789.88 " "$30,980.96 " 330104 220 2 Major stomach esophageal & duodenal procedures I N/A "$12,876.82 " N/A "$12,876.82 " N/A N/A N/A N/A "$12,232.98 " N/A "$12,361.75 " N/A N/A N/A N/A N/A "$16,482.33 " "$12,876.82 " N/A N/A N/A N/A "$13,263.13 " N/A N/A "$18,027.55 " "$49,340.65 " "$12,876.82 " "$17,383.71 " "$15,838.49 " N/A "$13,263.13 " N/A N/A N/A N/A N/A "$12,876.82 " "$43,330.83 " "$26,397.48 " "$12,876.82 " "$12,876.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,876.82 " "$12,876.82 " "$14,808.34 " "$12,876.82 " N/A "$12,232.98 " "$49,340.65 " 330104 220 3 Major stomach esophageal & duodenal procedures I N/A "$23,486.80 " N/A "$23,486.80 " N/A N/A N/A N/A "$22,312.46 " N/A "$22,547.33 " N/A N/A N/A N/A N/A "$30,063.11 " "$23,486.80 " N/A N/A N/A N/A "$24,191.41 " N/A N/A "$32,881.52 " "$90,990.87 " "$23,486.80 " "$31,707.18 " "$28,888.77 " N/A "$24,191.41 " N/A N/A N/A N/A N/A "$23,486.80 " "$79,907.95 " "$48,147.95 " "$23,486.80 " "$23,486.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,486.80 " "$23,486.80 " "$27,009.82 " "$23,486.80 " N/A "$22,312.46 " "$90,990.87 " 330104 220 4 Major stomach esophageal & duodenal procedures I N/A "$48,587.42 " N/A "$48,587.42 " N/A N/A N/A N/A "$46,158.05 " N/A "$46,643.92 " N/A N/A N/A N/A N/A "$62,191.90 " "$48,587.42 " N/A N/A N/A N/A "$50,045.04 " N/A N/A "$68,022.39 " "$189,525.10 " "$48,587.42 " "$65,593.02 " "$59,762.53 " N/A "$50,045.04 " N/A N/A N/A N/A N/A "$48,587.42 " "$166,440.46 " "$99,604.21 " "$48,587.42 " "$48,587.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$48,587.42 " "$48,587.42 " "$55,875.53 " "$48,587.42 " N/A "$46,158.05 " "$189,525.10 " 330104 221 1 Major small & large bowel procedures I N/A "$10,434.13 " N/A "$10,434.13 " N/A N/A N/A N/A "$9,912.42 " N/A "$10,016.76 " N/A N/A N/A N/A N/A "$13,355.68 " "$10,434.13 " N/A N/A N/A N/A "$10,747.15 " N/A N/A "$14,607.78 " "$39,751.68 " "$10,434.13 " "$14,086.07 " "$12,833.98 " N/A "$10,747.15 " N/A N/A N/A N/A N/A "$10,434.13 " "$34,909.83 " "$21,389.96 " "$10,434.13 " "$10,434.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,434.13 " "$10,434.13 " "$11,999.25 " "$10,434.13 " N/A "$9,912.42 " "$39,751.68 " 330104 221 2 Major small & large bowel procedures I N/A "$13,132.26 " N/A "$13,132.26 " N/A N/A N/A N/A "$12,475.65 " N/A "$12,606.97 " N/A N/A N/A N/A N/A "$16,809.30 " "$13,132.26 " N/A N/A N/A N/A "$13,526.23 " N/A N/A "$18,385.17 " "$50,343.40 " "$13,132.26 " "$17,728.55 " "$16,152.68 " N/A "$13,526.23 " N/A N/A N/A N/A N/A "$13,132.26 " "$44,211.44 " "$26,921.14 " "$13,132.26 " "$13,132.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,132.26 " "$13,132.26 " "$15,102.10 " "$13,132.26 " N/A "$12,475.65 " "$50,343.40 " 330104 221 3 Major small & large bowel procedures I N/A "$21,433.74 " N/A "$21,433.74 " N/A N/A N/A N/A "$20,362.05 " N/A "$20,576.39 " N/A N/A N/A N/A N/A "$27,435.19 " "$21,433.74 " N/A N/A N/A N/A "$22,076.75 " N/A N/A "$30,007.24 " "$82,931.44 " "$21,433.74 " "$28,935.55 " "$26,363.50 " N/A "$22,076.75 " N/A N/A N/A N/A N/A "$21,433.74 " "$72,830.18 " "$43,939.17 " "$21,433.74 " "$21,433.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,433.74 " "$21,433.74 " "$24,648.80 " "$21,433.74 " N/A "$20,362.05 " "$82,931.44 " 330104 221 4 Major small & large bowel procedures I N/A "$45,321.87 " N/A "$45,321.87 " N/A N/A N/A N/A "$43,055.77 " N/A "$43,508.99 " N/A N/A N/A N/A N/A "$58,011.99 " "$45,321.87 " N/A N/A N/A N/A "$46,681.52 " N/A N/A "$63,450.61 " "$176,705.94 " "$45,321.87 " "$61,184.52 " "$55,745.90 " N/A "$46,681.52 " N/A N/A N/A N/A N/A "$45,321.87 " "$155,182.71 " "$92,909.83 " "$45,321.87 " "$45,321.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$45,321.87 " "$45,321.87 " "$52,120.15 " "$45,321.87 " N/A "$43,055.77 " "$176,705.94 " 330104 222 1 Other stomach esophageal & duodenal procedures I N/A "$5,913.17 " N/A "$5,913.17 " N/A N/A N/A N/A "$5,617.51 " N/A "$5,676.64 " N/A N/A N/A N/A N/A "$7,568.86 " "$5,913.17 " N/A N/A N/A N/A "$6,090.56 " N/A N/A "$8,278.44 " "$22,004.35 " "$5,913.17 " "$7,982.78 " "$7,273.20 " N/A "$6,090.56 " N/A N/A N/A N/A N/A "$5,913.17 " "$19,324.16 " "$12,122.00 " "$5,913.17 " "$5,913.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,913.17 " "$5,913.17 " "$6,800.14 " "$5,913.17 " N/A "$5,617.51 " "$22,004.35 " 330104 222 2 Other stomach esophageal & duodenal procedures I N/A "$8,031.62 " N/A "$8,031.62 " N/A N/A N/A N/A "$7,630.04 " N/A "$7,710.36 " N/A N/A N/A N/A N/A "$10,280.48 " "$8,031.62 " N/A N/A N/A N/A "$8,272.57 " N/A N/A "$11,244.27 " "$30,320.49 " "$8,031.62 " "$10,842.69 " "$9,878.90 " N/A "$8,272.57 " N/A N/A N/A N/A N/A "$8,031.62 " "$26,627.37 " "$16,464.83 " "$8,031.62 " "$8,031.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,031.62 " "$8,031.62 " "$9,236.37 " "$8,031.62 " N/A "$7,630.04 " "$30,320.49 " 330104 222 3 Other stomach esophageal & duodenal procedures I N/A "$14,256.20 " N/A "$14,256.20 " N/A N/A N/A N/A "$13,543.39 " N/A "$13,685.95 " N/A N/A N/A N/A N/A "$18,247.94 " "$14,256.20 " N/A N/A N/A N/A "$14,683.89 " N/A N/A "$19,958.68 " "$54,755.50 " "$14,256.20 " "$19,245.87 " "$17,535.13 " N/A "$14,683.89 " N/A N/A N/A N/A N/A "$14,256.20 " "$48,086.14 " "$29,225.21 " "$14,256.20 " "$14,256.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,256.20 " "$14,256.20 " "$16,394.63 " "$14,256.20 " N/A "$13,543.39 " "$54,755.50 " 330104 222 4 Other stomach esophageal & duodenal procedures I N/A "$38,004.00 " N/A "$38,004.00 " N/A N/A N/A N/A "$36,103.80 " N/A "$36,483.84 " N/A N/A N/A N/A N/A "$48,645.13 " "$38,004.00 " N/A N/A N/A N/A "$39,144.12 " N/A N/A "$53,205.61 " "$147,979.16 " "$38,004.00 " "$51,305.41 " "$46,744.93 " N/A "$39,144.12 " N/A N/A N/A N/A N/A "$38,004.00 " "$129,954.92 " "$77,908.21 " "$38,004.00 " "$38,004.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$38,004.00 " "$38,004.00 " "$43,704.61 " "$38,004.00 " N/A "$36,103.80 " "$147,979.16 " 330104 223 1 Other small & large bowel procedures I N/A "$8,324.53 " N/A "$8,324.53 " N/A N/A N/A N/A "$7,908.30 " N/A "$7,991.55 " N/A N/A N/A N/A N/A "$10,655.40 " "$8,324.53 " N/A N/A N/A N/A "$8,574.26 " N/A N/A "$11,654.34 " "$31,470.31 " "$8,324.53 " "$11,238.11 " "$10,239.17 " N/A "$8,574.26 " N/A N/A N/A N/A N/A "$8,324.53 " "$27,637.14 " "$17,065.28 " "$8,324.53 " "$8,324.53 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,324.53 " "$8,324.53 " "$9,573.21 " "$8,324.53 " N/A "$7,908.30 " "$31,470.31 " 330104 223 2 Other small & large bowel procedures I N/A "$11,033.56 " N/A "$11,033.56 " N/A N/A N/A N/A "$10,481.88 " N/A "$10,592.22 " N/A N/A N/A N/A N/A "$14,122.96 " "$11,033.56 " N/A N/A N/A N/A "$11,364.57 " N/A N/A "$15,446.99 " "$42,104.80 " "$11,033.56 " "$14,895.31 " "$13,571.28 " N/A "$11,364.57 " N/A N/A N/A N/A N/A "$11,033.56 " "$36,976.33 " "$22,618.80 " "$11,033.56 " "$11,033.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,033.56 " "$11,033.56 " "$12,688.60 " "$11,033.56 " N/A "$10,481.88 " "$42,104.80 " 330104 223 3 Other small & large bowel procedures I N/A "$18,429.08 " N/A "$18,429.08 " N/A N/A N/A N/A "$17,507.62 " N/A "$17,691.92 " N/A N/A N/A N/A N/A "$23,589.22 " "$18,429.08 " N/A N/A N/A N/A "$18,981.95 " N/A N/A "$25,800.71 " "$71,136.42 " "$18,429.08 " "$24,879.26 " "$22,667.77 " N/A "$18,981.95 " N/A N/A N/A N/A N/A "$18,429.08 " "$62,471.82 " "$37,779.61 " "$18,429.08 " "$18,429.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,429.08 " "$18,429.08 " "$21,193.44 " "$18,429.08 " N/A "$17,507.62 " "$71,136.42 " 330104 223 4 Other small & large bowel procedures I N/A "$38,307.13 " N/A "$38,307.13 " N/A N/A N/A N/A "$36,391.77 " N/A "$36,774.84 " N/A N/A N/A N/A N/A "$49,033.12 " "$38,307.13 " N/A N/A N/A N/A "$39,456.34 " N/A N/A "$53,629.98 " "$149,169.09 " "$38,307.13 " "$51,714.62 " "$47,117.77 " N/A "$39,456.34 " N/A N/A N/A N/A N/A "$38,307.13 " "$130,999.92 " "$78,529.61 " "$38,307.13 " "$38,307.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$38,307.13 " "$38,307.13 " "$44,053.20 " "$38,307.13 " N/A "$36,391.77 " "$149,169.09 " 330104 224 1 Peritoneal adhesiolysis I N/A "$8,494.14 " N/A "$8,494.14 " N/A N/A N/A N/A "$8,069.43 " N/A "$8,154.38 " N/A N/A N/A N/A N/A "$10,872.50 " "$8,494.14 " N/A N/A N/A N/A "$8,748.97 " N/A N/A "$11,891.80 " "$32,136.13 " "$8,494.14 " "$11,467.09 " "$10,447.79 " N/A "$8,748.97 " N/A N/A N/A N/A N/A "$8,494.14 " "$28,221.87 " "$17,412.99 " "$8,494.14 " "$8,494.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,494.14 " "$8,494.14 " "$9,768.26 " "$8,494.14 " N/A "$8,069.43 " "$32,136.13 " 330104 224 2 Peritoneal adhesiolysis I N/A "$11,215.44 " N/A "$11,215.44 " N/A N/A N/A N/A "$10,654.66 " N/A "$10,766.82 " N/A N/A N/A N/A N/A "$14,355.76 " "$11,215.44 " N/A N/A N/A N/A "$11,551.90 " N/A N/A "$15,701.61 " "$42,818.76 " "$11,215.44 " "$15,140.84 " "$13,794.99 " N/A "$11,551.90 " N/A N/A N/A N/A N/A "$11,215.44 " "$37,603.33 " "$22,991.64 " "$11,215.44 " "$11,215.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,215.44 " "$11,215.44 " "$12,897.75 " "$11,215.44 " N/A "$10,654.66 " "$42,818.76 " 330104 224 3 Peritoneal adhesiolysis I N/A "$18,384.80 " N/A "$18,384.80 " N/A N/A N/A N/A "$17,465.56 " N/A "$17,649.41 " N/A N/A N/A N/A N/A "$23,532.55 " "$18,384.80 " N/A N/A N/A N/A "$18,936.35 " N/A N/A "$25,738.72 " "$70,962.61 " "$18,384.80 " "$24,819.48 " "$22,613.31 " N/A "$18,936.35 " N/A N/A N/A N/A N/A "$18,384.80 " "$62,319.19 " "$37,688.84 " "$18,384.80 " "$18,384.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,384.80 " "$18,384.80 " "$21,142.52 " "$18,384.80 " N/A "$17,465.56 " "$70,962.61 " 330104 224 4 Peritoneal adhesiolysis I N/A "$38,239.69 " N/A "$38,239.69 " N/A N/A N/A N/A "$36,327.71 " N/A "$36,710.10 " N/A N/A N/A N/A N/A "$48,946.80 " "$38,239.69 " N/A N/A N/A N/A "$39,386.88 " N/A N/A "$53,535.57 " "$148,904.36 " "$38,239.69 " "$51,623.58 " "$47,034.82 " N/A "$39,386.88 " N/A N/A N/A N/A N/A "$38,239.69 " "$130,767.43 " "$78,391.37 " "$38,239.69 " "$38,239.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$38,239.69 " "$38,239.69 " "$43,975.64 " "$38,239.69 " N/A "$36,327.71 " "$148,904.36 " 330104 225 1 Appendectomy I N/A "$5,212.24 " N/A "$5,212.24 " N/A N/A N/A N/A "$4,951.63 " N/A "$5,003.75 " N/A N/A N/A N/A N/A "$6,671.67 " "$5,212.24 " N/A N/A N/A N/A "$5,368.61 " N/A N/A "$7,297.14 " "$19,252.80 " "$5,212.24 " "$7,036.52 " "$6,411.06 " N/A "$5,368.61 " N/A N/A N/A N/A N/A "$5,212.24 " "$16,907.76 " "$10,685.09 " "$5,212.24 " "$5,212.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,212.24 " "$5,212.24 " "$5,994.08 " "$5,212.24 " N/A "$4,951.63 " "$19,252.80 " 330104 225 2 Appendectomy I N/A "$7,830.68 " N/A "$7,830.68 " N/A N/A N/A N/A "$7,439.14 " N/A "$7,517.45 " N/A N/A N/A N/A N/A "$10,023.27 " "$7,830.68 " N/A N/A N/A N/A "$8,065.60 " N/A N/A "$10,962.95 " "$29,531.66 " "$7,830.68 " "$10,571.41 " "$9,631.73 " N/A "$8,065.60 " N/A N/A N/A N/A N/A "$7,830.68 " "$25,934.63 " "$16,052.89 " "$7,830.68 " "$7,830.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,830.68 " "$7,830.68 " "$9,005.28 " "$7,830.68 " N/A "$7,439.14 " "$29,531.66 " 330104 225 3 Appendectomy I N/A "$14,127.46 " N/A "$14,127.46 " N/A N/A N/A N/A "$13,421.09 " N/A "$13,562.36 " N/A N/A N/A N/A N/A "$18,083.15 " "$14,127.46 " N/A N/A N/A N/A "$14,551.28 " N/A N/A "$19,778.44 " "$54,250.11 " "$14,127.46 " "$19,072.07 " "$17,376.77 " N/A "$14,551.28 " N/A N/A N/A N/A N/A "$14,127.46 " "$47,642.31 " "$28,961.29 " "$14,127.46 " "$14,127.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,127.46 " "$14,127.46 " "$16,246.58 " "$14,127.46 " N/A "$13,421.09 " "$54,250.11 " 330104 225 4 Appendectomy I N/A "$27,978.47 " N/A "$27,978.47 " N/A N/A N/A N/A "$26,579.55 " N/A "$26,859.33 " N/A N/A N/A N/A N/A "$35,812.44 " "$27,978.47 " N/A N/A N/A N/A "$28,817.82 " N/A N/A "$39,169.86 " "$108,623.23 " "$27,978.47 " "$37,770.94 " "$34,413.52 " N/A "$28,817.82 " N/A N/A N/A N/A N/A "$27,978.47 " "$95,392.64 " "$57,355.87 " "$27,978.47 " "$27,978.47 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,978.47 " "$27,978.47 " "$32,175.24 " "$27,978.47 " N/A "$26,579.55 " "$108,623.23 " 330104 226 1 Anal procedures I N/A "$4,523.57 " N/A "$4,523.57 " N/A N/A N/A N/A "$4,297.39 " N/A "$4,342.63 " N/A N/A N/A N/A N/A "$5,790.17 " "$4,523.57 " N/A N/A N/A N/A "$4,659.28 " N/A N/A "$6,333.00 " "$16,549.39 " "$4,523.57 " "$6,106.82 " "$5,563.99 " N/A "$4,659.28 " N/A N/A N/A N/A N/A "$4,523.57 " "$14,533.63 " "$9,273.32 " "$4,523.57 " "$4,523.57 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,523.57 " "$4,523.57 " "$5,202.11 " "$4,523.57 " N/A "$4,297.39 " "$16,549.39 " 330104 226 2 Anal procedures I N/A "$6,322.56 " N/A "$6,322.56 " N/A N/A N/A N/A "$6,006.43 " N/A "$6,069.65 " N/A N/A N/A N/A N/A "$8,092.87 " "$6,322.56 " N/A N/A N/A N/A "$6,512.23 " N/A N/A "$8,851.58 " "$23,611.42 " "$6,322.56 " "$8,535.45 " "$7,776.74 " N/A "$6,512.23 " N/A N/A N/A N/A N/A "$6,322.56 " "$20,735.49 " "$12,961.24 " "$6,322.56 " "$6,322.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,322.56 " "$6,322.56 " "$7,270.94 " "$6,322.56 " N/A "$6,006.43 " "$23,611.42 " 330104 226 3 Anal procedures I N/A "$10,514.51 " N/A "$10,514.51 " N/A N/A N/A N/A "$9,988.78 " N/A "$10,093.93 " N/A N/A N/A N/A N/A "$13,458.57 " "$10,514.51 " N/A N/A N/A N/A "$10,829.94 " N/A N/A "$14,720.31 " "$40,067.22 " "$10,514.51 " "$14,194.58 " "$12,932.84 " N/A "$10,829.94 " N/A N/A N/A N/A N/A "$10,514.51 " "$35,186.93 " "$21,554.74 " "$10,514.51 " "$10,514.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,514.51 " "$10,514.51 " "$12,091.68 " "$10,514.51 " N/A "$9,988.78 " "$40,067.22 " 330104 226 4 Anal procedures I N/A "$25,026.94 " N/A "$25,026.94 " N/A N/A N/A N/A "$23,775.59 " N/A "$24,025.86 " N/A N/A N/A N/A N/A "$32,034.48 " "$25,026.94 " N/A N/A N/A N/A "$25,777.75 " N/A N/A "$35,037.72 " "$97,036.79 " "$25,026.94 " "$33,786.37 " "$30,783.14 " N/A "$25,777.75 " N/A N/A N/A N/A N/A "$25,026.94 " "$85,217.46 " "$51,305.23 " "$25,026.94 " "$25,026.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,026.94 " "$25,026.94 " "$28,780.98 " "$25,026.94 " N/A "$23,775.59 " "$97,036.79 " 330104 227 1 Hernia procedures except inguinal femoral & umbilical I N/A "$7,387.91 " N/A "$7,387.91 " N/A N/A N/A N/A "$7,018.52 " N/A "$7,092.40 " N/A N/A N/A N/A N/A "$9,456.53 " "$7,387.91 " N/A N/A N/A N/A "$7,609.55 " N/A N/A "$10,343.08 " "$27,793.56 " "$7,387.91 " "$9,973.68 " "$9,087.13 " N/A "$7,609.55 " N/A N/A N/A N/A N/A "$7,387.91 " "$24,408.23 " "$15,145.22 " "$7,387.91 " "$7,387.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,387.91 " "$7,387.91 " "$8,496.10 " "$7,387.91 " N/A "$7,018.52 " "$27,793.56 " 330104 227 2 Hernia procedures except inguinal femoral & umbilical I N/A "$9,506.37 " N/A "$9,506.37 " N/A N/A N/A N/A "$9,031.05 " N/A "$9,126.11 " N/A N/A N/A N/A N/A "$12,168.15 " "$9,506.37 " N/A N/A N/A N/A "$9,791.56 " N/A N/A "$13,308.91 " "$36,109.70 " "$9,506.37 " "$12,833.60 " "$11,692.83 " N/A "$9,791.56 " N/A N/A N/A N/A N/A "$9,506.37 " "$31,711.44 " "$19,488.05 " "$9,506.37 " "$9,506.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,506.37 " "$9,506.37 " "$10,932.32 " "$9,506.37 " N/A "$9,031.05 " "$36,109.70 " 330104 227 3 Hernia procedures except inguinal femoral & umbilical I N/A "$16,100.14 " N/A "$16,100.14 " N/A N/A N/A N/A "$15,295.13 " N/A "$15,456.14 " N/A N/A N/A N/A N/A "$20,608.18 " "$16,100.14 " N/A N/A N/A N/A "$16,583.15 " N/A N/A "$22,540.20 " "$61,994.02 " "$16,100.14 " "$21,735.19 " "$19,803.17 " N/A "$16,583.15 " N/A N/A N/A N/A N/A "$16,100.14 " "$54,442.99 " "$33,005.29 " "$16,100.14 " "$16,100.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,100.14 " "$16,100.14 " "$18,515.16 " "$16,100.14 " N/A "$15,295.13 " "$61,994.02 " 330104 227 4 Hernia procedures except inguinal femoral & umbilical I N/A "$36,230.91 " N/A "$36,230.91 " N/A N/A N/A N/A "$34,419.36 " N/A "$34,781.67 " N/A N/A N/A N/A N/A "$46,375.56 " "$36,230.91 " N/A N/A N/A N/A "$37,317.83 " N/A N/A "$50,723.27 " "$141,018.74 " "$36,230.91 " "$48,911.72 " "$44,564.01 " N/A "$37,317.83 " N/A N/A N/A N/A N/A "$36,230.91 " "$123,842.30 " "$74,273.36 " "$36,230.91 " "$36,230.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$36,230.91 " "$36,230.91 " "$41,665.54 " "$36,230.91 " N/A "$34,419.36 " "$141,018.74 " 330104 228 1 Inguinal femoral & umbilical hernia procedures I N/A "$5,056.93 " N/A "$5,056.93 " N/A N/A N/A N/A "$4,804.09 " N/A "$4,854.65 " N/A N/A N/A N/A N/A "$6,472.87 " "$5,056.93 " N/A N/A N/A N/A "$5,208.64 " N/A N/A "$7,079.70 " "$18,643.13 " "$5,056.93 " "$6,826.86 " "$6,220.03 " N/A "$5,208.64 " N/A N/A N/A N/A N/A "$5,056.93 " "$16,372.35 " "$10,366.71 " "$5,056.93 " "$5,056.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,056.93 " "$5,056.93 " "$5,815.47 " "$5,056.93 " N/A "$4,804.09 " "$18,643.13 " 330104 228 2 Inguinal femoral & umbilical hernia procedures I N/A "$6,801.42 " N/A "$6,801.42 " N/A N/A N/A N/A "$6,461.35 " N/A "$6,529.36 " N/A N/A N/A N/A N/A "$8,705.82 " "$6,801.42 " N/A N/A N/A N/A "$7,005.46 " N/A N/A "$9,521.99 " "$25,491.24 " "$6,801.42 " "$9,181.92 " "$8,365.75 " N/A "$7,005.46 " N/A N/A N/A N/A N/A "$6,801.42 " "$22,386.34 " "$13,942.91 " "$6,801.42 " "$6,801.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,801.42 " "$6,801.42 " "$7,821.63 " "$6,801.42 " N/A "$6,461.35 " "$25,491.24 " 330104 228 3 Inguinal femoral & umbilical hernia procedures I N/A "$11,299.22 " N/A "$11,299.22 " N/A N/A N/A N/A "$10,734.26 " N/A "$10,847.25 " N/A N/A N/A N/A N/A "$14,463.00 " "$11,299.22 " N/A N/A N/A N/A "$11,638.20 " N/A N/A "$15,818.91 " "$43,147.66 " "$11,299.22 " "$15,253.95 " "$13,898.04 " N/A "$11,638.20 " N/A N/A N/A N/A N/A "$11,299.22 " "$37,892.17 " "$23,163.40 " "$11,299.22 " "$11,299.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,299.22 " "$11,299.22 " "$12,994.10 " "$11,299.22 " N/A "$10,734.26 " "$43,147.66 " 330104 228 4 Inguinal femoral & umbilical hernia procedures I N/A "$30,659.58 " N/A "$30,659.58 " N/A N/A N/A N/A "$29,126.60 " N/A "$29,433.19 " N/A N/A N/A N/A N/A "$39,244.26 " "$30,659.58 " N/A N/A N/A N/A "$31,579.36 " N/A N/A "$42,923.41 " "$119,148.09 " "$30,659.58 " "$41,390.43 " "$37,711.28 " N/A "$31,579.36 " N/A N/A N/A N/A N/A "$30,659.58 " "$104,635.55 " "$62,852.13 " "$30,659.58 " "$30,659.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$30,659.58 " "$30,659.58 " "$35,258.51 " "$30,659.58 " N/A "$29,126.60 " "$119,148.09 " 330104 229 1 Other digestive system & abdominal procedures I N/A "$7,264.62 " N/A "$7,264.62 " N/A N/A N/A N/A "$6,901.39 " N/A "$6,974.04 " N/A N/A N/A N/A N/A "$9,298.71 " "$7,264.62 " N/A N/A N/A N/A "$7,482.56 " N/A N/A "$10,170.47 " "$27,309.56 " "$7,264.62 " "$9,807.24 " "$8,935.48 " N/A "$7,482.56 " N/A N/A N/A N/A N/A "$7,264.62 " "$23,983.19 " "$14,892.47 " "$7,264.62 " "$7,264.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,264.62 " "$7,264.62 " "$8,354.31 " "$7,264.62 " N/A "$6,901.39 " "$27,309.56 " 330104 229 2 Other digestive system & abdominal procedures I N/A "$10,390.53 " N/A "$10,390.53 " N/A N/A N/A N/A "$9,871.01 " N/A "$9,974.91 " N/A N/A N/A N/A N/A "$13,299.88 " "$10,390.53 " N/A N/A N/A N/A "$10,702.25 " N/A N/A "$14,546.75 " "$39,580.55 " "$10,390.53 " "$14,027.22 " "$12,780.35 " N/A "$10,702.25 " N/A N/A N/A N/A N/A "$10,390.53 " "$34,759.54 " "$21,300.59 " "$10,390.53 " "$10,390.53 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,390.53 " "$10,390.53 " "$11,949.11 " "$10,390.53 " N/A "$9,871.01 " "$39,580.55 " 330104 229 3 Other digestive system & abdominal procedures I N/A "$18,057.16 " N/A "$18,057.16 " N/A N/A N/A N/A "$17,154.30 " N/A "$17,334.87 " N/A N/A N/A N/A N/A "$23,113.16 " "$18,057.16 " N/A N/A N/A N/A "$18,598.87 " N/A N/A "$25,280.02 " "$69,676.42 " "$18,057.16 " "$24,377.16 " "$22,210.30 " N/A "$18,598.87 " N/A N/A N/A N/A N/A "$18,057.16 " "$61,189.65 " "$37,017.17 " "$18,057.16 " "$18,057.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,057.16 " "$18,057.16 " "$20,765.73 " "$18,057.16 " N/A "$17,154.30 " "$69,676.42 " 330104 229 4 Other digestive system & abdominal procedures I N/A "$39,726.01 " N/A "$39,726.01 " N/A N/A N/A N/A "$37,739.71 " N/A "$38,136.97 " N/A N/A N/A N/A N/A "$50,849.30 " "$39,726.01 " N/A N/A N/A N/A "$40,917.80 " N/A N/A "$55,616.42 " "$154,739.03 " "$39,726.01 " "$53,630.12 " "$48,863.00 " N/A "$40,917.80 " N/A N/A N/A N/A N/A "$39,726.01 " "$135,891.42 " "$81,438.33 " "$39,726.01 " "$39,726.01 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$39,726.01 " "$39,726.01 " "$45,684.92 " "$39,726.01 " N/A "$37,739.71 " "$154,739.03 " 330104 240 1 Digestive malignancy I N/A "$5,074.64 " N/A "$5,074.64 " N/A N/A N/A N/A "$4,820.91 " N/A "$4,871.66 " N/A N/A N/A N/A N/A "$6,495.54 " "$5,074.64 " N/A N/A N/A N/A "$5,226.88 " N/A N/A "$7,104.50 " "$18,712.65 " "$5,074.64 " "$6,850.77 " "$6,241.81 " N/A "$5,226.88 " N/A N/A N/A N/A N/A "$5,074.64 " "$16,433.40 " "$10,403.02 " "$5,074.64 " "$5,074.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,074.64 " "$5,074.64 " "$5,835.84 " "$5,074.64 " N/A "$4,820.91 " "$18,712.65 " 330104 240 2 Digestive malignancy I N/A "$6,774.17 " N/A "$6,774.17 " N/A N/A N/A N/A "$6,435.47 " N/A "$6,503.21 " N/A N/A N/A N/A N/A "$8,670.94 " "$6,774.17 " N/A N/A N/A N/A "$6,977.40 " N/A N/A "$9,483.84 " "$25,384.28 " "$6,774.17 " "$9,145.14 " "$8,332.23 " N/A "$6,977.40 " N/A N/A N/A N/A N/A "$6,774.17 " "$22,292.41 " "$13,887.06 " "$6,774.17 " "$6,774.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,774.17 " "$6,774.17 " "$7,790.30 " "$6,774.17 " N/A "$6,435.47 " "$25,384.28 " 330104 240 3 Digestive malignancy I N/A "$11,093.50 " N/A "$11,093.50 " N/A N/A N/A N/A "$10,538.83 " N/A "$10,649.76 " N/A N/A N/A N/A N/A "$14,199.69 " "$11,093.50 " N/A N/A N/A N/A "$11,426.31 " N/A N/A "$15,530.91 " "$42,340.12 " "$11,093.50 " "$14,976.23 " "$13,645.01 " N/A "$11,426.31 " N/A N/A N/A N/A N/A "$11,093.50 " "$37,182.98 " "$22,741.69 " "$11,093.50 " "$11,093.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,093.50 " "$11,093.50 " "$12,757.53 " "$11,093.50 " N/A "$10,538.83 " "$42,340.12 " 330104 240 4 Digestive malignancy I N/A "$20,565.24 " N/A "$20,565.24 " N/A N/A N/A N/A "$19,536.98 " N/A "$19,742.63 " N/A N/A N/A N/A N/A "$26,323.51 " "$20,565.24 " N/A N/A N/A N/A "$21,182.20 " N/A N/A "$28,791.34 " "$79,522.09 " "$20,565.24 " "$27,763.08 " "$25,295.25 " N/A "$21,182.20 " N/A N/A N/A N/A N/A "$20,565.24 " "$69,836.09 " "$42,158.75 " "$20,565.24 " "$20,565.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,565.24 " "$20,565.24 " "$23,650.03 " "$20,565.24 " N/A "$19,536.98 " "$79,522.09 " 330104 241 1 Peptic ulcer & gastritis I N/A "$3,989.53 " N/A "$3,989.53 " N/A N/A N/A N/A "$3,790.05 " N/A "$3,829.95 " N/A N/A N/A N/A N/A "$5,106.60 " "$3,989.53 " N/A N/A N/A N/A "$4,109.22 " N/A N/A "$5,585.34 " "$14,452.97 " "$3,989.53 " "$5,385.87 " "$4,907.12 " N/A "$4,109.22 " N/A N/A N/A N/A N/A "$3,989.53 " "$12,692.56 " "$8,178.54 " "$3,989.53 " "$3,989.53 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,989.53 " "$3,989.53 " "$4,587.96 " "$3,989.53 " N/A "$3,790.05 " "$14,452.97 " 330104 241 2 Peptic ulcer & gastritis I N/A "$5,591.65 " N/A "$5,591.65 " N/A N/A N/A N/A "$5,312.07 " N/A "$5,367.99 " N/A N/A N/A N/A N/A "$7,157.32 " "$5,591.65 " N/A N/A N/A N/A "$5,759.40 " N/A N/A "$7,828.32 " "$20,742.22 " "$5,591.65 " "$7,548.73 " "$6,877.74 " N/A "$5,759.40 " N/A N/A N/A N/A N/A "$5,591.65 " "$18,215.76 " "$11,462.89 " "$5,591.65 " "$5,591.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,591.65 " "$5,591.65 " "$6,430.40 " "$5,591.65 " N/A "$5,312.07 " "$20,742.22 " 330104 241 3 Peptic ulcer & gastritis I N/A "$8,772.74 " N/A "$8,772.74 " N/A N/A N/A N/A "$8,334.10 " N/A "$8,421.83 " N/A N/A N/A N/A N/A "$11,229.11 " "$8,772.74 " N/A N/A N/A N/A "$9,035.92 " N/A N/A "$12,281.84 " "$33,229.80 " "$8,772.74 " "$11,843.20 " "$10,790.47 " N/A "$9,035.92 " N/A N/A N/A N/A N/A "$8,772.74 " "$29,182.32 " "$17,984.12 " "$8,772.74 " "$8,772.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,772.74 " "$8,772.74 " "$10,088.65 " "$8,772.74 " N/A "$8,334.10 " "$33,229.80 " 330104 241 4 Peptic ulcer & gastritis I N/A "$21,626.51 " N/A "$21,626.51 " N/A N/A N/A N/A "$20,545.19 " N/A "$20,761.45 " N/A N/A N/A N/A N/A "$27,681.94 " "$21,626.51 " N/A N/A N/A N/A "$22,275.31 " N/A N/A "$30,277.12 " "$83,688.18 " "$21,626.51 " "$29,195.79 " "$26,600.61 " N/A "$22,275.31 " N/A N/A N/A N/A N/A "$21,626.51 " "$73,494.75 " "$44,334.35 " "$21,626.51 " "$21,626.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,626.51 " "$21,626.51 " "$24,870.49 " "$21,626.51 " N/A "$20,545.19 " "$83,688.18 " 330104 242 1 Major esophageal disorders I N/A "$4,071.27 " N/A "$4,071.27 " N/A N/A N/A N/A "$3,867.71 " N/A "$3,908.42 " N/A N/A N/A N/A N/A "$5,211.23 " "$4,071.27 " N/A N/A N/A N/A "$4,193.41 " N/A N/A "$5,699.78 " "$14,773.85 " "$4,071.27 " "$5,496.22 " "$5,007.66 " N/A "$4,193.41 " N/A N/A N/A N/A N/A "$4,071.27 " "$12,974.36 " "$8,346.11 " "$4,071.27 " "$4,071.27 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,071.27 " "$4,071.27 " "$4,681.96 " "$4,071.27 " N/A "$3,867.71 " "$14,773.85 " 330104 242 2 Major esophageal disorders I N/A "$5,719.03 " N/A "$5,719.03 " N/A N/A N/A N/A "$5,433.08 " N/A "$5,490.27 " N/A N/A N/A N/A N/A "$7,320.36 " "$5,719.03 " N/A N/A N/A N/A "$5,890.61 " N/A N/A "$8,006.65 " "$21,242.26 " "$5,719.03 " "$7,720.70 " "$7,034.41 " N/A "$5,890.61 " N/A N/A N/A N/A N/A "$5,719.03 " "$18,654.90 " "$11,724.02 " "$5,719.03 " "$5,719.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,719.03 " "$5,719.03 " "$6,576.89 " "$5,719.03 " N/A "$5,433.08 " "$21,242.26 " 330104 242 3 Major esophageal disorders I N/A "$8,810.89 " N/A "$8,810.89 " N/A N/A N/A N/A "$8,370.34 " N/A "$8,458.45 " N/A N/A N/A N/A N/A "$11,277.94 " "$8,810.89 " N/A N/A N/A N/A "$9,075.21 " N/A N/A "$12,335.24 " "$33,379.54 " "$8,810.89 " "$11,894.70 " "$10,837.39 " N/A "$9,075.21 " N/A N/A N/A N/A N/A "$8,810.89 " "$29,313.83 " "$18,062.32 " "$8,810.89 " "$8,810.89 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,810.89 " "$8,810.89 " "$10,132.52 " "$8,810.89 " N/A "$8,370.34 " "$33,379.54 " 330104 242 4 Major esophageal disorders I N/A "$21,800.21 " N/A "$21,800.21 " N/A N/A N/A N/A "$20,710.20 " N/A "$20,928.21 " N/A N/A N/A N/A N/A "$27,904.27 " "$21,800.21 " N/A N/A N/A N/A "$22,454.22 " N/A N/A "$30,520.30 " "$84,370.05 " "$21,800.21 " "$29,430.29 " "$26,814.26 " N/A "$22,454.22 " N/A N/A N/A N/A N/A "$21,800.21 " "$74,093.56 " "$44,690.44 " "$21,800.21 " "$21,800.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,800.21 " "$21,800.21 " "$25,070.25 " "$21,800.21 " N/A "$20,710.20 " "$84,370.05 " 330104 243 1 Other esophageal disorders I N/A "$3,268.17 " N/A "$3,268.17 " N/A N/A N/A N/A "$3,104.76 " N/A "$3,137.44 " N/A N/A N/A N/A N/A "$4,183.25 " "$3,268.17 " N/A N/A N/A N/A "$3,366.21 " N/A N/A "$4,575.43 " "$11,621.20 " "$3,268.17 " "$4,412.02 " "$4,019.84 " N/A "$3,366.21 " N/A N/A N/A N/A N/A "$3,268.17 " "$10,205.71 " "$6,699.74 " "$3,268.17 " "$3,268.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,268.17 " "$3,268.17 " "$3,758.39 " "$3,268.17 " N/A "$3,104.76 " "$11,621.20 " 330104 243 2 Other esophageal disorders I N/A "$4,592.37 " N/A "$4,592.37 " N/A N/A N/A N/A "$4,362.75 " N/A "$4,408.68 " N/A N/A N/A N/A N/A "$5,878.23 " "$4,592.37 " N/A N/A N/A N/A "$4,730.14 " N/A N/A "$6,429.32 " "$16,819.46 " "$4,592.37 " "$6,199.70 " "$5,648.62 " N/A "$4,730.14 " N/A N/A N/A N/A N/A "$4,592.37 " "$14,770.81 " "$9,414.36 " "$4,592.37 " "$4,592.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,592.37 " "$4,592.37 " "$5,281.23 " "$4,592.37 " N/A "$4,362.75 " "$16,819.46 " 330104 243 3 Other esophageal disorders I N/A "$7,494.86 " N/A "$7,494.86 " N/A N/A N/A N/A "$7,120.11 " N/A "$7,195.06 " N/A N/A N/A N/A N/A "$9,593.42 " "$7,494.86 " N/A N/A N/A N/A "$7,719.70 " N/A N/A "$10,492.80 " "$28,213.37 " "$7,494.86 " "$10,118.06 " "$9,218.67 " N/A "$7,719.70 " N/A N/A N/A N/A N/A "$7,494.86 " "$24,776.91 " "$15,364.46 " "$7,494.86 " "$7,494.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,494.86 " "$7,494.86 " "$8,619.09 " "$7,494.86 " N/A "$7,120.11 " "$28,213.37 " 330104 243 4 Other esophageal disorders I N/A "$15,965.95 " N/A "$15,965.95 " N/A N/A N/A N/A "$15,167.65 " N/A "$15,327.31 " N/A N/A N/A N/A N/A "$20,436.42 " "$15,965.95 " N/A N/A N/A N/A "$16,444.93 " N/A N/A "$22,352.33 " "$61,467.24 " "$15,965.95 " "$21,554.03 " "$19,638.12 " N/A "$16,444.93 " N/A N/A N/A N/A N/A "$15,965.95 " "$53,980.37 " "$32,730.20 " "$15,965.95 " "$15,965.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,965.95 " "$15,965.95 " "$18,360.84 " "$15,965.95 " N/A "$15,167.65 " "$61,467.24 " 330104 244 1 Diverticulitis & diverticulosis I N/A "$3,851.25 " N/A "$3,851.25 " N/A N/A N/A N/A "$3,658.69 " N/A "$3,697.20 " N/A N/A N/A N/A N/A "$4,929.60 " "$3,851.25 " N/A N/A N/A N/A "$3,966.79 " N/A N/A "$5,391.75 " "$13,910.15 " "$3,851.25 " "$5,199.19 " "$4,737.04 " N/A "$3,966.79 " N/A N/A N/A N/A N/A "$3,851.25 " "$12,215.86 " "$7,895.07 " "$3,851.25 " "$3,851.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,851.25 " "$3,851.25 " "$4,428.94 " "$3,851.25 " N/A "$3,658.69 " "$13,910.15 " 330104 244 2 Diverticulitis & diverticulosis I N/A "$5,031.73 " N/A "$5,031.73 " N/A N/A N/A N/A "$4,780.14 " N/A "$4,830.46 " N/A N/A N/A N/A N/A "$6,440.61 " "$5,031.73 " N/A N/A N/A N/A "$5,182.68 " N/A N/A "$7,044.42 " "$18,544.19 " "$5,031.73 " "$6,792.83 " "$6,189.03 " N/A "$5,182.68 " N/A N/A N/A N/A N/A "$5,031.73 " "$16,285.46 " "$10,315.04 " "$5,031.73 " "$5,031.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,031.73 " "$5,031.73 " "$5,786.49 " "$5,031.73 " N/A "$4,780.14 " "$18,544.19 " 330104 244 3 Diverticulitis & diverticulosis I N/A "$8,220.99 " N/A "$8,220.99 " N/A N/A N/A N/A "$7,809.94 " N/A "$7,892.15 " N/A N/A N/A N/A N/A "$10,522.87 " "$8,220.99 " N/A N/A N/A N/A "$8,467.62 " N/A N/A "$11,509.39 " "$31,063.86 " "$8,220.99 " "$11,098.34 " "$10,111.82 " N/A "$8,467.62 " N/A N/A N/A N/A N/A "$8,220.99 " "$27,280.20 " "$16,853.03 " "$8,220.99 " "$8,220.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,220.99 " "$8,220.99 " "$9,454.14 " "$8,220.99 " N/A "$7,809.94 " "$31,063.86 " 330104 244 4 Diverticulitis & diverticulosis I N/A "$21,239.61 " N/A "$21,239.61 " N/A N/A N/A N/A "$20,177.63 " N/A "$20,390.02 " N/A N/A N/A N/A N/A "$27,186.70 " "$21,239.61 " N/A N/A N/A N/A "$21,876.79 " N/A N/A "$29,735.45 " "$82,169.35 " "$21,239.61 " "$28,673.47 " "$26,124.72 " N/A "$21,876.79 " N/A N/A N/A N/A N/A "$21,239.61 " "$72,160.91 " "$43,541.19 " "$21,239.61 " "$21,239.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,239.61 " "$21,239.61 " "$24,425.55 " "$21,239.61 " N/A "$20,177.63 " "$82,169.35 " 330104 245 1 Inflammatory bowel disease I N/A "$4,563.08 " N/A "$4,563.08 " N/A N/A N/A N/A "$4,334.93 " N/A "$4,380.56 " N/A N/A N/A N/A N/A "$5,840.74 " "$4,563.08 " N/A N/A N/A N/A "$4,699.97 " N/A N/A "$6,388.31 " "$16,704.48 " "$4,563.08 " "$6,160.16 " "$5,612.59 " N/A "$4,699.97 " N/A N/A N/A N/A N/A "$4,563.08 " "$14,669.83 " "$9,354.31 " "$4,563.08 " "$4,563.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,563.08 " "$4,563.08 " "$5,247.54 " "$4,563.08 " N/A "$4,334.93 " "$16,704.48 " 330104 245 2 Inflammatory bowel disease I N/A "$5,590.29 " N/A "$5,590.29 " N/A N/A N/A N/A "$5,310.78 " N/A "$5,366.68 " N/A N/A N/A N/A N/A "$7,155.57 " "$5,590.29 " N/A N/A N/A N/A "$5,758.00 " N/A N/A "$7,826.41 " "$20,736.87 " "$5,590.29 " "$7,546.89 " "$6,876.06 " N/A "$5,758.00 " N/A N/A N/A N/A N/A "$5,590.29 " "$18,211.07 " "$11,460.10 " "$5,590.29 " "$5,590.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,590.29 " "$5,590.29 " "$6,428.84 " "$5,590.29 " N/A "$5,310.78 " "$20,736.87 " 330104 245 3 Inflammatory bowel disease I N/A "$8,605.17 " N/A "$8,605.17 " N/A N/A N/A N/A "$8,174.91 " N/A "$8,260.97 " N/A N/A N/A N/A N/A "$11,014.62 " "$8,605.17 " N/A N/A N/A N/A "$8,863.33 " N/A N/A "$12,047.24 " "$32,571.99 " "$8,605.17 " "$11,616.98 " "$10,584.36 " N/A "$8,863.33 " N/A N/A N/A N/A N/A "$8,605.17 " "$28,604.64 " "$17,640.60 " "$8,605.17 " "$8,605.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,605.17 " "$8,605.17 " "$9,895.95 " "$8,605.17 " N/A "$8,174.91 " "$32,571.99 " 330104 245 4 Inflammatory bowel disease I N/A "$14,989.83 " N/A "$14,989.83 " N/A N/A N/A N/A "$14,240.33 " N/A "$14,390.23 " N/A N/A N/A N/A N/A "$19,186.98 " "$14,989.83 " N/A N/A N/A N/A "$15,439.52 " N/A N/A "$20,985.76 " "$57,635.40 " "$14,989.83 " "$20,236.27 " "$18,437.49 " N/A "$15,439.52 " N/A N/A N/A N/A N/A "$14,989.83 " "$50,615.26 " "$30,729.14 " "$14,989.83 " "$14,989.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,989.83 " "$14,989.83 " "$17,238.30 " "$14,989.83 " N/A "$14,240.33 " "$57,635.40 " 330104 246 1 Gastrointestinal vascular insufficiency I N/A "$4,552.18 " N/A "$4,552.18 " N/A N/A N/A N/A "$4,324.57 " N/A "$4,370.09 " N/A N/A N/A N/A N/A "$5,826.79 " "$4,552.18 " N/A N/A N/A N/A "$4,688.75 " N/A N/A "$6,373.05 " "$16,661.69 " "$4,552.18 " "$6,145.44 " "$5,599.18 " N/A "$4,688.75 " N/A N/A N/A N/A N/A "$4,552.18 " "$14,632.26 " "$9,331.97 " "$4,552.18 " "$4,552.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,552.18 " "$4,552.18 " "$5,235.01 " "$4,552.18 " N/A "$4,324.57 " "$16,661.69 " 330104 246 2 Gastrointestinal vascular insufficiency I N/A "$5,652.28 " N/A "$5,652.28 " N/A N/A N/A N/A "$5,369.67 " N/A "$5,426.19 " N/A N/A N/A N/A N/A "$7,234.92 " "$5,652.28 " N/A N/A N/A N/A "$5,821.85 " N/A N/A "$7,913.19 " "$20,980.20 " "$5,652.28 " "$7,630.58 " "$6,952.30 " N/A "$5,821.85 " N/A N/A N/A N/A N/A "$5,652.28 " "$18,424.76 " "$11,587.17 " "$5,652.28 " "$5,652.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,652.28 " "$5,652.28 " "$6,500.12 " "$5,652.28 " N/A "$5,369.67 " "$20,980.20 " 330104 246 3 Gastrointestinal vascular insufficiency I N/A "$9,113.33 " N/A "$9,113.33 " N/A N/A N/A N/A "$8,657.66 " N/A "$8,748.80 " N/A N/A N/A N/A N/A "$11,665.06 " "$9,113.33 " N/A N/A N/A N/A "$9,386.73 " N/A N/A "$12,758.66 " "$34,566.80 " "$9,113.33 " "$12,302.99 " "$11,209.39 " N/A "$9,386.73 " N/A N/A N/A N/A N/A "$9,113.33 " "$30,356.47 " "$18,682.32 " "$9,113.33 " "$9,113.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,113.33 " "$9,113.33 " "$10,480.33 " "$9,113.33 " N/A "$8,657.66 " "$34,566.80 " 330104 246 4 Gastrointestinal vascular insufficiency I N/A "$19,731.49 " N/A "$19,731.49 " N/A N/A N/A N/A "$18,744.91 " N/A "$18,942.23 " N/A N/A N/A N/A N/A "$25,256.30 " "$19,731.49 " N/A N/A N/A N/A "$20,323.43 " N/A N/A "$27,624.08 " "$76,249.11 " "$19,731.49 " "$26,637.50 " "$24,269.73 " N/A "$20,323.43 " N/A N/A N/A N/A N/A "$19,731.49 " "$66,961.77 " "$40,449.54 " "$19,731.49 " "$19,731.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,731.49 " "$19,731.49 " "$22,691.21 " "$19,731.49 " N/A "$18,744.91 " "$76,249.11 " 330104 247 1 Intestinal obstruction I N/A "$3,648.94 " N/A "$3,648.94 " N/A N/A N/A N/A "$3,466.50 " N/A "$3,502.99 " N/A N/A N/A N/A N/A "$4,670.65 " "$3,648.94 " N/A N/A N/A N/A "$3,758.41 " N/A N/A "$5,108.52 " "$13,115.97 " "$3,648.94 " "$4,926.07 " "$4,488.20 " N/A "$3,758.41 " N/A N/A N/A N/A N/A "$3,648.94 " "$11,518.41 " "$7,480.33 " "$3,648.94 " "$3,648.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,648.94 " "$3,648.94 " "$4,196.28 " "$3,648.94 " N/A "$3,466.50 " "$13,115.97 " 330104 247 2 Intestinal obstruction I N/A "$4,892.09 " N/A "$4,892.09 " N/A N/A N/A N/A "$4,647.48 " N/A "$4,696.40 " N/A N/A N/A N/A N/A "$6,261.87 " "$4,892.09 " N/A N/A N/A N/A "$5,038.85 " N/A N/A "$6,848.92 " "$17,996.02 " "$4,892.09 " "$6,604.32 " "$6,017.27 " N/A "$5,038.85 " N/A N/A N/A N/A N/A "$4,892.09 " "$15,804.06 " "$10,028.78 " "$4,892.09 " "$4,892.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,892.09 " "$4,892.09 " "$5,625.90 " "$4,892.09 " N/A "$4,647.48 " "$17,996.02 " 330104 247 3 Intestinal obstruction I N/A "$8,511.17 " N/A "$8,511.17 " N/A N/A N/A N/A "$8,085.61 " N/A "$8,170.72 " N/A N/A N/A N/A N/A "$10,894.30 " "$8,511.17 " N/A N/A N/A N/A "$8,766.51 " N/A N/A "$11,915.64 " "$32,202.98 " "$8,511.17 " "$11,490.08 " "$10,468.74 " N/A "$8,766.51 " N/A N/A N/A N/A N/A "$8,511.17 " "$28,280.58 " "$17,447.90 " "$8,511.17 " "$8,511.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,511.17 " "$8,511.17 " "$9,787.85 " "$8,511.17 " N/A "$8,085.61 " "$32,202.98 " 330104 247 4 Intestinal obstruction I N/A "$17,716.57 " N/A "$17,716.57 " N/A N/A N/A N/A "$16,830.74 " N/A "$17,007.91 " N/A N/A N/A N/A N/A "$22,677.21 " "$17,716.57 " N/A N/A N/A N/A "$18,248.07 " N/A N/A "$24,803.20 " "$68,339.42 " "$17,716.57 " "$23,917.37 " "$21,791.38 " N/A "$18,248.07 " N/A N/A N/A N/A N/A "$17,716.57 " "$60,015.50 " "$36,318.97 " "$17,716.57 " "$17,716.57 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,716.57 " "$17,716.57 " "$20,374.05 " "$17,716.57 " N/A "$16,830.74 " "$68,339.42 " 330104 248 1 Major gastrointestinal & peritoneal infections I N/A "$4,361.45 " N/A "$4,361.45 " N/A N/A N/A N/A "$4,143.38 " N/A "$4,186.99 " N/A N/A N/A N/A N/A "$5,582.66 " "$4,361.45 " N/A N/A N/A N/A "$4,492.30 " N/A N/A "$6,106.03 " "$15,912.97 " "$4,361.45 " "$5,887.96 " "$5,364.59 " N/A "$4,492.30 " N/A N/A N/A N/A N/A "$4,361.45 " "$13,974.73 " "$8,940.98 " "$4,361.45 " "$4,361.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,361.45 " "$4,361.45 " "$5,015.67 " "$4,361.45 " N/A "$4,143.38 " "$15,912.97 " 330104 248 2 Major gastrointestinal & peritoneal infections I N/A "$6,073.25 " N/A "$6,073.25 " N/A N/A N/A N/A "$5,769.58 " N/A "$5,830.32 " N/A N/A N/A N/A N/A "$7,773.75 " "$6,073.25 " N/A N/A N/A N/A "$6,255.44 " N/A N/A "$8,502.54 " "$22,632.74 " "$6,073.25 " "$8,198.88 " "$7,470.09 " N/A "$6,255.44 " N/A N/A N/A N/A N/A "$6,073.25 " "$19,876.01 " "$12,450.15 " "$6,073.25 " "$6,073.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,073.25 " "$6,073.25 " "$6,984.23 " "$6,073.25 " N/A "$5,769.58 " "$22,632.74 " 330104 248 3 Major gastrointestinal & peritoneal infections I N/A "$9,291.80 " N/A "$9,291.80 " N/A N/A N/A N/A "$8,827.21 " N/A "$8,920.13 " N/A N/A N/A N/A N/A "$11,893.50 " "$9,291.80 " N/A N/A N/A N/A "$9,570.55 " N/A N/A "$13,008.52 " "$35,267.39 " "$9,291.80 " "$12,543.93 " "$11,428.91 " N/A "$9,570.55 " N/A N/A N/A N/A N/A "$9,291.80 " "$30,971.73 " "$19,048.18 " "$9,291.80 " "$9,291.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,291.80 " "$9,291.80 " "$10,685.57 " "$9,291.80 " N/A "$8,827.21 " "$35,267.39 " 330104 248 4 Major gastrointestinal & peritoneal infections I N/A "$22,354.01 " N/A "$22,354.01 " N/A N/A N/A N/A "$21,236.31 " N/A "$21,459.85 " N/A N/A N/A N/A N/A "$28,613.13 " "$22,354.01 " N/A N/A N/A N/A "$23,024.63 " N/A N/A "$31,295.61 " "$86,544.01 " "$22,354.01 " "$30,177.91 " "$27,495.43 " N/A "$23,024.63 " N/A N/A N/A N/A N/A "$22,354.01 " "$76,002.73 " "$45,825.72 " "$22,354.01 " "$22,354.01 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,354.01 " "$22,354.01 " "$25,707.11 " "$22,354.01 " N/A "$21,236.31 " "$86,544.01 " 330104 249 1 Other gastroenteritis nausa & vomiting I N/A "$3,203.45 " N/A "$3,203.45 " N/A N/A N/A N/A "$3,043.28 " N/A "$3,075.32 " N/A N/A N/A N/A N/A "$4,100.42 " "$3,203.45 " N/A N/A N/A N/A "$3,299.56 " N/A N/A "$4,484.84 " "$11,367.17 " "$3,203.45 " "$4,324.66 " "$3,940.25 " N/A "$3,299.56 " N/A N/A N/A N/A N/A "$3,203.45 " "$9,982.62 " "$6,567.08 " "$3,203.45 " "$3,203.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,203.45 " "$3,203.45 " "$3,683.97 " "$3,203.45 " N/A "$3,043.28 " "$11,367.17 " 330104 249 2 Other gastroenteritis nausa & vomiting I N/A "$3,947.30 " N/A "$3,947.30 " N/A N/A N/A N/A "$3,749.93 " N/A "$3,789.41 " N/A N/A N/A N/A N/A "$5,052.54 " "$3,947.30 " N/A N/A N/A N/A "$4,065.72 " N/A N/A "$5,526.22 " "$14,287.18 " "$3,947.30 " "$5,328.85 " "$4,855.18 " N/A "$4,065.72 " N/A N/A N/A N/A N/A "$3,947.30 " "$12,546.97 " "$8,091.96 " "$3,947.30 " "$3,947.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,947.30 " "$3,947.30 " "$4,539.39 " "$3,947.30 " N/A "$3,749.93 " "$14,287.18 " 330104 249 3 Other gastroenteritis nausa & vomiting I N/A "$5,998.32 " N/A "$5,998.32 " N/A N/A N/A N/A "$5,698.40 " N/A "$5,758.38 " N/A N/A N/A N/A N/A "$7,677.84 " "$5,998.32 " N/A N/A N/A N/A "$6,178.27 " N/A N/A "$8,397.64 " "$22,338.60 " "$5,998.32 " "$8,097.73 " "$7,377.93 " N/A "$6,178.27 " N/A N/A N/A N/A N/A "$5,998.32 " "$19,617.70 " "$12,296.55 " "$5,998.32 " "$5,998.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,998.32 " "$5,998.32 " "$6,898.06 " "$5,998.32 " N/A "$5,698.40 " "$22,338.60 " 330104 249 4 Other gastroenteritis nausa & vomiting I N/A "$14,085.91 " N/A "$14,085.91 " N/A N/A N/A N/A "$13,381.61 " N/A "$13,522.47 " N/A N/A N/A N/A N/A "$18,029.96 " "$14,085.91 " N/A N/A N/A N/A "$14,508.48 " N/A N/A "$19,720.27 " "$54,087.00 " "$14,085.91 " "$19,015.97 " "$17,325.67 " N/A "$14,508.48 " N/A N/A N/A N/A N/A "$14,085.91 " "$47,499.06 " "$28,876.11 " "$14,085.91 " "$14,085.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,085.91 " "$14,085.91 " "$16,198.79 " "$14,085.91 " N/A "$13,381.61 " "$54,087.00 " 330104 251 1 Abdominal pain I N/A "$3,225.25 " N/A "$3,225.25 " N/A N/A N/A N/A "$3,063.99 " N/A "$3,096.24 " N/A N/A N/A N/A N/A "$4,128.32 " "$3,225.25 " N/A N/A N/A N/A "$3,322.01 " N/A N/A "$4,515.35 " "$11,452.74 " "$3,225.25 " "$4,354.09 " "$3,967.06 " N/A "$3,322.01 " N/A N/A N/A N/A N/A "$3,225.25 " "$10,057.77 " "$6,611.77 " "$3,225.25 " "$3,225.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,225.25 " "$3,225.25 " "$3,709.04 " "$3,225.25 " N/A "$3,063.99 " "$11,452.74 " 330104 251 2 Abdominal pain I N/A "$4,169.36 " N/A "$4,169.36 " N/A N/A N/A N/A "$3,960.89 " N/A "$4,002.59 " N/A N/A N/A N/A N/A "$5,336.78 " "$4,169.36 " N/A N/A N/A N/A "$4,294.44 " N/A N/A "$5,837.11 " "$15,158.91 " "$4,169.36 " "$5,628.64 " "$5,128.31 " N/A "$4,294.44 " N/A N/A N/A N/A N/A "$4,169.36 " "$13,312.51 " "$8,547.19 " "$4,169.36 " "$4,169.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,169.36 " "$4,169.36 " "$4,794.77 " "$4,169.36 " N/A "$3,960.89 " "$15,158.91 " 330104 251 3 Abdominal pain I N/A "$6,080.06 " N/A "$6,080.06 " N/A N/A N/A N/A "$5,776.05 " N/A "$5,836.85 " N/A N/A N/A N/A N/A "$7,782.47 " "$6,080.06 " N/A N/A N/A N/A "$6,262.46 " N/A N/A "$8,512.08 " "$22,659.48 " "$6,080.06 " "$8,208.08 " "$7,478.47 " N/A "$6,262.46 " N/A N/A N/A N/A N/A "$6,080.06 " "$19,899.49 " "$12,464.12 " "$6,080.06 " "$6,080.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,080.06 " "$6,080.06 " "$6,992.07 " "$6,080.06 " N/A "$5,776.05 " "$22,659.48 " 330104 251 4 Abdominal pain I N/A "$13,497.37 " N/A "$13,497.37 " N/A N/A N/A N/A "$12,822.50 " N/A "$12,957.48 " N/A N/A N/A N/A N/A "$17,276.64 " "$13,497.37 " N/A N/A N/A N/A "$13,902.29 " N/A N/A "$18,896.32 " "$51,776.66 " "$13,497.37 " "$18,221.45 " "$16,601.77 " N/A "$13,902.29 " N/A N/A N/A N/A N/A "$13,497.37 " "$45,470.13 " "$27,669.61 " "$13,497.37 " "$13,497.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,497.37 " "$13,497.37 " "$15,521.98 " "$13,497.37 " N/A "$12,822.50 " "$51,776.66 " 330104 252 1 Malfunction reaction & complication of GI device or procedure I N/A "$4,458.18 " N/A "$4,458.18 " N/A N/A N/A N/A "$4,235.27 " N/A "$4,279.85 " N/A N/A N/A N/A N/A "$5,706.47 " "$4,458.18 " N/A N/A N/A N/A "$4,591.92 " N/A N/A "$6,241.45 " "$16,292.68 " "$4,458.18 " "$6,018.54 " "$5,483.56 " N/A "$4,591.92 " N/A N/A N/A N/A N/A "$4,458.18 " "$14,308.19 " "$9,139.27 " "$4,458.18 " "$4,458.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,458.18 " "$4,458.18 " "$5,126.91 " "$4,458.18 " N/A "$4,235.27 " "$16,292.68 " 330104 252 2 Malfunction reaction & complication of GI device or procedure I N/A "$5,626.39 " N/A "$5,626.39 " N/A N/A N/A N/A "$5,345.07 " N/A "$5,401.34 " N/A N/A N/A N/A N/A "$7,201.78 " "$5,626.39 " N/A N/A N/A N/A "$5,795.19 " N/A N/A "$7,876.95 " "$20,878.59 " "$5,626.39 " "$7,595.63 " "$6,920.47 " N/A "$5,795.19 " N/A N/A N/A N/A N/A "$5,626.39 " "$18,335.53 " "$11,534.11 " "$5,626.39 " "$5,626.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,626.39 " "$5,626.39 " "$6,470.35 " "$5,626.39 " N/A "$5,345.07 " "$20,878.59 " 330104 252 3 Malfunction reaction & complication of GI device or procedure I N/A "$8,767.97 " N/A "$8,767.97 " N/A N/A N/A N/A "$8,329.57 " N/A "$8,417.25 " N/A N/A N/A N/A N/A "$11,223.01 " "$8,767.97 " N/A N/A N/A N/A "$9,031.01 " N/A N/A "$12,275.16 " "$33,211.08 " "$8,767.97 " "$11,836.76 " "$10,784.61 " N/A "$9,031.01 " N/A N/A N/A N/A N/A "$8,767.97 " "$29,165.89 " "$17,974.35 " "$8,767.97 " "$8,767.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,767.97 " "$8,767.97 " "$10,083.17 " "$8,767.97 " N/A "$8,329.57 " "$33,211.08 " 330104 252 4 Malfunction reaction & complication of GI device or procedure I N/A "$19,613.64 " N/A "$19,613.64 " N/A N/A N/A N/A "$18,632.96 " N/A "$18,829.10 " N/A N/A N/A N/A N/A "$25,105.46 " "$19,613.64 " N/A N/A N/A N/A "$20,202.05 " N/A N/A "$27,459.10 " "$75,786.51 " "$19,613.64 " "$26,478.42 " "$24,124.78 " N/A "$20,202.05 " N/A N/A N/A N/A N/A "$19,613.64 " "$66,555.52 " "$40,207.97 " "$19,613.64 " "$19,613.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,613.64 " "$19,613.64 " "$22,555.69 " "$19,613.64 " N/A "$18,632.96 " "$75,786.51 " 330104 253 1 Other & unspecified gastrointestinal hemorrhage I N/A "$4,465.67 " N/A "$4,465.67 " N/A N/A N/A N/A "$4,242.39 " N/A "$4,287.05 " N/A N/A N/A N/A N/A "$5,716.06 " "$4,465.67 " N/A N/A N/A N/A "$4,599.64 " N/A N/A "$6,251.94 " "$16,322.10 " "$4,465.67 " "$6,028.66 " "$5,492.78 " N/A "$4,599.64 " N/A N/A N/A N/A N/A "$4,465.67 " "$14,334.02 " "$9,154.63 " "$4,465.67 " "$4,465.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,465.67 " "$4,465.67 " "$5,135.52 " "$4,465.67 " N/A "$4,242.39 " "$16,322.10 " 330104 253 2 Other & unspecified gastrointestinal hemorrhage I N/A "$5,861.40 " N/A "$5,861.40 " N/A N/A N/A N/A "$5,568.33 " N/A "$5,626.94 " N/A N/A N/A N/A N/A "$7,502.59 " "$5,861.40 " N/A N/A N/A N/A "$6,037.24 " N/A N/A "$8,205.96 " "$21,801.12 " "$5,861.40 " "$7,912.89 " "$7,209.52 " N/A "$6,037.24 " N/A N/A N/A N/A N/A "$5,861.40 " "$19,145.69 " "$12,015.87 " "$5,861.40 " "$5,861.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,861.40 " "$5,861.40 " "$6,740.61 " "$5,861.40 " N/A "$5,568.33 " "$21,801.12 " 330104 253 3 Other & unspecified gastrointestinal hemorrhage I N/A "$9,413.05 " N/A "$9,413.05 " N/A N/A N/A N/A "$8,942.39 " N/A "$9,036.52 " N/A N/A N/A N/A N/A "$12,048.70 " "$9,413.05 " N/A N/A N/A N/A "$9,695.44 " N/A N/A "$13,178.26 " "$35,743.36 " "$9,413.05 " "$12,707.61 " "$11,578.05 " N/A "$9,695.44 " N/A N/A N/A N/A N/A "$9,413.05 " "$31,389.73 " "$19,296.74 " "$9,413.05 " "$9,413.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,413.05 " "$9,413.05 " "$10,825.00 " "$9,413.05 " N/A "$8,942.39 " "$35,743.36 " 330104 253 4 Other & unspecified gastrointestinal hemorrhage I N/A "$16,423.70 " N/A "$16,423.70 " N/A N/A N/A N/A "$15,602.51 " N/A "$15,766.75 " N/A N/A N/A N/A N/A "$21,022.34 " "$16,423.70 " N/A N/A N/A N/A "$16,916.41 " N/A N/A "$22,993.18 " "$63,264.17 " "$16,423.70 " "$22,171.99 " "$20,201.15 " N/A "$16,916.41 " N/A N/A N/A N/A N/A "$16,423.70 " "$55,558.43 " "$33,668.58 " "$16,423.70 " "$16,423.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,423.70 " "$16,423.70 " "$18,887.25 " "$16,423.70 " N/A "$15,602.51 " "$63,264.17 " 330104 254 1 Other digestive system diagnoses I N/A "$3,709.57 " N/A "$3,709.57 " N/A N/A N/A N/A "$3,524.09 " N/A "$3,561.19 " N/A N/A N/A N/A N/A "$4,748.25 " "$3,709.57 " N/A N/A N/A N/A "$3,820.85 " N/A N/A "$5,193.40 " "$13,353.96 " "$3,709.57 " "$5,007.92 " "$4,562.77 " N/A "$3,820.85 " N/A N/A N/A N/A N/A "$3,709.57 " "$11,727.41 " "$7,604.61 " "$3,709.57 " "$3,709.57 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,709.57 " "$3,709.57 " "$4,266.00 " "$3,709.57 " N/A "$3,524.09 " "$13,353.96 " 330104 254 2 Other digestive system diagnoses I N/A "$5,223.82 " N/A "$5,223.82 " N/A N/A N/A N/A "$4,962.63 " N/A "$5,014.87 " N/A N/A N/A N/A N/A "$6,686.49 " "$5,223.82 " N/A N/A N/A N/A "$5,380.53 " N/A N/A "$7,313.35 " "$19,298.26 " "$5,223.82 " "$7,052.16 " "$6,425.30 " N/A "$5,380.53 " N/A N/A N/A N/A N/A "$5,223.82 " "$16,947.68 " "$10,708.83 " "$5,223.82 " "$5,223.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,223.82 " "$5,223.82 " "$6,007.39 " "$5,223.82 " N/A "$4,962.63 " "$19,298.26 " 330104 254 3 Other digestive system diagnoses I N/A "$8,567.71 " N/A "$8,567.71 " N/A N/A N/A N/A "$8,139.32 " N/A "$8,225.00 " N/A N/A N/A N/A N/A "$10,966.67 " "$8,567.71 " N/A N/A N/A N/A "$8,824.74 " N/A N/A "$11,994.79 " "$32,424.92 " "$8,567.71 " "$11,566.41 " "$10,538.28 " N/A "$8,824.74 " N/A N/A N/A N/A N/A "$8,567.71 " "$28,475.49 " "$17,563.80 " "$8,567.71 " "$8,567.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,567.71 " "$8,567.71 " "$9,852.86 " "$8,567.71 " N/A "$8,139.32 " "$32,424.92 " 330104 254 4 Other digestive system diagnoses I N/A "$18,073.51 " N/A "$18,073.51 " N/A N/A N/A N/A "$17,169.83 " N/A "$17,350.56 " N/A N/A N/A N/A N/A "$23,134.09 " "$18,073.51 " N/A N/A N/A N/A "$18,615.71 " N/A N/A "$25,302.91 " "$69,740.59 " "$18,073.51 " "$24,399.23 " "$22,230.41 " N/A "$18,615.71 " N/A N/A N/A N/A N/A "$18,073.51 " "$61,246.01 " "$37,050.69 " "$18,073.51 " "$18,073.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,073.51 " "$18,073.51 " "$20,784.53 " "$18,073.51 " N/A "$17,169.83 " "$69,740.59 " 330104 260 1 Major pancreas liver & shunt procedures I N/A "$10,251.57 " N/A "$10,251.57 " N/A N/A N/A N/A "$9,738.99 " N/A "$9,841.51 " N/A N/A N/A N/A N/A "$13,122.01 " "$10,251.57 " N/A N/A N/A N/A "$10,559.12 " N/A N/A "$14,352.20 " "$39,035.05 " "$10,251.57 " "$13,839.62 " "$12,609.43 " N/A "$10,559.12 " N/A N/A N/A N/A N/A "$10,251.57 " "$34,280.48 " "$21,015.72 " "$10,251.57 " "$10,251.57 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,251.57 " "$10,251.57 " "$11,789.31 " "$10,251.57 " N/A "$9,738.99 " "$39,035.05 " 330104 260 2 Major pancreas liver & shunt procedures I N/A "$13,878.83 " N/A "$13,878.83 " N/A N/A N/A N/A "$13,184.89 " N/A "$13,323.68 " N/A N/A N/A N/A N/A "$17,764.90 " "$13,878.83 " N/A N/A N/A N/A "$14,295.19 " N/A N/A "$19,430.36 " "$53,274.10 " "$13,878.83 " "$18,736.42 " "$17,070.96 " N/A "$14,295.19 " N/A N/A N/A N/A N/A "$13,878.83 " "$46,785.18 " "$28,451.60 " "$13,878.83 " "$13,878.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,878.83 " "$13,878.83 " "$15,960.65 " "$13,878.83 " N/A "$13,184.89 " "$53,274.10 " 330104 260 3 Major pancreas liver & shunt procedures I N/A "$21,732.10 " N/A "$21,732.10 " N/A N/A N/A N/A "$20,645.49 " N/A "$20,862.81 " N/A N/A N/A N/A N/A "$27,817.08 " "$21,732.10 " N/A N/A N/A N/A "$22,384.06 " N/A N/A "$30,424.93 " "$84,102.65 " "$21,732.10 " "$29,338.33 " "$26,730.48 " N/A "$22,384.06 " N/A N/A N/A N/A N/A "$21,732.10 " "$73,858.73 " "$44,550.80 " "$21,732.10 " "$21,732.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,732.10 " "$21,732.10 " "$24,991.91 " "$21,732.10 " N/A "$20,645.49 " "$84,102.65 " 330104 260 4 Major pancreas liver & shunt procedures I N/A "$50,895.24 " N/A "$50,895.24 " N/A N/A N/A N/A "$48,350.48 " N/A "$48,859.43 " N/A N/A N/A N/A N/A "$65,145.91 " "$50,895.24 " N/A N/A N/A N/A "$52,422.10 " N/A N/A "$71,253.34 " "$198,584.61 " "$50,895.24 " "$68,708.58 " "$62,601.15 " N/A "$52,422.10 " N/A N/A N/A N/A N/A "$50,895.24 " "$174,396.50 " "$104,335.24 " "$50,895.24 " "$50,895.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$50,895.24 " "$50,895.24 " "$58,529.53 " "$50,895.24 " N/A "$48,350.48 " "$198,584.61 " 330104 261 1 Major biliary tract procedures I N/A "$9,832.65 " N/A "$9,832.65 " N/A N/A N/A N/A "$9,341.02 " N/A "$9,439.34 " N/A N/A N/A N/A N/A "$12,585.79 " "$9,832.65 " N/A N/A N/A N/A "$10,127.63 " N/A N/A "$13,765.71 " "$37,390.54 " "$9,832.65 " "$13,274.08 " "$12,094.16 " N/A "$10,127.63 " N/A N/A N/A N/A N/A "$9,832.65 " "$32,836.28 " "$20,156.93 " "$9,832.65 " "$9,832.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,832.65 " "$9,832.65 " "$11,307.55 " "$9,832.65 " N/A "$9,341.02 " "$37,390.54 " 330104 261 2 Major biliary tract procedures I N/A "$13,944.90 " N/A "$13,944.90 " N/A N/A N/A N/A "$13,247.66 " N/A "$13,387.11 " N/A N/A N/A N/A N/A "$17,849.48 " "$13,944.90 " N/A N/A N/A N/A "$14,363.25 " N/A N/A "$19,522.86 " "$53,533.48 " "$13,944.90 " "$18,825.62 " "$17,152.23 " N/A "$14,363.25 " N/A N/A N/A N/A N/A "$13,944.90 " "$47,012.97 " "$28,587.05 " "$13,944.90 " "$13,944.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,944.90 " "$13,944.90 " "$16,036.64 " "$13,944.90 " N/A "$13,247.66 " "$53,533.48 " 330104 261 3 Major biliary tract procedures I N/A "$21,344.51 " N/A "$21,344.51 " N/A N/A N/A N/A "$20,277.28 " N/A "$20,490.73 " N/A N/A N/A N/A N/A "$27,320.97 " "$21,344.51 " N/A N/A N/A N/A "$21,984.84 " N/A N/A "$29,882.31 " "$82,581.14 " "$21,344.51 " "$28,815.09 " "$26,253.74 " N/A "$21,984.84 " N/A N/A N/A N/A N/A "$21,344.51 " "$72,522.55 " "$43,756.24 " "$21,344.51 " "$21,344.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,344.51 " "$21,344.51 " "$24,546.18 " "$21,344.51 " N/A "$20,277.28 " "$82,581.14 " 330104 261 4 Major biliary tract procedures I N/A "$42,136.01 " N/A "$42,136.01 " N/A N/A N/A N/A "$40,029.21 " N/A "$40,450.57 " N/A N/A N/A N/A N/A "$53,934.10 " "$42,136.01 " N/A N/A N/A N/A "$43,400.09 " N/A N/A "$58,990.42 " "$164,199.64 " "$42,136.01 " "$56,883.62 " "$51,827.29 " N/A "$43,400.09 " N/A N/A N/A N/A N/A "$42,136.01 " "$144,199.71 " "$86,378.82 " "$42,136.01 " "$42,136.01 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,136.01 " "$42,136.01 " "$48,456.41 " "$42,136.01 " N/A "$40,029.21 " "$164,199.64 " 330104 262 1 Cholecystectomy except laparoscopic I N/A "$9,256.38 " N/A "$9,256.38 " N/A N/A N/A N/A "$8,793.56 " N/A "$8,886.12 " N/A N/A N/A N/A N/A "$11,848.16 " "$9,256.38 " N/A N/A N/A N/A "$9,534.07 " N/A N/A "$12,958.93 " "$35,128.34 " "$9,256.38 " "$12,496.11 " "$11,385.34 " N/A "$9,534.07 " N/A N/A N/A N/A N/A "$9,256.38 " "$30,849.62 " "$18,975.57 " "$9,256.38 " "$9,256.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,256.38 " "$9,256.38 " "$10,644.83 " "$9,256.38 " N/A "$8,793.56 " "$35,128.34 " 330104 262 2 Cholecystectomy except laparoscopic I N/A "$11,244.04 " N/A "$11,244.04 " N/A N/A N/A N/A "$10,681.84 " N/A "$10,794.28 " N/A N/A N/A N/A N/A "$14,392.38 " "$11,244.04 " N/A N/A N/A N/A "$11,581.37 " N/A N/A "$15,741.66 " "$42,931.07 " "$11,244.04 " "$15,179.46 " "$13,830.17 " N/A "$11,581.37 " N/A N/A N/A N/A N/A "$11,244.04 " "$37,701.96 " "$23,050.29 " "$11,244.04 " "$11,244.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,244.04 " "$11,244.04 " "$12,930.65 " "$11,244.04 " N/A "$10,681.84 " "$42,931.07 " 330104 262 3 Cholecystectomy except laparoscopic I N/A "$18,951.54 " N/A "$18,951.54 " N/A N/A N/A N/A "$18,003.96 " N/A "$18,193.48 " N/A N/A N/A N/A N/A "$24,257.97 " "$18,951.54 " N/A N/A N/A N/A "$19,520.09 " N/A N/A "$26,532.16 " "$73,187.38 " "$18,951.54 " "$25,584.58 " "$23,310.39 " N/A "$19,520.09 " N/A N/A N/A N/A N/A "$18,951.54 " "$64,272.97 " "$38,850.66 " "$18,951.54 " "$18,951.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,951.54 " "$18,951.54 " "$21,794.27 " "$18,951.54 " N/A "$18,003.96 " "$73,187.38 " 330104 262 4 Cholecystectomy except laparoscopic I N/A "$41,543.39 " N/A "$41,543.39 " N/A N/A N/A N/A "$39,466.22 " N/A "$39,881.65 " N/A N/A N/A N/A N/A "$53,175.54 " "$41,543.39 " N/A N/A N/A N/A "$42,789.69 " N/A N/A "$58,160.75 " "$161,873.26 " "$41,543.39 " "$56,083.58 " "$51,098.37 " N/A "$42,789.69 " N/A N/A N/A N/A N/A "$41,543.39 " "$142,156.69 " "$85,163.95 " "$41,543.39 " "$41,543.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,543.39 " "$41,543.39 " "$47,774.90 " "$41,543.39 " N/A "$39,466.22 " "$161,873.26 " 330104 263 1 Laparoscopic cholecystectomy I N/A "$6,333.45 " N/A "$6,333.45 " N/A N/A N/A N/A "$6,016.78 " N/A "$6,080.12 " N/A N/A N/A N/A N/A "$8,106.82 " "$6,333.45 " N/A N/A N/A N/A "$6,523.46 " N/A N/A "$8,866.84 " "$23,654.20 " "$6,333.45 " "$8,550.16 " "$7,790.15 " N/A "$6,523.46 " N/A N/A N/A N/A N/A "$6,333.45 " "$20,773.06 " "$12,983.58 " "$6,333.45 " "$6,333.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,333.45 " "$6,333.45 " "$7,283.47 " "$6,333.45 " N/A "$6,016.78 " "$23,654.20 " 330104 263 2 Laparoscopic cholecystectomy I N/A "$8,289.11 " N/A "$8,289.11 " N/A N/A N/A N/A "$7,874.65 " N/A "$7,957.54 " N/A N/A N/A N/A N/A "$10,610.06 " "$8,289.11 " N/A N/A N/A N/A "$8,537.78 " N/A N/A "$11,604.75 " "$31,331.26 " "$8,289.11 " "$11,190.30 " "$10,195.60 " N/A "$8,537.78 " N/A N/A N/A N/A N/A "$8,289.11 " "$27,515.03 " "$16,992.67 " "$8,289.11 " "$8,289.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,289.11 " "$8,289.11 " "$9,532.47 " "$8,289.11 " N/A "$7,874.65 " "$31,331.26 " 330104 263 3 Laparoscopic cholecystectomy I N/A "$11,311.48 " N/A "$11,311.48 " N/A N/A N/A N/A "$10,745.91 " N/A "$10,859.02 " N/A N/A N/A N/A N/A "$14,478.70 " "$11,311.48 " N/A N/A N/A N/A "$11,650.83 " N/A N/A "$15,836.07 " "$43,195.80 " "$11,311.48 " "$15,270.50 " "$13,913.12 " N/A "$11,650.83 " N/A N/A N/A N/A N/A "$11,311.48 " "$37,934.44 " "$23,188.54 " "$11,311.48 " "$11,311.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,311.48 " "$11,311.48 " "$13,008.20 " "$11,311.48 " N/A "$10,745.91 " "$43,195.80 " 330104 263 4 Laparoscopic cholecystectomy I N/A "$25,304.86 " N/A "$25,304.86 " N/A N/A N/A N/A "$24,039.62 " N/A "$24,292.66 " N/A N/A N/A N/A N/A "$32,390.22 " "$25,304.86 " N/A N/A N/A N/A "$26,064.00 " N/A N/A "$35,426.80 " "$98,127.78 " "$25,304.86 " "$34,161.56 " "$31,124.98 " N/A "$26,064.00 " N/A N/A N/A N/A N/A "$25,304.86 " "$86,175.57 " "$51,874.96 " "$25,304.86 " "$25,304.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,304.86 " "$25,304.86 " "$29,100.59 " "$25,304.86 " N/A "$24,039.62 " "$98,127.78 " 330104 264 1 Other hepatobiliary pancreas & abdominal procedures I N/A "$9,393.97 " N/A "$9,393.97 " N/A N/A N/A N/A "$8,924.27 " N/A "$9,018.21 " N/A N/A N/A N/A N/A "$12,024.29 " "$9,393.97 " N/A N/A N/A N/A "$9,675.79 " N/A N/A "$13,151.56 " "$35,668.49 " "$9,393.97 " "$12,681.86 " "$11,554.59 " N/A "$9,675.79 " N/A N/A N/A N/A N/A "$9,393.97 " "$31,323.97 " "$19,257.65 " "$9,393.97 " "$9,393.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,393.97 " "$9,393.97 " "$10,803.07 " "$9,393.97 " N/A "$8,924.27 " "$35,668.49 " 330104 264 2 Other hepatobiliary pancreas & abdominal procedures I N/A "$10,607.83 " N/A "$10,607.83 " N/A N/A N/A N/A "$10,077.44 " N/A "$10,183.51 " N/A N/A N/A N/A N/A "$13,578.02 " "$10,607.83 " N/A N/A N/A N/A "$10,926.06 " N/A N/A "$14,850.96 " "$40,433.55 " "$10,607.83 " "$14,320.57 " "$13,047.63 " N/A "$10,926.06 " N/A N/A N/A N/A N/A "$10,607.83 " "$35,508.64 " "$21,746.05 " "$10,607.83 " "$10,607.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,607.83 " "$10,607.83 " "$12,199.00 " "$10,607.83 " N/A "$10,077.44 " "$40,433.55 " 330104 264 3 Other hepatobiliary pancreas & abdominal procedures I N/A "$19,765.54 " N/A "$19,765.54 " N/A N/A N/A N/A "$18,777.27 " N/A "$18,974.92 " N/A N/A N/A N/A N/A "$25,299.90 " "$19,765.54 " N/A N/A N/A N/A "$20,358.51 " N/A N/A "$27,671.76 " "$76,382.81 " "$19,765.54 " "$26,683.48 " "$24,311.62 " N/A "$20,358.51 " N/A N/A N/A N/A N/A "$19,765.54 " "$67,079.19 " "$40,519.36 " "$19,765.54 " "$19,765.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,765.54 " "$19,765.54 " "$22,730.38 " "$19,765.54 " N/A "$18,777.27 " "$76,382.81 " 330104 264 4 Other hepatobiliary pancreas & abdominal procedures I N/A "$42,231.38 " N/A "$42,231.38 " N/A N/A N/A N/A "$40,119.81 " N/A "$40,542.12 " N/A N/A N/A N/A N/A "$54,056.16 " "$42,231.38 " N/A N/A N/A N/A "$43,498.32 " N/A N/A "$59,123.93 " "$164,574.00 " "$42,231.38 " "$57,012.36 " "$51,944.59 " N/A "$43,498.32 " N/A N/A N/A N/A N/A "$42,231.38 " "$144,528.47 " "$86,574.32 " "$42,231.38 " "$42,231.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,231.38 " "$42,231.38 " "$48,566.08 " "$42,231.38 " N/A "$40,119.81 " "$164,574.00 " 330104 279 1 Hepatic coma & other major acute liver disorders I N/A "$4,051.52 " N/A "$4,051.52 " N/A N/A N/A N/A "$3,848.94 " N/A "$3,889.46 " N/A N/A N/A N/A N/A "$5,185.94 " "$4,051.52 " N/A N/A N/A N/A "$4,173.06 " N/A N/A "$5,672.12 " "$14,696.30 " "$4,051.52 " "$5,469.55 " "$4,983.37 " N/A "$4,173.06 " N/A N/A N/A N/A N/A "$4,051.52 " "$12,906.26 " "$8,305.61 " "$4,051.52 " "$4,051.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,051.52 " "$4,051.52 " "$4,659.25 " "$4,051.52 " N/A "$3,848.94 " "$14,696.30 " 330104 279 2 Hepatic coma & other major acute liver disorders I N/A "$5,636.61 " N/A "$5,636.61 " N/A N/A N/A N/A "$5,354.78 " N/A "$5,411.15 " N/A N/A N/A N/A N/A "$7,214.86 " "$5,636.61 " N/A N/A N/A N/A "$5,805.71 " N/A N/A "$7,891.26 " "$20,918.70 " "$5,636.61 " "$7,609.43 " "$6,933.03 " N/A "$5,805.71 " N/A N/A N/A N/A N/A "$5,636.61 " "$18,370.75 " "$11,555.05 " "$5,636.61 " "$5,636.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,636.61 " "$5,636.61 " "$6,482.10 " "$5,636.61 " N/A "$5,354.78 " "$20,918.70 " 330104 279 3 Hepatic coma & other major acute liver disorders I N/A "$9,556.09 " N/A "$9,556.09 " N/A N/A N/A N/A "$9,078.29 " N/A "$9,173.85 " N/A N/A N/A N/A N/A "$12,231.80 " "$9,556.09 " N/A N/A N/A N/A "$9,842.78 " N/A N/A "$13,378.53 " "$36,304.90 " "$9,556.09 " "$12,900.73 " "$11,753.99 " N/A "$9,842.78 " N/A N/A N/A N/A N/A "$9,556.09 " "$31,882.87 " "$19,589.99 " "$9,556.09 " "$9,556.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,556.09 " "$9,556.09 " "$10,989.51 " "$9,556.09 " N/A "$9,078.29 " "$36,304.90 " 330104 279 4 Hepatic coma & other major acute liver disorders I N/A "$25,545.31 " N/A "$25,545.31 " N/A N/A N/A N/A "$24,268.05 " N/A "$24,523.50 " N/A N/A N/A N/A N/A "$32,698.00 " "$25,545.31 " N/A N/A N/A N/A "$26,311.67 " N/A N/A "$35,763.44 " "$99,071.70 " "$25,545.31 " "$34,486.17 " "$31,420.74 " N/A "$26,311.67 " N/A N/A N/A N/A N/A "$25,545.31 " "$87,004.51 " "$52,367.89 " "$25,545.31 " "$25,545.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,545.31 " "$25,545.31 " "$29,377.11 " "$25,545.31 " N/A "$24,268.05 " "$99,071.70 " 330104 280 1 Alcoholic liver disease I N/A "$3,958.20 " N/A "$3,958.20 " N/A N/A N/A N/A "$3,760.29 " N/A "$3,799.87 " N/A N/A N/A N/A N/A "$5,066.49 " "$3,958.20 " N/A N/A N/A N/A "$4,076.94 " N/A N/A "$5,541.48 " "$14,329.97 " "$3,958.20 " "$5,343.57 " "$4,868.58 " N/A "$4,076.94 " N/A N/A N/A N/A N/A "$3,958.20 " "$12,584.54 " "$8,114.30 " "$3,958.20 " "$3,958.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,958.20 " "$3,958.20 " "$4,551.93 " "$3,958.20 " N/A "$3,760.29 " "$14,329.97 " 330104 280 2 Alcoholic liver disease I N/A "$5,437.03 " N/A "$5,437.03 " N/A N/A N/A N/A "$5,165.18 " N/A "$5,219.55 " N/A N/A N/A N/A N/A "$6,959.40 " "$5,437.03 " N/A N/A N/A N/A "$5,600.14 " N/A N/A "$7,611.84 " "$20,135.22 " "$5,437.03 " "$7,339.99 " "$6,687.54 " N/A "$5,600.14 " N/A N/A N/A N/A N/A "$5,437.03 " "$17,682.70 " "$11,145.91 " "$5,437.03 " "$5,437.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,437.03 " "$5,437.03 " "$6,252.58 " "$5,437.03 " N/A "$5,165.18 " "$20,135.22 " 330104 280 3 Alcoholic liver disease I N/A "$8,939.63 " N/A "$8,939.63 " N/A N/A N/A N/A "$8,492.65 " N/A "$8,582.04 " N/A N/A N/A N/A N/A "$11,442.73 " "$8,939.63 " N/A N/A N/A N/A "$9,207.82 " N/A N/A "$12,515.48 " "$33,884.93 " "$8,939.63 " "$12,068.50 " "$10,995.74 " N/A "$9,207.82 " N/A N/A N/A N/A N/A "$8,939.63 " "$29,757.66 " "$18,326.24 " "$8,939.63 " "$8,939.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,939.63 " "$8,939.63 " "$10,280.57 " "$8,939.63 " N/A "$8,492.65 " "$33,884.93 " 330104 280 4 Alcoholic liver disease I N/A "$23,551.51 " N/A "$23,551.51 " N/A N/A N/A N/A "$22,373.94 " N/A "$22,609.45 " N/A N/A N/A N/A N/A "$30,145.94 " "$23,551.51 " N/A N/A N/A N/A "$24,258.06 " N/A N/A "$32,972.12 " "$91,244.90 " "$23,551.51 " "$31,794.54 " "$28,968.36 " N/A "$24,258.06 " N/A N/A N/A N/A N/A "$23,551.51 " "$80,131.04 " "$48,280.60 " "$23,551.51 " "$23,551.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,551.51 " "$23,551.51 " "$27,084.24 " "$23,551.51 " N/A "$22,373.94 " "$91,244.90 " 330104 281 1 Malignancy of hepatobiliary system & pancreas I N/A "$4,851.90 " N/A "$4,851.90 " N/A N/A N/A N/A "$4,609.30 " N/A "$4,657.82 " N/A N/A N/A N/A N/A "$6,210.43 " "$4,851.90 " N/A N/A N/A N/A "$4,997.46 " N/A N/A "$6,792.66 " "$17,838.25 " "$4,851.90 " "$6,550.06 " "$5,967.84 " N/A "$4,997.46 " N/A N/A N/A N/A N/A "$4,851.90 " "$15,665.51 " "$9,946.39 " "$4,851.90 " "$4,851.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,851.90 " "$4,851.90 " "$5,579.68 " "$4,851.90 " N/A "$4,609.30 " "$17,838.25 " 330104 281 2 Malignancy of hepatobiliary system & pancreas I N/A "$6,712.19 " N/A "$6,712.19 " N/A N/A N/A N/A "$6,376.58 " N/A "$6,443.70 " N/A N/A N/A N/A N/A "$8,591.60 " "$6,712.19 " N/A N/A N/A N/A "$6,913.55 " N/A N/A "$9,397.06 " "$25,140.95 " "$6,712.19 " "$9,061.45 " "$8,255.99 " N/A "$6,913.55 " N/A N/A N/A N/A N/A "$6,712.19 " "$22,078.72 " "$13,759.98 " "$6,712.19 " "$6,712.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,712.19 " "$6,712.19 " "$7,719.02 " "$6,712.19 " N/A "$6,376.58 " "$25,140.95 " 330104 281 3 Malignancy of hepatobiliary system & pancreas I N/A "$9,695.05 " N/A "$9,695.05 " N/A N/A N/A N/A "$9,210.30 " N/A "$9,307.25 " N/A N/A N/A N/A N/A "$12,409.67 " "$9,695.05 " N/A N/A N/A N/A "$9,985.90 " N/A N/A "$13,573.07 " "$36,850.39 " "$9,695.05 " "$13,088.32 " "$11,924.91 " N/A "$9,985.90 " N/A N/A N/A N/A N/A "$9,695.05 " "$32,361.92 " "$19,874.86 " "$9,695.05 " "$9,695.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,695.05 " "$9,695.05 " "$11,149.31 " "$9,695.05 " N/A "$9,210.30 " "$36,850.39 " 330104 281 4 Malignancy of hepatobiliary system & pancreas I N/A "$16,782.00 " N/A "$16,782.00 " N/A N/A N/A N/A "$15,942.90 " N/A "$16,110.72 " N/A N/A N/A N/A N/A "$21,480.96 " "$16,782.00 " N/A N/A N/A N/A "$17,285.46 " N/A N/A "$23,494.80 " "$64,670.69 " "$16,782.00 " "$22,655.70 " "$20,641.86 " N/A "$17,285.46 " N/A N/A N/A N/A N/A "$16,782.00 " "$56,793.64 " "$34,403.09 " "$16,782.00 " "$16,782.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,782.00 " "$16,782.00 " "$19,299.30 " "$16,782.00 " N/A "$15,942.90 " "$64,670.69 " 330104 282 1 Disorders of pancreas except malignancy I N/A "$4,067.87 " N/A "$4,067.87 " N/A N/A N/A N/A "$3,864.47 " N/A "$3,905.15 " N/A N/A N/A N/A N/A "$5,206.87 " "$4,067.87 " N/A N/A N/A N/A "$4,189.90 " N/A N/A "$5,695.01 " "$14,760.48 " "$4,067.87 " "$5,491.62 " "$5,003.48 " N/A "$4,189.90 " N/A N/A N/A N/A N/A "$4,067.87 " "$12,962.62 " "$8,339.13 " "$4,067.87 " "$4,067.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,067.87 " "$4,067.87 " "$4,678.05 " "$4,067.87 " N/A "$3,864.47 " "$14,760.48 " 330104 282 2 Disorders of pancreas except malignancy I N/A "$5,395.48 " N/A "$5,395.48 " N/A N/A N/A N/A "$5,125.70 " N/A "$5,179.66 " N/A N/A N/A N/A N/A "$6,906.21 " "$5,395.48 " N/A N/A N/A N/A "$5,557.34 " N/A N/A "$7,553.67 " "$19,972.11 " "$5,395.48 " "$7,283.89 " "$6,636.44 " N/A "$5,557.34 " N/A N/A N/A N/A N/A "$5,395.48 " "$17,539.45 " "$11,060.73 " "$5,395.48 " "$5,395.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,395.48 " "$5,395.48 " "$6,204.80 " "$5,395.48 " N/A "$5,125.70 " "$19,972.11 " 330104 282 3 Disorders of pancreas except malignancy I N/A "$9,584.70 " N/A "$9,584.70 " N/A N/A N/A N/A "$9,105.47 " N/A "$9,201.31 " N/A N/A N/A N/A N/A "$12,268.42 " "$9,584.70 " N/A N/A N/A N/A "$9,872.24 " N/A N/A "$13,418.58 " "$36,417.21 " "$9,584.70 " "$12,939.35 " "$11,789.18 " N/A "$9,872.24 " N/A N/A N/A N/A N/A "$9,584.70 " "$31,981.50 " "$19,648.64 " "$9,584.70 " "$9,584.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,584.70 " "$9,584.70 " "$11,022.41 " "$9,584.70 " N/A "$9,105.47 " "$36,417.21 " 330104 282 4 Disorders of pancreas except malignancy I N/A "$23,854.64 " N/A "$23,854.64 " N/A N/A N/A N/A "$22,661.91 " N/A "$22,900.45 " N/A N/A N/A N/A N/A "$30,533.94 " "$23,854.64 " N/A N/A N/A N/A "$24,570.28 " N/A N/A "$33,396.49 " "$92,434.83 " "$23,854.64 " "$32,203.76 " "$29,341.20 " N/A "$24,570.28 " N/A N/A N/A N/A N/A "$23,854.64 " "$81,176.03 " "$48,902.01 " "$23,854.64 " "$23,854.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,854.64 " "$23,854.64 " "$27,432.83 " "$23,854.64 " N/A "$22,661.91 " "$92,434.83 " 330104 283 1 Other disorders of the liver I N/A "$4,146.88 " N/A "$4,146.88 " N/A N/A N/A N/A "$3,939.54 " N/A "$3,981.01 " N/A N/A N/A N/A N/A "$5,308.01 " "$4,146.88 " N/A N/A N/A N/A "$4,271.29 " N/A N/A "$5,805.64 " "$15,070.66 " "$4,146.88 " "$5,598.29 " "$5,100.67 " N/A "$4,271.29 " N/A N/A N/A N/A N/A "$4,146.88 " "$13,235.02 " "$8,501.11 " "$4,146.88 " "$4,146.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,146.88 " "$4,146.88 " "$4,768.91 " "$4,146.88 " N/A "$3,939.54 " "$15,070.66 " 330104 283 2 Other disorders of the liver I N/A "$5,398.20 " N/A "$5,398.20 " N/A N/A N/A N/A "$5,128.29 " N/A "$5,182.27 " N/A N/A N/A N/A N/A "$6,909.70 " "$5,398.20 " N/A N/A N/A N/A "$5,560.15 " N/A N/A "$7,557.48 " "$19,982.80 " "$5,398.20 " "$7,287.57 " "$6,639.79 " N/A "$5,560.15 " N/A N/A N/A N/A N/A "$5,398.20 " "$17,548.85 " "$11,066.31 " "$5,398.20 " "$5,398.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,398.20 " "$5,398.20 " "$6,207.93 " "$5,398.20 " N/A "$5,128.29 " "$19,982.80 " 330104 283 3 Other disorders of the liver I N/A "$8,512.53 " N/A "$8,512.53 " N/A N/A N/A N/A "$8,086.91 " N/A "$8,172.03 " N/A N/A N/A N/A N/A "$10,896.04 " "$8,512.53 " N/A N/A N/A N/A "$8,767.91 " N/A N/A "$11,917.55 " "$32,208.33 " "$8,512.53 " "$11,491.92 " "$10,470.42 " N/A "$8,767.91 " N/A N/A N/A N/A N/A "$8,512.53 " "$28,285.27 " "$17,450.69 " "$8,512.53 " "$8,512.53 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,512.53 " "$8,512.53 " "$9,789.41 " "$8,512.53 " N/A "$8,086.91 " "$32,208.33 " 330104 283 4 Other disorders of the liver I N/A "$17,948.17 " N/A "$17,948.17 " N/A N/A N/A N/A "$17,050.76 " N/A "$17,230.24 " N/A N/A N/A N/A N/A "$22,973.66 " "$17,948.17 " N/A N/A N/A N/A "$18,486.61 " N/A N/A "$25,127.44 " "$69,248.58 " "$17,948.17 " "$24,230.03 " "$22,076.25 " N/A "$18,486.61 " N/A N/A N/A N/A N/A "$17,948.17 " "$60,813.93 " "$36,793.75 " "$17,948.17 " "$17,948.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,948.17 " "$17,948.17 " "$20,640.39 " "$17,948.17 " N/A "$17,050.76 " "$69,248.58 " 330104 284 1 Disorders of gallbladder & biliary tract I N/A "$4,242.25 " N/A "$4,242.25 " N/A N/A N/A N/A "$4,030.13 " N/A "$4,072.56 " N/A N/A N/A N/A N/A "$5,430.08 " "$4,242.25 " N/A N/A N/A N/A "$4,369.51 " N/A N/A "$5,939.15 " "$15,445.02 " "$4,242.25 " "$5,727.03 " "$5,217.96 " N/A "$4,369.51 " N/A N/A N/A N/A N/A "$4,242.25 " "$13,563.78 " "$8,696.61 " "$4,242.25 " "$4,242.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,242.25 " "$4,242.25 " "$4,878.58 " "$4,242.25 " N/A "$4,030.13 " "$15,445.02 " 330104 284 2 Disorders of gallbladder & biliary tract I N/A "$5,945.18 " N/A "$5,945.18 " N/A N/A N/A N/A "$5,647.93 " N/A "$5,707.38 " N/A N/A N/A N/A N/A "$7,609.84 " "$5,945.18 " N/A N/A N/A N/A "$6,123.54 " N/A N/A "$8,323.26 " "$22,130.02 " "$5,945.18 " "$8,026.00 " "$7,312.58 " N/A "$6,123.54 " N/A N/A N/A N/A N/A "$5,945.18 " "$19,434.53 " "$12,187.63 " "$5,945.18 " "$5,945.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,945.18 " "$5,945.18 " "$6,836.96 " "$5,945.18 " N/A "$5,647.93 " "$22,130.02 " 330104 284 3 Disorders of gallbladder & biliary tract I N/A "$9,284.99 " N/A "$9,284.99 " N/A N/A N/A N/A "$8,820.74 " N/A "$8,913.59 " N/A N/A N/A N/A N/A "$11,884.78 " "$9,284.99 " N/A N/A N/A N/A "$9,563.53 " N/A N/A "$12,998.98 " "$35,240.65 " "$9,284.99 " "$12,534.73 " "$11,420.53 " N/A "$9,563.53 " N/A N/A N/A N/A N/A "$9,284.99 " "$30,948.25 " "$19,034.22 " "$9,284.99 " "$9,284.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,284.99 " "$9,284.99 " "$10,677.73 " "$9,284.99 " N/A "$8,820.74 " "$35,240.65 " 330104 284 4 Disorders of gallbladder & biliary tract I N/A "$20,499.17 " N/A "$20,499.17 " N/A N/A N/A N/A "$19,474.21 " N/A "$19,679.20 " N/A N/A N/A N/A N/A "$26,238.94 " "$20,499.17 " N/A N/A N/A N/A "$21,114.14 " N/A N/A "$28,698.84 " "$79,262.71 " "$20,499.17 " "$27,673.88 " "$25,213.98 " N/A "$21,114.14 " N/A N/A N/A N/A N/A "$20,499.17 " "$69,608.31 " "$42,023.30 " "$20,499.17 " "$20,499.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,499.17 " "$20,499.17 " "$23,574.04 " "$20,499.17 " N/A "$19,474.21 " "$79,262.71 " 330104 301 1 Hip joint replacement I N/A "$12,878.18 " N/A "$12,878.18 " N/A N/A N/A N/A "$12,234.27 " N/A "$12,363.06 " N/A N/A N/A N/A N/A "$16,484.07 " "$12,878.18 " N/A N/A N/A N/A "$13,264.53 " N/A N/A "$18,029.46 " "$49,346.00 " "$12,878.18 " "$17,385.55 " "$15,840.17 " N/A "$13,264.53 " N/A N/A N/A N/A N/A "$12,878.18 " "$43,335.53 " "$26,400.28 " "$12,878.18 " "$12,878.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,878.18 " "$12,878.18 " "$14,809.91 " "$12,878.18 " N/A "$12,234.27 " "$49,346.00 " 330104 301 2 Hip joint replacement I N/A "$13,372.04 " N/A "$13,372.04 " N/A N/A N/A N/A "$12,703.43 " N/A "$12,837.15 " N/A N/A N/A N/A N/A "$17,116.21 " "$13,372.04 " N/A N/A N/A N/A "$13,773.20 " N/A N/A "$18,720.85 " "$51,284.65 " "$13,372.04 " "$18,052.25 " "$16,447.60 " N/A "$13,773.20 " N/A N/A N/A N/A N/A "$13,372.04 " "$45,038.05 " "$27,412.67 " "$13,372.04 " "$13,372.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,372.04 " "$13,372.04 " "$15,377.84 " "$13,372.04 " N/A "$12,703.43 " "$51,284.65 " 330104 301 3 Hip joint replacement I N/A "$17,587.15 " N/A "$17,587.15 " N/A N/A N/A N/A "$16,707.79 " N/A "$16,883.66 " N/A N/A N/A N/A N/A "$22,511.55 " "$17,587.15 " N/A N/A N/A N/A "$18,114.76 " N/A N/A "$24,622.00 " "$67,831.36 " "$17,587.15 " "$23,742.65 " "$21,632.19 " N/A "$18,114.76 " N/A N/A N/A N/A N/A "$17,587.15 " "$59,569.33 " "$36,053.65 " "$17,587.15 " "$17,587.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,587.15 " "$17,587.15 " "$20,225.22 " "$17,587.15 " N/A "$16,707.79 " "$67,831.36 " 330104 301 4 Hip joint replacement I N/A "$41,544.07 " N/A "$41,544.07 " N/A N/A N/A N/A "$39,466.87 " N/A "$39,882.31 " N/A N/A N/A N/A N/A "$53,176.41 " "$41,544.07 " N/A N/A N/A N/A "$42,790.39 " N/A N/A "$58,161.70 " "$161,875.94 " "$41,544.07 " "$56,084.50 " "$51,099.21 " N/A "$42,790.39 " N/A N/A N/A N/A N/A "$41,544.07 " "$142,159.04 " "$85,165.35 " "$41,544.07 " "$41,544.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,544.07 " "$41,544.07 " "$47,775.68 " "$41,544.07 " N/A "$39,466.87 " "$161,875.94 " 330104 302 1 Knee joint replacement I N/A "$12,385.69 " N/A "$12,385.69 " N/A N/A N/A N/A "$11,766.41 " N/A "$11,890.27 " N/A N/A N/A N/A N/A "$15,853.69 " "$12,385.69 " N/A N/A N/A N/A "$12,757.26 " N/A N/A "$17,339.97 " "$47,412.69 " "$12,385.69 " "$16,720.69 " "$15,234.40 " N/A "$12,757.26 " N/A N/A N/A N/A N/A "$12,385.69 " "$41,637.71 " "$25,390.67 " "$12,385.69 " "$12,385.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,385.69 " "$12,385.69 " "$14,243.55 " "$12,385.69 " N/A "$11,766.41 " "$47,412.69 " 330104 302 2 Knee joint replacement I N/A "$13,935.37 " N/A "$13,935.37 " N/A N/A N/A N/A "$13,238.60 " N/A "$13,377.95 " N/A N/A N/A N/A N/A "$17,837.27 " "$13,935.37 " N/A N/A N/A N/A "$14,353.43 " N/A N/A "$19,509.51 " "$53,496.04 " "$13,935.37 " "$18,812.75 " "$17,140.50 " N/A "$14,353.43 " N/A N/A N/A N/A N/A "$13,935.37 " "$46,980.09 " "$28,567.50 " "$13,935.37 " "$13,935.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,935.37 " "$13,935.37 " "$16,025.67 " "$13,935.37 " N/A "$13,238.60 " "$53,496.04 " 330104 302 3 Knee joint replacement I N/A "$18,655.91 " N/A "$18,655.91 " N/A N/A N/A N/A "$17,723.11 " N/A "$17,909.67 " N/A N/A N/A N/A N/A "$23,879.56 " "$18,655.91 " N/A N/A N/A N/A "$19,215.59 " N/A N/A "$26,118.27 " "$72,026.86 " "$18,655.91 " "$25,185.48 " "$22,946.77 " N/A "$19,215.59 " N/A N/A N/A N/A N/A "$18,655.91 " "$63,253.81 " "$38,244.62 " "$18,655.91 " "$18,655.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,655.91 " "$18,655.91 " "$21,454.30 " "$18,655.91 " N/A "$17,723.11 " "$72,026.86 " 330104 302 4 Knee joint replacement I N/A "$37,382.77 " N/A "$37,382.77 " N/A N/A N/A N/A "$35,513.63 " N/A "$35,887.46 " N/A N/A N/A N/A N/A "$47,849.95 " "$37,382.77 " N/A N/A N/A N/A "$38,504.26 " N/A N/A "$52,335.88 " "$145,540.47 " "$37,382.77 " "$50,466.74 " "$45,980.81 " N/A "$38,504.26 " N/A N/A N/A N/A N/A "$37,382.77 " "$127,813.27 " "$76,634.68 " "$37,382.77 " "$37,382.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$37,382.77 " "$37,382.77 " "$42,990.19 " "$37,382.77 " N/A "$35,513.63 " "$145,540.47 " 330104 303 1 Dorsal & lumbar fusion proc for curvature of back I N/A "$30,414.35 " N/A "$30,414.35 " N/A N/A N/A N/A "$28,893.64 " N/A "$29,197.78 " N/A N/A N/A N/A N/A "$38,930.37 " "$30,414.35 " N/A N/A N/A N/A "$31,326.78 " N/A N/A "$42,580.09 " "$118,185.45 " "$30,414.35 " "$41,059.38 " "$37,409.65 " N/A "$31,326.78 " N/A N/A N/A N/A N/A "$30,414.35 " "$103,790.16 " "$62,349.42 " "$30,414.35 " "$30,414.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$30,414.35 " "$30,414.35 " "$34,976.51 " "$30,414.35 " N/A "$28,893.64 " "$118,185.45 " 330104 303 2 Dorsal & lumbar fusion proc for curvature of back I N/A "$36,331.04 " N/A "$36,331.04 " N/A N/A N/A N/A "$34,514.49 " N/A "$34,877.80 " N/A N/A N/A N/A N/A "$46,503.73 " "$36,331.04 " N/A N/A N/A N/A "$37,420.97 " N/A N/A "$50,863.45 " "$141,411.82 " "$36,331.04 " "$49,046.90 " "$44,687.18 " N/A "$37,420.97 " N/A N/A N/A N/A N/A "$36,331.04 " "$124,187.50 " "$74,478.63 " "$36,331.04 " "$36,331.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$36,331.04 " "$36,331.04 " "$41,780.69 " "$36,331.04 " N/A "$34,514.49 " "$141,411.82 " 330104 303 3 Dorsal & lumbar fusion proc for curvature of back I N/A "$47,908.29 " N/A "$47,908.29 " N/A N/A N/A N/A "$45,512.87 " N/A "$45,991.96 " N/A N/A N/A N/A N/A "$61,322.61 " "$47,908.29 " N/A N/A N/A N/A "$49,345.54 " N/A N/A "$67,071.60 " "$186,859.12 " "$47,908.29 " "$64,676.19 " "$58,927.20 " N/A "$49,345.54 " N/A N/A N/A N/A N/A "$47,908.29 " "$164,099.20 " "$98,211.99 " "$47,908.29 " "$47,908.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$47,908.29 " "$47,908.29 " "$55,094.53 " "$47,908.29 " N/A "$45,512.87 " "$186,859.12 " 330104 303 4 Dorsal & lumbar fusion proc for curvature of back I N/A "$74,518.39 " N/A "$74,518.39 " N/A N/A N/A N/A "$70,792.47 " N/A "$71,537.65 " N/A N/A N/A N/A N/A "$95,383.54 " "$74,518.39 " N/A N/A N/A N/A "$76,753.94 " N/A N/A "$104,325.75 " "$291,318.93 " "$74,518.39 " "$100,599.83 " "$91,657.62 " N/A "$76,753.94 " N/A N/A N/A N/A N/A "$74,518.39 " "$255,835.54 " "$152,762.70 " "$74,518.39 " "$74,518.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$74,518.39 " "$74,518.39 " "$85,696.15 " "$74,518.39 " N/A "$70,792.47 " "$291,318.93 " 330104 304 1 Dorsal & lumbar fusion proc except for curvature of back I N/A "$21,193.29 " N/A "$21,193.29 " N/A N/A N/A N/A "$20,133.62 " N/A "$20,345.56 " N/A N/A N/A N/A N/A "$27,127.41 " "$21,193.29 " N/A N/A N/A N/A "$21,829.09 " N/A N/A "$29,670.60 " "$81,987.51 " "$21,193.29 " "$28,610.94 " "$26,067.74 " N/A "$21,829.09 " N/A N/A N/A N/A N/A "$21,193.29 " "$72,001.23 " "$43,446.24 " "$21,193.29 " "$21,193.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,193.29 " "$21,193.29 " "$24,372.28 " "$21,193.29 " N/A "$20,133.62 " "$81,987.51 " 330104 304 2 Dorsal & lumbar fusion proc except for curvature of back I N/A "$25,748.30 " N/A "$25,748.30 " N/A N/A N/A N/A "$24,460.89 " N/A "$24,718.37 " N/A N/A N/A N/A N/A "$32,957.83 " "$25,748.30 " N/A N/A N/A N/A "$26,520.75 " N/A N/A "$36,047.63 " "$99,868.55 " "$25,748.30 " "$34,760.21 " "$31,670.41 " N/A "$26,520.75 " N/A N/A N/A N/A N/A "$25,748.30 " "$87,704.31 " "$52,784.02 " "$25,748.30 " "$25,748.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,748.30 " "$25,748.30 " "$29,610.55 " "$25,748.30 " N/A "$24,460.89 " "$99,868.55 " 330104 304 3 Dorsal & lumbar fusion proc except for curvature of back I N/A "$36,598.06 " N/A "$36,598.06 " N/A N/A N/A N/A "$34,768.16 " N/A "$35,134.14 " N/A N/A N/A N/A N/A "$46,845.52 " "$36,598.06 " N/A N/A N/A N/A "$37,696.00 " N/A N/A "$51,237.28 " "$142,460.02 " "$36,598.06 " "$49,407.38 " "$45,015.61 " N/A "$37,696.00 " N/A N/A N/A N/A N/A "$36,598.06 " "$125,108.03 " "$75,026.02 " "$36,598.06 " "$36,598.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$36,598.06 " "$36,598.06 " "$42,087.77 " "$36,598.06 " N/A "$34,768.16 " "$142,460.02 " 330104 304 4 Dorsal & lumbar fusion proc except for curvature of back I N/A "$62,854.63 " N/A "$62,854.63 " N/A N/A N/A N/A "$59,711.90 " N/A "$60,340.45 " N/A N/A N/A N/A N/A "$80,453.93 " "$62,854.63 " N/A N/A N/A N/A "$64,740.27 " N/A N/A "$87,996.48 " "$245,532.03 " "$62,854.63 " "$84,853.75 " "$77,311.20 " N/A "$64,740.27 " N/A N/A N/A N/A N/A "$62,854.63 " "$215,625.60 " "$128,851.99 " "$62,854.63 " "$62,854.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$62,854.63 " "$62,854.63 " "$72,282.83 " "$62,854.63 " N/A "$59,711.90 " "$245,532.03 " 330104 305 1 Amputation of lower limb except toes I N/A "$9,579.93 " N/A "$9,579.93 " N/A N/A N/A N/A "$9,100.94 " N/A "$9,196.74 " N/A N/A N/A N/A N/A "$12,262.32 " "$9,579.93 " N/A N/A N/A N/A "$9,867.33 " N/A N/A "$13,411.91 " "$36,398.49 " "$9,579.93 " "$12,932.91 " "$11,783.32 " N/A "$9,867.33 " N/A N/A N/A N/A N/A "$9,579.93 " "$31,965.06 " "$19,638.86 " "$9,579.93 " "$9,579.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,579.93 " "$9,579.93 " "$11,016.92 " "$9,579.93 " N/A "$9,100.94 " "$36,398.49 " 330104 305 2 Amputation of lower limb except toes I N/A "$13,366.59 " N/A "$13,366.59 " N/A N/A N/A N/A "$12,698.26 " N/A "$12,831.92 " N/A N/A N/A N/A N/A "$17,109.23 " "$13,366.59 " N/A N/A N/A N/A "$13,767.58 " N/A N/A "$18,713.22 " "$51,263.25 " "$13,366.59 " "$18,044.89 " "$16,440.90 " N/A "$13,767.58 " N/A N/A N/A N/A N/A "$13,366.59 " "$45,019.26 " "$27,401.50 " "$13,366.59 " "$13,366.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,366.59 " "$13,366.59 " "$15,371.57 " "$13,366.59 " N/A "$12,698.26 " "$51,263.25 " 330104 305 3 Amputation of lower limb except toes I N/A "$23,344.44 " N/A "$23,344.44 " N/A N/A N/A N/A "$22,177.22 " N/A "$22,410.66 " N/A N/A N/A N/A N/A "$29,880.88 " "$23,344.44 " N/A N/A N/A N/A "$24,044.77 " N/A N/A "$32,682.21 " "$90,432.01 " "$23,344.44 " "$31,514.99 " "$28,713.66 " N/A "$24,044.77 " N/A N/A N/A N/A N/A "$23,344.44 " "$79,417.16 " "$47,856.10 " "$23,344.44 " "$23,344.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,344.44 " "$23,344.44 " "$26,846.10 " "$23,344.44 " N/A "$22,177.22 " "$90,432.01 " 330104 305 4 Amputation of lower limb except toes I N/A "$43,234.07 " N/A "$43,234.07 " N/A N/A N/A N/A "$41,072.36 " N/A "$41,504.70 " N/A N/A N/A N/A N/A "$55,339.60 " "$43,234.07 " N/A N/A N/A N/A "$44,531.09 " N/A N/A "$60,527.69 " "$168,510.13 " "$43,234.07 " "$58,365.99 " "$53,177.90 " N/A "$44,531.09 " N/A N/A N/A N/A N/A "$43,234.07 " "$147,985.17 " "$88,629.84 " "$43,234.07 " "$43,234.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,234.07 " "$43,234.07 " "$49,719.18 " "$43,234.07 " N/A "$41,072.36 " "$168,510.13 " 330104 308 1 Hip and femur fracture repair I N/A "$9,405.55 " N/A "$9,405.55 " N/A N/A N/A N/A "$8,935.28 " N/A "$9,029.33 " N/A N/A N/A N/A N/A "$12,039.11 " "$9,405.55 " N/A N/A N/A N/A "$9,687.72 " N/A N/A "$13,167.77 " "$35,713.94 " "$9,405.55 " "$12,697.50 " "$11,568.83 " N/A "$9,687.72 " N/A N/A N/A N/A N/A "$9,405.55 " "$31,363.89 " "$19,281.38 " "$9,405.55 " "$9,405.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,405.55 " "$9,405.55 " "$10,816.39 " "$9,405.55 " N/A "$8,935.28 " "$35,713.94 " 330104 308 2 Hip and femur fracture repair I N/A "$12,833.23 " N/A "$12,833.23 " N/A N/A N/A N/A "$12,191.56 " N/A "$12,319.90 " N/A N/A N/A N/A N/A "$16,426.53 " "$12,833.23 " N/A N/A N/A N/A "$13,218.22 " N/A N/A "$17,966.52 " "$49,169.51 " "$12,833.23 " "$17,324.85 " "$15,784.87 " N/A "$13,218.22 " N/A N/A N/A N/A N/A "$12,833.23 " "$43,180.54 " "$26,308.11 " "$12,833.23 " "$12,833.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,833.23 " "$12,833.23 " "$14,758.21 " "$12,833.23 " N/A "$12,191.56 " "$49,169.51 " 330104 308 3 Hip and femur fracture repair I N/A "$19,010.80 " N/A "$19,010.80 " N/A N/A N/A N/A "$18,060.26 " N/A "$18,250.37 " N/A N/A N/A N/A N/A "$24,333.83 " "$19,010.80 " N/A N/A N/A N/A "$19,581.13 " N/A N/A "$26,615.12 " "$73,420.02 " "$19,010.80 " "$25,664.58 " "$23,383.29 " N/A "$19,581.13 " N/A N/A N/A N/A N/A "$19,010.80 " "$64,477.27 " "$38,972.14 " "$19,010.80 " "$19,010.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,010.80 " "$19,010.80 " "$21,862.42 " "$19,010.80 " N/A "$18,060.26 " "$73,420.02 " 330104 308 4 Hip and femur fracture repair I N/A "$39,603.40 " N/A "$39,603.40 " N/A N/A N/A N/A "$37,623.23 " N/A "$38,019.27 " N/A N/A N/A N/A N/A "$50,692.36 " "$39,603.40 " N/A N/A N/A N/A "$40,791.51 " N/A N/A "$55,444.76 " "$154,257.71 " "$39,603.40 " "$53,464.59 " "$48,712.19 " N/A "$40,791.51 " N/A N/A N/A N/A N/A "$39,603.40 " "$135,468.73 " "$81,186.98 " "$39,603.40 " "$39,603.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$39,603.40 " "$39,603.40 " "$45,543.91 " "$39,603.40 " N/A "$37,623.23 " "$154,257.71 " 330104 309 1 Other significant hip and femur surgery I N/A "$8,791.13 " N/A "$8,791.13 " N/A N/A N/A N/A "$8,351.58 " N/A "$8,439.49 " N/A N/A N/A N/A N/A "$11,252.65 " "$8,791.13 " N/A N/A N/A N/A "$9,054.87 " N/A N/A "$12,307.59 " "$33,302.00 " "$8,791.13 " "$11,868.03 " "$10,813.09 " N/A "$9,054.87 " N/A N/A N/A N/A N/A "$8,791.13 " "$29,245.73 " "$18,021.82 " "$8,791.13 " "$8,791.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,791.13 " "$8,791.13 " "$10,109.80 " "$8,791.13 " N/A "$8,351.58 " "$33,302.00 " 330104 309 2 Other significant hip and femur surgery I N/A "$13,078.45 " N/A "$13,078.45 " N/A N/A N/A N/A "$12,424.53 " N/A "$12,555.31 " N/A N/A N/A N/A N/A "$16,740.41 " "$13,078.45 " N/A N/A N/A N/A "$13,470.80 " N/A N/A "$18,309.83 " "$50,132.15 " "$13,078.45 " "$17,655.91 " "$16,086.49 " N/A "$13,470.80 " N/A N/A N/A N/A N/A "$13,078.45 " "$44,025.93 " "$26,810.82 " "$13,078.45 " "$13,078.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,078.45 " "$13,078.45 " "$15,040.22 " "$13,078.45 " N/A "$12,424.53 " "$50,132.15 " 330104 309 3 Other significant hip and femur surgery I N/A "$20,892.21 " N/A "$20,892.21 " N/A N/A N/A N/A "$19,847.60 " N/A "$20,056.52 " N/A N/A N/A N/A N/A "$26,742.03 " "$20,892.21 " N/A N/A N/A N/A "$21,518.97 " N/A N/A "$29,249.09 " "$80,805.61 " "$20,892.21 " "$28,204.48 " "$25,697.42 " N/A "$21,518.97 " N/A N/A N/A N/A N/A "$20,892.21 " "$70,963.28 " "$42,829.03 " "$20,892.21 " "$20,892.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,892.21 " "$20,892.21 " "$24,026.04 " "$20,892.21 " N/A "$19,847.60 " "$80,805.61 " 330104 309 4 Other significant hip and femur surgery I N/A "$39,441.96 " N/A "$39,441.96 " N/A N/A N/A N/A "$37,469.87 " N/A "$37,864.29 " N/A N/A N/A N/A N/A "$50,485.72 " "$39,441.96 " N/A N/A N/A N/A "$40,625.22 " N/A N/A "$55,218.75 " "$153,623.97 " "$39,441.96 " "$53,246.65 " "$48,513.62 " N/A "$40,625.22 " N/A N/A N/A N/A N/A "$39,441.96 " "$134,912.18 " "$80,856.03 " "$39,441.96 " "$39,441.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$39,441.96 " "$39,441.96 " "$45,358.26 " "$39,441.96 " N/A "$37,469.87 " "$153,623.97 " 330104 310 1 Intervertebral disc excision & decompression I N/A "$6,178.83 " N/A "$6,178.83 " N/A N/A N/A N/A "$5,869.89 " N/A "$5,931.67 " N/A N/A N/A N/A N/A "$7,908.90 " "$6,178.83 " N/A N/A N/A N/A "$6,364.19 " N/A N/A "$8,650.36 " "$23,047.21 " "$6,178.83 " "$8,341.42 " "$7,599.96 " N/A "$6,364.19 " N/A N/A N/A N/A N/A "$6,178.83 " "$20,240.00 " "$12,666.60 " "$6,178.83 " "$6,178.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,178.83 " "$6,178.83 " "$7,105.65 " "$6,178.83 " N/A "$5,869.89 " "$23,047.21 " 330104 310 2 Intervertebral disc excision & decompression I N/A "$8,631.74 " N/A "$8,631.74 " N/A N/A N/A N/A "$8,200.15 " N/A "$8,286.47 " N/A N/A N/A N/A N/A "$11,048.63 " "$8,631.74 " N/A N/A N/A N/A "$8,890.69 " N/A N/A "$12,084.43 " "$32,676.28 " "$8,631.74 " "$11,652.85 " "$10,617.04 " N/A "$8,890.69 " N/A N/A N/A N/A N/A "$8,631.74 " "$28,696.23 " "$17,695.06 " "$8,631.74 " "$8,631.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,631.74 " "$8,631.74 " "$9,926.50 " "$8,631.74 " N/A "$8,200.15 " "$32,676.28 " 330104 310 3 Intervertebral disc excision & decompression I N/A "$17,643.68 " N/A "$17,643.68 " N/A N/A N/A N/A "$16,761.50 " N/A "$16,937.94 " N/A N/A N/A N/A N/A "$22,583.92 " "$17,643.68 " N/A N/A N/A N/A "$18,172.99 " N/A N/A "$24,701.16 " "$68,053.30 " "$17,643.68 " "$23,818.97 " "$21,701.73 " N/A "$18,172.99 " N/A N/A N/A N/A N/A "$17,643.68 " "$59,764.24 " "$36,169.55 " "$17,643.68 " "$17,643.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,643.68 " "$17,643.68 " "$20,290.24 " "$17,643.68 " N/A "$16,761.50 " "$68,053.30 " 330104 310 4 Intervertebral disc excision & decompression I N/A "$46,915.14 " N/A "$46,915.14 " N/A N/A N/A N/A "$44,569.38 " N/A "$45,038.53 " N/A N/A N/A N/A N/A "$60,051.37 " "$46,915.14 " N/A N/A N/A N/A "$48,322.59 " N/A N/A "$65,681.19 " "$182,960.43 " "$46,915.14 " "$63,335.43 " "$57,705.62 " N/A "$48,322.59 " N/A N/A N/A N/A N/A "$46,915.14 " "$160,675.38 " "$96,176.03 " "$46,915.14 " "$46,915.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$46,915.14 " "$46,915.14 " "$53,952.41 " "$46,915.14 " N/A "$44,569.38 " "$182,960.43 " 330104 312 1 Skin graft except hand for musculoskeletal & connective tissue diagnoses I N/A "$8,610.62 " N/A "$8,610.62 " N/A N/A N/A N/A "$8,180.09 " N/A "$8,266.20 " N/A N/A N/A N/A N/A "$11,021.60 " "$8,610.62 " N/A N/A N/A N/A "$8,868.94 " N/A N/A "$12,054.87 " "$32,593.39 " "$8,610.62 " "$11,624.34 " "$10,591.07 " N/A "$8,868.94 " N/A N/A N/A N/A N/A "$8,610.62 " "$28,623.43 " "$17,651.78 " "$8,610.62 " "$8,610.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,610.62 " "$8,610.62 " "$9,902.22 " "$8,610.62 " N/A "$8,180.09 " "$32,593.39 " 330104 312 2 Skin graft except hand for musculoskeletal & connective tissue diagnoses I N/A "$15,656.70 " N/A "$15,656.70 " N/A N/A N/A N/A "$14,873.86 " N/A "$15,030.43 " N/A N/A N/A N/A N/A "$20,040.57 " "$15,656.70 " N/A N/A N/A N/A "$16,126.40 " N/A N/A "$21,919.37 " "$60,253.24 " "$15,656.70 " "$21,136.54 " "$19,257.74 " N/A "$16,126.40 " N/A N/A N/A N/A N/A "$15,656.70 " "$52,914.24 " "$32,096.23 " "$15,656.70 " "$15,656.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,656.70 " "$15,656.70 " "$18,005.20 " "$15,656.70 " N/A "$14,873.86 " "$60,253.24 " 330104 312 3 Skin graft except hand for musculoskeletal & connective tissue diagnoses I N/A "$31,149.34 " N/A "$31,149.34 " N/A N/A N/A N/A "$29,591.87 " N/A "$29,903.37 " N/A N/A N/A N/A N/A "$39,871.16 " "$31,149.34 " N/A N/A N/A N/A "$32,083.82 " N/A N/A "$43,609.08 " "$121,070.70 " "$31,149.34 " "$42,051.61 " "$38,313.69 " N/A "$32,083.82 " N/A N/A N/A N/A N/A "$31,149.34 " "$106,323.98 " "$63,856.15 " "$31,149.34 " "$31,149.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$31,149.34 " "$31,149.34 " "$35,821.74 " "$31,149.34 " N/A "$29,591.87 " "$121,070.70 " 330104 312 4 Skin graft except hand for musculoskeletal & connective tissue diagnoses I N/A "$61,629.20 " N/A "$61,629.20 " N/A N/A N/A N/A "$58,547.74 " N/A "$59,164.03 " N/A N/A N/A N/A N/A "$78,885.37 " "$61,629.20 " N/A N/A N/A N/A "$63,478.07 " N/A N/A "$86,280.88 " "$240,721.50 " "$61,629.20 " "$83,199.42 " "$75,803.91 " N/A "$63,478.07 " N/A N/A N/A N/A N/A "$61,629.20 " "$211,401.01 " "$126,339.85 " "$61,629.20 " "$61,629.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$61,629.20 " "$61,629.20 " "$70,873.58 " "$61,629.20 " N/A "$58,547.74 " "$240,721.50 " 330104 313 1 Knee & lower leg procedures except foot I N/A "$8,456.68 " N/A "$8,456.68 " N/A N/A N/A N/A "$8,033.84 " N/A "$8,118.41 " N/A N/A N/A N/A N/A "$10,824.55 " "$8,456.68 " N/A N/A N/A N/A "$8,710.38 " N/A N/A "$11,839.35 " "$31,989.06 " "$8,456.68 " "$11,416.51 " "$10,401.71 " N/A "$8,710.38 " N/A N/A N/A N/A N/A "$8,456.68 " "$28,092.71 " "$17,336.19 " "$8,456.68 " "$8,456.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,456.68 " "$8,456.68 " "$9,725.18 " "$8,456.68 " N/A "$8,033.84 " "$31,989.06 " 330104 313 2 Knee & lower leg procedures except foot I N/A "$12,266.49 " N/A "$12,266.49 " N/A N/A N/A N/A "$11,653.16 " N/A "$11,775.83 " N/A N/A N/A N/A N/A "$15,701.11 " "$12,266.49 " N/A N/A N/A N/A "$12,634.48 " N/A N/A "$17,173.08 " "$46,944.74 " "$12,266.49 " "$16,559.76 " "$15,087.78 " N/A "$12,634.48 " N/A N/A N/A N/A N/A "$12,266.49 " "$41,226.75 " "$25,146.30 " "$12,266.49 " "$12,266.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,266.49 " "$12,266.49 " "$14,106.46 " "$12,266.49 " N/A "$11,653.16 " "$46,944.74 " 330104 313 3 Knee & lower leg procedures except foot I N/A "$19,891.56 " N/A "$19,891.56 " N/A N/A N/A N/A "$18,896.98 " N/A "$19,095.90 " N/A N/A N/A N/A N/A "$25,461.20 " "$19,891.56 " N/A N/A N/A N/A "$20,488.31 " N/A N/A "$27,848.19 " "$76,877.50 " "$19,891.56 " "$26,853.61 " "$24,466.62 " N/A "$20,488.31 " N/A N/A N/A N/A N/A "$19,891.56 " "$67,513.62 " "$40,777.70 " "$19,891.56 " "$19,891.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,891.56 " "$19,891.56 " "$22,875.30 " "$19,891.56 " N/A "$18,896.98 " "$76,877.50 " 330104 313 4 Knee & lower leg procedures except foot I N/A "$44,388.66 " N/A "$44,388.66 " N/A N/A N/A N/A "$42,169.22 " N/A "$42,613.11 " N/A N/A N/A N/A N/A "$56,817.48 " "$44,388.66 " N/A N/A N/A N/A "$45,720.32 " N/A N/A "$62,144.12 " "$173,042.56 " "$44,388.66 " "$59,924.69 " "$54,598.05 " N/A "$45,720.32 " N/A N/A N/A N/A N/A "$44,388.66 " "$151,965.54 " "$90,996.75 " "$44,388.66 " "$44,388.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$44,388.66 " "$44,388.66 " "$51,046.96 " "$44,388.66 " N/A "$42,169.22 " "$173,042.56 " 330104 314 1 Foot & toe procedures I N/A "$7,517.34 " N/A "$7,517.34 " N/A N/A N/A N/A "$7,141.47 " N/A "$7,216.64 " N/A N/A N/A N/A N/A "$9,622.19 " "$7,517.34 " N/A N/A N/A N/A "$7,742.86 " N/A N/A "$10,524.27 " "$28,301.62 " "$7,517.34 " "$10,148.40 " "$9,246.32 " N/A "$7,742.86 " N/A N/A N/A N/A N/A "$7,517.34 " "$24,854.41 " "$15,410.54 " "$7,517.34 " "$7,517.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,517.34 " "$7,517.34 " "$8,644.94 " "$7,517.34 " N/A "$7,141.47 " "$28,301.62 " 330104 314 2 Foot & toe procedures I N/A "$9,532.93 " N/A "$9,532.93 " N/A N/A N/A N/A "$9,056.29 " N/A "$9,151.62 " N/A N/A N/A N/A N/A "$12,202.15 " "$9,532.93 " N/A N/A N/A N/A "$9,818.92 " N/A N/A "$13,346.11 " "$36,213.98 " "$9,532.93 " "$12,869.46 " "$11,725.51 " N/A "$9,818.92 " N/A N/A N/A N/A N/A "$9,532.93 " "$31,803.03 " "$19,542.51 " "$9,532.93 " "$9,532.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,532.93 " "$9,532.93 " "$10,962.87 " "$9,532.93 " N/A "$9,056.29 " "$36,213.98 " 330104 314 3 Foot & toe procedures I N/A "$14,153.34 " N/A "$14,153.34 " N/A N/A N/A N/A "$13,445.68 " N/A "$13,587.21 " N/A N/A N/A N/A N/A "$18,116.28 " "$14,153.34 " N/A N/A N/A N/A "$14,577.94 " N/A N/A "$19,814.68 " "$54,351.72 " "$14,153.34 " "$19,107.01 " "$17,408.61 " N/A "$14,577.94 " N/A N/A N/A N/A N/A "$14,153.34 " "$47,731.55 " "$29,014.35 " "$14,153.34 " "$14,153.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,153.34 " "$14,153.34 " "$16,276.34 " "$14,153.34 " N/A "$13,445.68 " "$54,351.72 " 330104 314 4 Foot & toe procedures I N/A "$26,498.96 " N/A "$26,498.96 " N/A N/A N/A N/A "$25,174.01 " N/A "$25,439.00 " N/A N/A N/A N/A N/A "$33,918.67 " "$26,498.96 " N/A N/A N/A N/A "$27,293.93 " N/A N/A "$37,098.54 " "$102,815.30 " "$26,498.96 " "$35,773.59 " "$32,593.72 " N/A "$27,293.93 " N/A N/A N/A N/A N/A "$26,498.96 " "$90,292.14 " "$54,322.87 " "$26,498.96 " "$26,498.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,498.96 " "$26,498.96 " "$30,473.80 " "$26,498.96 " N/A "$25,174.01 " "$102,815.30 " 330104 315 1 Shoulder upper arm & forearm procedures except joint replacement I N/A "$5,816.44 " N/A "$5,816.44 " N/A N/A N/A N/A "$5,525.62 " N/A "$5,583.78 " N/A N/A N/A N/A N/A "$7,445.05 " "$5,816.44 " N/A N/A N/A N/A "$5,990.94 " N/A N/A "$8,143.02 " "$21,624.64 " "$5,816.44 " "$7,852.20 " "$7,154.22 " N/A "$5,990.94 " N/A N/A N/A N/A N/A "$5,816.44 " "$18,990.70 " "$11,923.71 " "$5,816.44 " "$5,816.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,816.44 " "$5,816.44 " "$6,688.91 " "$5,816.44 " N/A "$5,525.62 " "$21,624.64 " 330104 315 2 Shoulder upper arm & forearm procedures except joint replacement I N/A "$9,728.43 " N/A "$9,728.43 " N/A N/A N/A N/A "$9,242.01 " N/A "$9,339.29 " N/A N/A N/A N/A N/A "$12,452.39 " "$9,728.43 " N/A N/A N/A N/A "$10,020.28 " N/A N/A "$13,619.80 " "$36,981.42 " "$9,728.43 " "$13,133.38 " "$11,965.97 " N/A "$10,020.28 " N/A N/A N/A N/A N/A "$9,728.43 " "$32,476.99 " "$19,943.28 " "$9,728.43 " "$9,728.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,728.43 " "$9,728.43 " "$11,187.69 " "$9,728.43 " N/A "$9,242.01 " "$36,981.42 " 330104 315 3 Shoulder upper arm & forearm procedures except joint replacement I N/A "$18,482.89 " N/A "$18,482.89 " N/A N/A N/A N/A "$17,558.75 " N/A "$17,743.58 " N/A N/A N/A N/A N/A "$23,658.10 " "$18,482.89 " N/A N/A N/A N/A "$19,037.38 " N/A N/A "$25,876.05 " "$71,347.67 " "$18,482.89 " "$24,951.90 " "$22,733.96 " N/A "$19,037.38 " N/A N/A N/A N/A N/A "$18,482.89 " "$62,657.34 " "$37,889.93 " "$18,482.89 " "$18,482.89 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,482.89 " "$18,482.89 " "$21,255.33 " "$18,482.89 " N/A "$17,558.75 " "$71,347.67 " 330104 315 4 Shoulder upper arm & forearm procedures except joint replacement I N/A "$35,275.22 " N/A "$35,275.22 " N/A N/A N/A N/A "$33,511.46 " N/A "$33,864.21 " N/A N/A N/A N/A N/A "$45,152.28 " "$35,275.22 " N/A N/A N/A N/A "$36,333.47 " N/A N/A "$49,385.30 " "$137,267.12 " "$35,275.22 " "$47,621.54 " "$43,388.52 " N/A "$36,333.47 " N/A N/A N/A N/A N/A "$35,275.22 " "$120,547.63 " "$72,314.20 " "$35,275.22 " "$35,275.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$35,275.22 " "$35,275.22 " "$40,566.50 " "$35,275.22 " N/A "$33,511.46 " "$137,267.12 " 330104 316 1 Hand & wrist procedures I N/A "$5,188.40 " N/A "$5,188.40 " N/A N/A N/A N/A "$4,928.98 " N/A "$4,980.86 " N/A N/A N/A N/A N/A "$6,641.15 " "$5,188.40 " N/A N/A N/A N/A "$5,344.05 " N/A N/A "$7,263.76 " "$19,159.21 " "$5,188.40 " "$7,004.34 " "$6,381.73 " N/A "$5,344.05 " N/A N/A N/A N/A N/A "$5,188.40 " "$16,825.57 " "$10,636.22 " "$5,188.40 " "$5,188.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,188.40 " "$5,188.40 " "$5,966.66 " "$5,188.40 " N/A "$4,928.98 " "$19,159.21 " 330104 316 2 Hand & wrist procedures I N/A "$8,349.73 " N/A "$8,349.73 " N/A N/A N/A N/A "$7,932.25 " N/A "$8,015.74 " N/A N/A N/A N/A N/A "$10,687.66 " "$8,349.73 " N/A N/A N/A N/A "$8,600.22 " N/A N/A "$11,689.62 " "$31,569.24 " "$8,349.73 " "$11,272.14 " "$10,270.17 " N/A "$8,600.22 " N/A N/A N/A N/A N/A "$8,349.73 " "$27,724.03 " "$17,116.95 " "$8,349.73 " "$8,349.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,349.73 " "$8,349.73 " "$9,602.19 " "$8,349.73 " N/A "$7,932.25 " "$31,569.24 " 330104 316 3 Hand & wrist procedures I N/A "$14,837.92 " N/A "$14,837.92 " N/A N/A N/A N/A "$14,096.03 " N/A "$14,244.41 " N/A N/A N/A N/A N/A "$18,992.54 " "$14,837.92 " N/A N/A N/A N/A "$15,283.06 " N/A N/A "$20,773.09 " "$57,039.09 " "$14,837.92 " "$20,031.20 " "$18,250.65 " N/A "$15,283.06 " N/A N/A N/A N/A N/A "$14,837.92 " "$50,091.59 " "$30,417.74 " "$14,837.92 " "$14,837.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,837.92 " "$14,837.92 " "$17,063.61 " "$14,837.92 " N/A "$14,096.03 " "$57,039.09 " 330104 316 4 Hand & wrist procedures I N/A "$16,570.15 " N/A "$16,570.15 " N/A N/A N/A N/A "$15,741.64 " N/A "$15,907.35 " N/A N/A N/A N/A N/A "$21,209.79 " "$16,570.15 " N/A N/A N/A N/A "$17,067.26 " N/A N/A "$23,198.21 " "$63,839.08 " "$16,570.15 " "$22,369.71 " "$20,381.29 " N/A "$17,067.26 " N/A N/A N/A N/A N/A "$16,570.15 " "$56,063.31 " "$33,968.81 " "$16,570.15 " "$16,570.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,570.15 " "$16,570.15 " "$19,055.67 " "$16,570.15 " N/A "$15,741.64 " "$63,839.08 " 330104 317 1 Tendon muscle & other soft tissue procedures I N/A "$6,436.99 " N/A "$6,436.99 " N/A N/A N/A N/A "$6,115.14 " N/A "$6,179.51 " N/A N/A N/A N/A N/A "$8,239.35 " "$6,436.99 " N/A N/A N/A N/A "$6,630.10 " N/A N/A "$9,011.79 " "$24,060.65 " "$6,436.99 " "$8,689.94 " "$7,917.50 " N/A "$6,630.10 " N/A N/A N/A N/A N/A "$6,436.99 " "$21,130.00 " "$13,195.83 " "$6,436.99 " "$6,436.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,436.99 " "$6,436.99 " "$7,402.54 " "$6,436.99 " N/A "$6,115.14 " "$24,060.65 " 330104 317 2 Tendon muscle & other soft tissue procedures I N/A "$10,081.96 " N/A "$10,081.96 " N/A N/A N/A N/A "$9,577.86 " N/A "$9,678.68 " N/A N/A N/A N/A N/A "$12,904.91 " "$10,081.96 " N/A N/A N/A N/A "$10,384.42 " N/A N/A "$14,114.74 " "$38,369.23 " "$10,081.96 " "$13,610.65 " "$12,400.81 " N/A "$10,384.42 " N/A N/A N/A N/A N/A "$10,081.96 " "$33,695.76 " "$20,668.02 " "$10,081.96 " "$10,081.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,081.96 " "$10,081.96 " "$11,594.25 " "$10,081.96 " N/A "$9,577.86 " "$38,369.23 " 330104 317 3 Tendon muscle & other soft tissue procedures I N/A "$18,071.46 " N/A "$18,071.46 " N/A N/A N/A N/A "$17,167.89 " N/A "$17,348.60 " N/A N/A N/A N/A N/A "$23,131.47 " "$18,071.46 " N/A N/A N/A N/A "$18,613.61 " N/A N/A "$25,300.05 " "$69,732.57 " "$18,071.46 " "$24,396.47 " "$22,227.90 " N/A "$18,613.61 " N/A N/A N/A N/A N/A "$18,071.46 " "$61,238.97 " "$37,046.50 " "$18,071.46 " "$18,071.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,071.46 " "$18,071.46 " "$20,782.18 " "$18,071.46 " N/A "$17,167.89 " "$69,732.57 " 330104 317 4 Tendon muscle & other soft tissue procedures I N/A "$43,344.42 " N/A "$43,344.42 " N/A N/A N/A N/A "$41,177.20 " N/A "$41,610.64 " N/A N/A N/A N/A N/A "$55,480.85 " "$43,344.42 " N/A N/A N/A N/A "$44,644.75 " N/A N/A "$60,682.18 " "$168,943.32 " "$43,344.42 " "$58,514.96 " "$53,313.63 " N/A "$44,644.75 " N/A N/A N/A N/A N/A "$43,344.42 " "$148,365.59 " "$88,856.05 " "$43,344.42 " "$43,344.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,344.42 " "$43,344.42 " "$49,846.08 " "$43,344.42 " N/A "$41,177.20 " "$168,943.32 " 330104 320 1 Other musculoskeletal system & connective tissue procedures I N/A "$7,292.55 " N/A "$7,292.55 " N/A N/A N/A N/A "$6,927.92 " N/A "$7,000.85 " N/A N/A N/A N/A N/A "$9,334.46 " "$7,292.55 " N/A N/A N/A N/A "$7,511.32 " N/A N/A "$10,209.57 " "$27,419.20 " "$7,292.55 " "$9,844.94 " "$8,969.83 " N/A "$7,511.32 " N/A N/A N/A N/A N/A "$7,292.55 " "$24,079.47 " "$14,949.72 " "$7,292.55 " "$7,292.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,292.55 " "$7,292.55 " "$8,386.43 " "$7,292.55 " N/A "$6,927.92 " "$27,419.20 " 330104 320 2 Other musculoskeletal system & connective tissue procedures I N/A "$11,395.95 " N/A "$11,395.95 " N/A N/A N/A N/A "$10,826.15 " N/A "$10,940.11 " N/A N/A N/A N/A N/A "$14,586.81 " "$11,395.95 " N/A N/A N/A N/A "$11,737.83 " N/A N/A "$15,954.33 " "$43,527.37 " "$11,395.95 " "$15,384.53 " "$14,017.01 " N/A "$11,737.83 " N/A N/A N/A N/A N/A "$11,395.95 " "$38,225.63 " "$23,361.69 " "$11,395.95 " "$11,395.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,395.95 " "$11,395.95 " "$13,105.34 " "$11,395.95 " N/A "$10,826.15 " "$43,527.37 " 330104 320 3 Other musculoskeletal system & connective tissue procedures I N/A "$17,438.65 " N/A "$17,438.65 " N/A N/A N/A N/A "$16,566.72 " N/A "$16,741.10 " N/A N/A N/A N/A N/A "$22,321.47 " "$17,438.65 " N/A N/A N/A N/A "$17,961.81 " N/A N/A "$24,414.11 " "$67,248.43 " "$17,438.65 " "$23,542.18 " "$21,449.54 " N/A "$17,961.81 " N/A N/A N/A N/A N/A "$17,438.65 " "$59,057.40 " "$35,749.23 " "$17,438.65 " "$17,438.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,438.65 " "$17,438.65 " "$20,054.45 " "$17,438.65 " N/A "$16,566.72 " "$67,248.43 " 330104 320 4 Other musculoskeletal system & connective tissue procedures I N/A "$34,391.05 " N/A "$34,391.05 " N/A N/A N/A N/A "$32,671.50 " N/A "$33,015.41 " N/A N/A N/A N/A N/A "$44,020.55 " "$34,391.05 " N/A N/A N/A N/A "$35,422.78 " N/A N/A "$48,147.47 " "$133,796.26 " "$34,391.05 " "$46,427.92 " "$42,300.99 " N/A "$35,422.78 " N/A N/A N/A N/A N/A "$34,391.05 " "$117,499.54 " "$70,501.66 " "$34,391.05 " "$34,391.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,391.05 " "$34,391.05 " "$39,549.71 " "$34,391.05 " N/A "$32,671.50 " "$133,796.26 " 330104 321 1 Cervical spinal fusion & other back/neck proc exc disc excis/decomp I N/A "$11,422.51 " N/A "$11,422.51 " N/A N/A N/A N/A "$10,851.39 " N/A "$10,965.61 " N/A N/A N/A N/A N/A "$14,620.82 " "$11,422.51 " N/A N/A N/A N/A "$11,765.19 " N/A N/A "$15,991.52 " "$43,631.66 " "$11,422.51 " "$15,420.39 " "$14,049.69 " N/A "$11,765.19 " N/A N/A N/A N/A N/A "$11,422.51 " "$38,317.21 " "$23,416.15 " "$11,422.51 " "$11,422.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,422.51 " "$11,422.51 " "$13,135.89 " "$11,422.51 " N/A "$10,851.39 " "$43,631.66 " 330104 321 2 Cervical spinal fusion & other back/neck proc exc disc excis/decomp I N/A "$14,933.29 " N/A "$14,933.29 " N/A N/A N/A N/A "$14,186.62 " N/A "$14,335.96 " N/A N/A N/A N/A N/A "$19,114.61 " "$14,933.29 " N/A N/A N/A N/A "$15,381.29 " N/A N/A "$20,906.60 " "$57,413.45 " "$14,933.29 " "$20,159.94 " "$18,367.94 " N/A "$15,381.29 " N/A N/A N/A N/A N/A "$14,933.29 " "$50,420.35 " "$30,613.24 " "$14,933.29 " "$14,933.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,933.29 " "$14,933.29 " "$17,173.28 " "$14,933.29 " N/A "$14,186.62 " "$57,413.45 " 330104 321 3 Cervical spinal fusion & other back/neck proc exc disc excis/decomp I N/A "$25,528.97 " N/A "$25,528.97 " N/A N/A N/A N/A "$24,252.52 " N/A "$24,507.81 " N/A N/A N/A N/A N/A "$32,677.08 " "$25,528.97 " N/A N/A N/A N/A "$26,294.83 " N/A N/A "$35,740.55 " "$99,007.52 " "$25,528.97 " "$34,464.10 " "$31,400.63 " N/A "$26,294.83 " N/A N/A N/A N/A N/A "$25,528.97 " "$86,948.16 " "$52,334.38 " "$25,528.97 " "$25,528.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,528.97 " "$25,528.97 " "$29,358.31 " "$25,528.97 " N/A "$24,252.52 " "$99,007.52 " 330104 321 4 Cervical spinal fusion & other back/neck proc exc disc excis/decomp I N/A "$48,427.34 " N/A "$48,427.34 " N/A N/A N/A N/A "$46,005.98 " N/A "$46,490.25 " N/A N/A N/A N/A N/A "$61,987.00 " "$48,427.34 " N/A N/A N/A N/A "$49,880.16 " N/A N/A "$67,798.28 " "$188,896.71 " "$48,427.34 " "$65,376.91 " "$59,565.63 " N/A "$49,880.16 " N/A N/A N/A N/A N/A "$48,427.34 " "$165,888.61 " "$99,276.06 " "$48,427.34 " "$48,427.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$48,427.34 " "$48,427.34 " "$55,691.45 " "$48,427.34 " N/A "$46,005.98 " "$188,896.71 " 330104 322 1 Shoulder & elbow joint replacement # I N/A "$11,072.39 " N/A "$11,072.39 " N/A N/A N/A N/A "$10,518.77 " N/A "$10,629.49 " N/A N/A N/A N/A N/A "$14,172.66 " "$11,072.39 " N/A N/A N/A N/A "$11,404.56 " N/A N/A "$15,501.34 " "$42,257.22 " "$11,072.39 " "$14,947.72 " "$13,619.04 " N/A "$11,404.56 " N/A N/A N/A N/A N/A "$11,072.39 " "$37,110.18 " "$22,698.40 " "$11,072.39 " "$11,072.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,072.39 " "$11,072.39 " "$12,733.25 " "$11,072.39 " N/A "$10,518.77 " "$42,257.22 " 330104 322 2 Shoulder & elbow joint replacement # I N/A "$12,198.37 " N/A "$12,198.37 " N/A N/A N/A N/A "$11,588.45 " N/A "$11,710.44 " N/A N/A N/A N/A N/A "$15,613.91 " "$12,198.37 " N/A N/A N/A N/A "$12,564.32 " N/A N/A "$17,077.72 " "$46,677.34 " "$12,198.37 " "$16,467.80 " "$15,004.00 " N/A "$12,564.32 " N/A N/A N/A N/A N/A "$12,198.37 " "$40,991.92 " "$25,006.66 " "$12,198.37 " "$12,198.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,198.37 " "$12,198.37 " "$14,028.13 " "$12,198.37 " N/A "$11,588.45 " "$46,677.34 " 330104 322 3 Shoulder & elbow joint replacement # I N/A "$20,222.61 " N/A "$20,222.61 " N/A N/A N/A N/A "$19,211.48 " N/A "$19,413.71 " N/A N/A N/A N/A N/A "$25,884.94 " "$20,222.61 " N/A N/A N/A N/A "$20,829.29 " N/A N/A "$28,311.66 " "$78,177.06 " "$20,222.61 " "$27,300.53 " "$24,873.81 " N/A "$20,829.29 " N/A N/A N/A N/A N/A "$20,222.61 " "$68,654.90 " "$41,456.36 " "$20,222.61 " "$20,222.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,222.61 " "$20,222.61 " "$23,256.00 " "$20,222.61 " N/A "$19,211.48 " "$78,177.06 " 330104 322 4 Shoulder & elbow joint replacement # I N/A "$23,593.07 " N/A "$23,593.07 " N/A N/A N/A N/A "$22,413.41 " N/A "$22,649.34 " N/A N/A N/A N/A N/A "$30,199.12 " "$23,593.07 " N/A N/A N/A N/A "$24,300.86 " N/A N/A "$33,030.29 " "$91,408.02 " "$23,593.07 " "$31,850.64 " "$29,019.47 " N/A "$24,300.86 " N/A N/A N/A N/A N/A "$23,593.07 " "$80,274.29 " "$48,365.79 " "$23,593.07 " "$23,593.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,593.07 " "$23,593.07 " "$27,132.03 " "$23,593.07 " N/A "$22,413.41 " "$91,408.02 " 330104 340 1 Fracture of femur I N/A "$3,909.15 " N/A "$3,909.15 " N/A N/A N/A N/A "$3,713.69 " N/A "$3,752.79 " N/A N/A N/A N/A N/A "$5,003.71 " "$3,909.15 " N/A N/A N/A N/A "$4,026.43 " N/A N/A "$5,472.81 " "$14,137.44 " "$3,909.15 " "$5,277.36 " "$4,808.26 " N/A "$4,026.43 " N/A N/A N/A N/A N/A "$3,909.15 " "$12,415.46 " "$8,013.76 " "$3,909.15 " "$3,909.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,909.15 " "$3,909.15 " "$4,495.53 " "$3,909.15 " N/A "$3,713.69 " "$14,137.44 " 330104 340 2 Fracture of femur I N/A "$5,131.18 " N/A "$5,131.18 " N/A N/A N/A N/A "$4,874.62 " N/A "$4,925.93 " N/A N/A N/A N/A N/A "$6,567.91 " "$5,131.18 " N/A N/A N/A N/A "$5,285.12 " N/A N/A "$7,183.65 " "$18,934.59 " "$5,131.18 " "$6,927.09 " "$6,311.35 " N/A "$5,285.12 " N/A N/A N/A N/A N/A "$5,131.18 " "$16,628.31 " "$10,518.92 " "$5,131.18 " "$5,131.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,131.18 " "$5,131.18 " "$5,900.86 " "$5,131.18 " N/A "$4,874.62 " "$18,934.59 " 330104 340 3 Fracture of femur I N/A "$11,911.60 " N/A "$11,911.60 " N/A N/A N/A N/A "$11,316.02 " N/A "$11,435.13 " N/A N/A N/A N/A N/A "$15,246.84 " "$11,911.60 " N/A N/A N/A N/A "$12,268.94 " N/A N/A "$16,676.23 " "$45,551.59 " "$11,911.60 " "$16,080.65 " "$14,651.26 " N/A "$12,268.94 " N/A N/A N/A N/A N/A "$11,911.60 " "$40,003.29 " "$24,418.77 " "$11,911.60 " "$11,911.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,911.60 " "$11,911.60 " "$13,698.34 " "$11,911.60 " N/A "$11,316.02 " "$45,551.59 " 330104 340 4 Fracture of femur I N/A "$16,098.10 " N/A "$16,098.10 " N/A N/A N/A N/A "$15,293.19 " N/A "$15,454.17 " N/A N/A N/A N/A N/A "$20,605.57 " "$16,098.10 " N/A N/A N/A N/A "$16,581.04 " N/A N/A "$22,537.34 " "$61,985.99 " "$16,098.10 " "$21,732.43 " "$19,800.66 " N/A "$16,581.04 " N/A N/A N/A N/A N/A "$16,098.10 " "$54,435.94 " "$33,001.10 " "$16,098.10 " "$16,098.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,098.10 " "$16,098.10 " "$18,512.81 " "$16,098.10 " N/A "$15,293.19 " "$61,985.99 " 330104 341 1 Fracture of pelvis or dislocation of hip I N/A "$4,207.51 " N/A "$4,207.51 " N/A N/A N/A N/A "$3,997.13 " N/A "$4,039.21 " N/A N/A N/A N/A N/A "$5,385.61 " "$4,207.51 " N/A N/A N/A N/A "$4,333.73 " N/A N/A "$5,890.51 " "$15,308.65 " "$4,207.51 " "$5,680.13 " "$5,175.23 " N/A "$4,333.73 " N/A N/A N/A N/A N/A "$4,207.51 " "$13,444.02 " "$8,625.39 " "$4,207.51 " "$4,207.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,207.51 " "$4,207.51 " "$4,838.63 " "$4,207.51 " N/A "$3,997.13 " "$15,308.65 " 330104 341 2 Fracture of pelvis or dislocation of hip I N/A "$5,170.01 " N/A "$5,170.01 " N/A N/A N/A N/A "$4,911.51 " N/A "$4,963.21 " N/A N/A N/A N/A N/A "$6,617.61 " "$5,170.01 " N/A N/A N/A N/A "$5,325.11 " N/A N/A "$7,238.01 " "$19,087.01 " "$5,170.01 " "$6,979.51 " "$6,359.11 " N/A "$5,325.11 " N/A N/A N/A N/A N/A "$5,170.01 " "$16,762.17 " "$10,598.51 " "$5,170.01 " "$5,170.01 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,170.01 " "$5,170.01 " "$5,945.51 " "$5,170.01 " N/A "$4,911.51 " "$19,087.01 " 330104 341 3 Fracture of pelvis or dislocation of hip I N/A "$6,861.36 " N/A "$6,861.36 " N/A N/A N/A N/A "$6,518.30 " N/A "$6,586.91 " N/A N/A N/A N/A N/A "$8,782.55 " "$6,861.36 " N/A N/A N/A N/A "$7,067.21 " N/A N/A "$9,605.91 " "$25,726.55 " "$6,861.36 " "$9,262.84 " "$8,439.48 " N/A "$7,067.21 " N/A N/A N/A N/A N/A "$6,861.36 " "$22,592.99 " "$14,065.80 " "$6,861.36 " "$6,861.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,861.36 " "$6,861.36 " "$7,890.57 " "$6,861.36 " N/A "$6,518.30 " "$25,726.55 " 330104 341 4 Fracture of pelvis or dislocation of hip I N/A "$7,281.65 " N/A "$7,281.65 " N/A N/A N/A N/A "$6,917.57 " N/A "$6,990.38 " N/A N/A N/A N/A N/A "$9,320.51 " "$7,281.65 " N/A N/A N/A N/A "$7,500.10 " N/A N/A "$10,194.31 " "$27,376.41 " "$7,281.65 " "$9,830.23 " "$8,956.43 " N/A "$7,500.10 " N/A N/A N/A N/A N/A "$7,281.65 " "$24,041.90 " "$14,927.38 " "$7,281.65 " "$7,281.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,281.65 " "$7,281.65 " "$8,373.90 " "$7,281.65 " N/A "$6,917.57 " "$27,376.41 " 330104 342 1 Fractures & dislocations except femur pelvis & back I N/A "$3,336.28 " N/A "$3,336.28 " N/A N/A N/A N/A "$3,169.47 " N/A "$3,202.83 " N/A N/A N/A N/A N/A "$4,270.44 " "$3,336.28 " N/A N/A N/A N/A "$3,436.37 " N/A N/A "$4,670.80 " "$11,888.60 " "$3,336.28 " "$4,503.98 " "$4,103.63 " N/A "$3,436.37 " N/A N/A N/A N/A N/A "$3,336.28 " "$10,440.54 " "$6,839.38 " "$3,336.28 " "$3,336.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,336.28 " "$3,336.28 " "$3,836.73 " "$3,336.28 " N/A "$3,169.47 " "$11,888.60 " 330104 342 2 Fractures & dislocations except femur pelvis & back I N/A "$4,798.77 " N/A "$4,798.77 " N/A N/A N/A N/A "$4,558.83 " N/A "$4,606.82 " N/A N/A N/A N/A N/A "$6,142.42 " "$4,798.77 " N/A N/A N/A N/A "$4,942.73 " N/A N/A "$6,718.27 " "$17,629.68 " "$4,798.77 " "$6,478.34 " "$5,902.48 " N/A "$4,942.73 " N/A N/A N/A N/A N/A "$4,798.77 " "$15,482.34 " "$9,837.47 " "$4,798.77 " "$4,798.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,798.77 " "$4,798.77 " "$5,518.58 " "$4,798.77 " N/A "$4,558.83 " "$17,629.68 " 330104 342 3 Fractures & dislocations except femur pelvis & back I N/A "$7,687.63 " N/A "$7,687.63 " N/A N/A N/A N/A "$7,303.25 " N/A "$7,380.12 " N/A N/A N/A N/A N/A "$9,840.17 " "$7,687.63 " N/A N/A N/A N/A "$7,918.26 " N/A N/A "$10,762.68 " "$28,970.12 " "$7,687.63 " "$10,378.30 " "$9,455.78 " N/A "$7,918.26 " N/A N/A N/A N/A N/A "$7,687.63 " "$25,441.48 " "$15,759.64 " "$7,687.63 " "$7,687.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,687.63 " "$7,687.63 " "$8,840.77 " "$7,687.63 " N/A "$7,303.25 " "$28,970.12 " 330104 342 4 Fractures & dislocations except femur pelvis & back I N/A "$18,335.76 " N/A "$18,335.76 " N/A N/A N/A N/A "$17,418.97 " N/A "$17,602.33 " N/A N/A N/A N/A N/A "$23,469.77 " "$18,335.76 " N/A N/A N/A N/A "$18,885.83 " N/A N/A "$25,670.06 " "$70,770.08 " "$18,335.76 " "$24,753.27 " "$22,552.98 " N/A "$18,885.83 " N/A N/A N/A N/A N/A "$18,335.76 " "$62,150.11 " "$37,588.30 " "$18,335.76 " "$18,335.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,335.76 " "$18,335.76 " "$21,086.12 " "$18,335.76 " N/A "$17,418.97 " "$70,770.08 " 330104 343 1 Musculoskeletal malignancy & pathol fracture d/t muscskel malig I N/A "$5,959.49 " N/A "$5,959.49 " N/A N/A N/A N/A "$5,661.51 " N/A "$5,721.11 " N/A N/A N/A N/A N/A "$7,628.15 " "$5,959.49 " N/A N/A N/A N/A "$6,138.27 " N/A N/A "$8,343.28 " "$22,186.18 " "$5,959.49 " "$8,045.31 " "$7,330.17 " N/A "$6,138.27 " N/A N/A N/A N/A N/A "$5,959.49 " "$19,483.85 " "$12,216.95 " "$5,959.49 " "$5,959.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,959.49 " "$5,959.49 " "$6,853.41 " "$5,959.49 " N/A "$5,661.51 " "$22,186.18 " 330104 343 2 Musculoskeletal malignancy & pathol fracture d/t muscskel malig I N/A "$7,103.18 " N/A "$7,103.18 " N/A N/A N/A N/A "$6,748.02 " N/A "$6,819.05 " N/A N/A N/A N/A N/A "$9,092.07 " "$7,103.18 " N/A N/A N/A N/A "$7,316.28 " N/A N/A "$9,944.45 " "$26,675.82 " "$7,103.18 " "$9,589.30 " "$8,736.91 " N/A "$7,316.28 " N/A N/A N/A N/A N/A "$7,103.18 " "$23,426.64 " "$14,561.52 " "$7,103.18 " "$7,103.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,103.18 " "$7,103.18 " "$8,168.66 " "$7,103.18 " N/A "$6,748.02 " "$26,675.82 " 330104 343 3 Musculoskeletal malignancy & pathol fracture d/t muscskel malig I N/A "$14,929.88 " N/A "$14,929.88 " N/A N/A N/A N/A "$14,183.39 " N/A "$14,332.69 " N/A N/A N/A N/A N/A "$19,110.25 " "$14,929.88 " N/A N/A N/A N/A "$15,377.78 " N/A N/A "$20,901.84 " "$57,400.08 " "$14,929.88 " "$20,155.34 " "$18,363.76 " N/A "$15,377.78 " N/A N/A N/A N/A N/A "$14,929.88 " "$50,408.61 " "$30,606.26 " "$14,929.88 " "$14,929.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,929.88 " "$14,929.88 " "$17,169.36 " "$14,929.88 " N/A "$14,183.39 " "$57,400.08 " 330104 343 4 Musculoskeletal malignancy & pathol fracture d/t muscskel malig I N/A "$26,545.28 " N/A "$26,545.28 " N/A N/A N/A N/A "$25,218.01 " N/A "$25,483.47 " N/A N/A N/A N/A N/A "$33,977.96 " "$26,545.28 " N/A N/A N/A N/A "$27,341.64 " N/A N/A "$37,163.39 " "$102,997.13 " "$26,545.28 " "$35,836.13 " "$32,650.69 " N/A "$27,341.64 " N/A N/A N/A N/A N/A "$26,545.28 " "$90,451.82 " "$54,417.82 " "$26,545.28 " "$26,545.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,545.28 " "$26,545.28 " "$30,527.07 " "$26,545.28 " N/A "$25,218.01 " "$102,997.13 " 330104 344 1 Osteomyelitis septic arthritis & other musculoskeletal infections I N/A "$5,785.11 " N/A "$5,785.11 " N/A N/A N/A N/A "$5,495.85 " N/A "$5,553.70 " N/A N/A N/A N/A N/A "$7,404.94 " "$5,785.11 " N/A N/A N/A N/A "$5,958.66 " N/A N/A "$8,099.15 " "$21,501.63 " "$5,785.11 " "$7,809.90 " "$7,115.68 " N/A "$5,958.66 " N/A N/A N/A N/A N/A "$5,785.11 " "$18,882.68 " "$11,859.47 " "$5,785.11 " "$5,785.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,785.11 " "$5,785.11 " "$6,652.87 " "$5,785.11 " N/A "$5,495.85 " "$21,501.63 " 330104 344 2 Osteomyelitis septic arthritis & other musculoskeletal infections I N/A "$8,139.93 " N/A "$8,139.93 " N/A N/A N/A N/A "$7,732.93 " N/A "$7,814.33 " N/A N/A N/A N/A N/A "$10,419.11 " "$8,139.93 " N/A N/A N/A N/A "$8,384.13 " N/A N/A "$11,395.90 " "$30,745.65 " "$8,139.93 " "$10,988.91 " "$10,012.11 " N/A "$8,384.13 " N/A N/A N/A N/A N/A "$8,139.93 " "$27,000.75 " "$16,686.86 " "$8,139.93 " "$8,139.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,139.93 " "$8,139.93 " "$9,360.92 " "$8,139.93 " N/A "$7,732.93 " "$30,745.65 " 330104 344 3 Osteomyelitis septic arthritis & other musculoskeletal infections I N/A "$12,455.85 " N/A "$12,455.85 " N/A N/A N/A N/A "$11,833.06 " N/A "$11,957.62 " N/A N/A N/A N/A N/A "$15,943.49 " "$12,455.85 " N/A N/A N/A N/A "$12,829.53 " N/A N/A "$17,438.20 " "$47,688.12 " "$12,455.85 " "$16,815.40 " "$15,320.70 " N/A "$12,829.53 " N/A N/A N/A N/A N/A "$12,455.85 " "$41,879.58 " "$25,534.50 " "$12,455.85 " "$12,455.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,455.85 " "$12,455.85 " "$14,324.23 " "$12,455.85 " N/A "$11,833.06 " "$47,688.12 " 330104 344 4 Osteomyelitis septic arthritis & other musculoskeletal infections I N/A "$23,691.16 " N/A "$23,691.16 " N/A N/A N/A N/A "$22,506.60 " N/A "$22,743.51 " N/A N/A N/A N/A N/A "$30,324.68 " "$23,691.16 " N/A N/A N/A N/A "$24,401.89 " N/A N/A "$33,167.62 " "$91,793.07 " "$23,691.16 " "$31,983.06 " "$29,140.12 " N/A "$24,401.89 " N/A N/A N/A N/A N/A "$23,691.16 " "$80,612.44 " "$48,566.87 " "$23,691.16 " "$23,691.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,691.16 " "$23,691.16 " "$27,244.83 " "$23,691.16 " N/A "$22,506.60 " "$91,793.07 " 330104 346 1 Connective tissue disorders I N/A "$5,290.58 " N/A "$5,290.58 " N/A N/A N/A N/A "$5,026.05 " N/A "$5,078.95 " N/A N/A N/A N/A N/A "$6,771.94 " "$5,290.58 " N/A N/A N/A N/A "$5,449.29 " N/A N/A "$7,406.81 " "$19,560.31 " "$5,290.58 " "$7,142.28 " "$6,507.41 " N/A "$5,449.29 " N/A N/A N/A N/A N/A "$5,290.58 " "$17,177.81 " "$10,845.68 " "$5,290.58 " "$5,290.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,290.58 " "$5,290.58 " "$6,084.16 " "$5,290.58 " N/A "$5,026.05 " "$19,560.31 " 330104 346 2 Connective tissue disorders I N/A "$6,862.05 " N/A "$6,862.05 " N/A N/A N/A N/A "$6,518.94 " N/A "$6,587.56 " N/A N/A N/A N/A N/A "$8,783.42 " "$6,862.05 " N/A N/A N/A N/A "$7,067.91 " N/A N/A "$9,606.86 " "$25,729.23 " "$6,862.05 " "$9,263.76 " "$8,440.32 " N/A "$7,067.91 " N/A N/A N/A N/A N/A "$6,862.05 " "$22,595.34 " "$14,067.19 " "$6,862.05 " "$6,862.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,862.05 " "$6,862.05 " "$7,891.35 " "$6,862.05 " N/A "$6,518.94 " "$25,729.23 " 330104 346 3 Connective tissue disorders I N/A "$11,635.04 " N/A "$11,635.04 " N/A N/A N/A N/A "$11,053.29 " N/A "$11,169.64 " N/A N/A N/A N/A N/A "$14,892.85 " "$11,635.04 " N/A N/A N/A N/A "$11,984.09 " N/A N/A "$16,289.05 " "$44,465.95 " "$11,635.04 " "$15,707.30 " "$14,311.10 " N/A "$11,984.09 " N/A N/A N/A N/A N/A "$11,635.04 " "$39,049.88 " "$23,851.83 " "$11,635.04 " "$11,635.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,635.04 " "$11,635.04 " "$13,380.29 " "$11,635.04 " N/A "$11,053.29 " "$44,465.95 " 330104 346 4 Connective tissue disorders I N/A "$33,511.66 " N/A "$33,511.66 " N/A N/A N/A N/A "$31,836.07 " N/A "$32,171.19 " N/A N/A N/A N/A N/A "$42,894.92 " "$33,511.66 " N/A N/A N/A N/A "$34,517.01 " N/A N/A "$46,916.32 " "$130,344.13 " "$33,511.66 " "$45,240.73 " "$41,219.34 " N/A "$34,517.01 " N/A N/A N/A N/A N/A "$33,511.66 " "$114,467.88 " "$68,698.89 " "$33,511.66 " "$33,511.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$33,511.66 " "$33,511.66 " "$38,538.40 " "$33,511.66 " N/A "$31,836.07 " "$130,344.13 " 330104 347 1 Other back & neck disorders fractures & injuries I N/A "$4,048.11 " N/A "$4,048.11 " N/A N/A N/A N/A "$3,845.71 " N/A "$3,886.19 " N/A N/A N/A N/A N/A "$5,181.58 " "$4,048.11 " N/A N/A N/A N/A "$4,169.56 " N/A N/A "$5,667.36 " "$14,682.93 " "$4,048.11 " "$5,464.95 " "$4,979.18 " N/A "$4,169.56 " N/A N/A N/A N/A N/A "$4,048.11 " "$12,894.52 " "$8,298.63 " "$4,048.11 " "$4,048.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,048.11 " "$4,048.11 " "$4,655.33 " "$4,048.11 " N/A "$3,845.71 " "$14,682.93 " 330104 347 2 Other back & neck disorders fractures & injuries I N/A "$5,380.49 " N/A "$5,380.49 " N/A N/A N/A N/A "$5,111.47 " N/A "$5,165.27 " N/A N/A N/A N/A N/A "$6,887.03 " "$5,380.49 " N/A N/A N/A N/A "$5,541.90 " N/A N/A "$7,532.69 " "$19,913.28 " "$5,380.49 " "$7,263.66 " "$6,618.00 " N/A "$5,541.90 " N/A N/A N/A N/A N/A "$5,380.49 " "$17,487.79 " "$11,030.00 " "$5,380.49 " "$5,380.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,380.49 " "$5,380.49 " "$6,187.56 " "$5,380.49 " N/A "$5,111.47 " "$19,913.28 " 330104 347 3 Other back & neck disorders fractures & injuries I N/A "$7,962.14 " N/A "$7,962.14 " N/A N/A N/A N/A "$7,564.04 " N/A "$7,643.66 " N/A N/A N/A N/A N/A "$10,191.54 " "$7,962.14 " N/A N/A N/A N/A "$8,201.01 " N/A N/A "$11,147.00 " "$30,047.74 " "$7,962.14 " "$10,748.89 " "$9,793.44 " N/A "$8,201.01 " N/A N/A N/A N/A N/A "$7,962.14 " "$26,387.85 " "$16,322.39 " "$7,962.14 " "$7,962.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,962.14 " "$7,962.14 " "$9,156.46 " "$7,962.14 " N/A "$7,564.04 " "$30,047.74 " 330104 347 4 Other back & neck disorders fractures & injuries I N/A "$21,800.89 " N/A "$21,800.89 " N/A N/A N/A N/A "$20,710.85 " N/A "$20,928.86 " N/A N/A N/A N/A N/A "$27,905.15 " "$21,800.89 " N/A N/A N/A N/A "$22,454.92 " N/A N/A "$30,521.25 " "$84,372.72 " "$21,800.89 " "$29,431.21 " "$26,815.10 " N/A "$22,454.92 " N/A N/A N/A N/A N/A "$21,800.89 " "$74,095.91 " "$44,691.83 " "$21,800.89 " "$21,800.89 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,800.89 " "$21,800.89 " "$25,071.03 " "$21,800.89 " N/A "$20,710.85 " "$84,372.72 " 330104 349 1 Malfunction reaction complic of orthopedic device or procedure I N/A "$4,012.69 " N/A "$4,012.69 " N/A N/A N/A N/A "$3,812.06 " N/A "$3,852.18 " N/A N/A N/A N/A N/A "$5,136.24 " "$4,012.69 " N/A N/A N/A N/A "$4,133.07 " N/A N/A "$5,617.77 " "$14,543.89 " "$4,012.69 " "$5,417.13 " "$4,935.61 " N/A "$4,133.07 " N/A N/A N/A N/A N/A "$4,012.69 " "$12,772.40 " "$8,226.02 " "$4,012.69 " "$4,012.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,012.69 " "$4,012.69 " "$4,614.59 " "$4,012.69 " N/A "$3,812.06 " "$14,543.89 " 330104 349 2 Malfunction reaction complic of orthopedic device or procedure I N/A "$6,296.67 " N/A "$6,296.67 " N/A N/A N/A N/A "$5,981.84 " N/A "$6,044.80 " N/A N/A N/A N/A N/A "$8,059.74 " "$6,296.67 " N/A N/A N/A N/A "$6,485.57 " N/A N/A "$8,815.34 " "$23,509.81 " "$6,296.67 " "$8,500.51 " "$7,744.90 " N/A "$6,485.57 " N/A N/A N/A N/A N/A "$6,296.67 " "$20,646.25 " "$12,908.17 " "$6,296.67 " "$6,296.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,296.67 " "$6,296.67 " "$7,241.17 " "$6,296.67 " N/A "$5,981.84 " "$23,509.81 " 330104 349 3 Malfunction reaction complic of orthopedic device or procedure I N/A "$10,920.49 " N/A "$10,920.49 " N/A N/A N/A N/A "$10,374.46 " N/A "$10,483.67 " N/A N/A N/A N/A N/A "$13,978.22 " "$10,920.49 " N/A N/A N/A N/A "$11,248.10 " N/A N/A "$15,288.68 " "$41,660.92 " "$10,920.49 " "$14,742.66 " "$13,432.20 " N/A "$11,248.10 " N/A N/A N/A N/A N/A "$10,920.49 " "$36,586.51 " "$22,387.00 " "$10,920.49 " "$10,920.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,920.49 " "$10,920.49 " "$12,558.56 " "$10,920.49 " N/A "$10,374.46 " "$41,660.92 " 330104 349 4 Malfunction reaction complic of orthopedic device or procedure I N/A "$24,635.26 " N/A "$24,635.26 " N/A N/A N/A N/A "$23,403.50 " N/A "$23,649.85 " N/A N/A N/A N/A N/A "$31,533.14 " "$24,635.26 " N/A N/A N/A N/A "$25,374.32 " N/A N/A "$34,489.37 " "$95,499.24 " "$24,635.26 " "$33,257.61 " "$30,301.37 " N/A "$25,374.32 " N/A N/A N/A N/A N/A "$24,635.26 " "$83,867.19 " "$50,502.29 " "$24,635.26 " "$24,635.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,635.26 " "$24,635.26 " "$28,330.55 " "$24,635.26 " N/A "$23,403.50 " "$95,499.24 " 330104 351 1 Other musculoskeletal system & connective tissue diagnoses I N/A "$3,651.67 " N/A "$3,651.67 " N/A N/A N/A N/A "$3,469.08 " N/A "$3,505.60 " N/A N/A N/A N/A N/A "$4,674.14 " "$3,651.67 " N/A N/A N/A N/A "$3,761.22 " N/A N/A "$5,112.34 " "$13,126.67 " "$3,651.67 " "$4,929.75 " "$4,491.55 " N/A "$3,761.22 " N/A N/A N/A N/A N/A "$3,651.67 " "$11,527.80 " "$7,485.92 " "$3,651.67 " "$3,651.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,651.67 " "$3,651.67 " "$4,199.42 " "$3,651.67 " N/A "$3,469.08 " "$13,126.67 " 330104 351 2 Other musculoskeletal system & connective tissue diagnoses I N/A "$4,659.13 " N/A "$4,659.13 " N/A N/A N/A N/A "$4,426.17 " N/A "$4,472.76 " N/A N/A N/A N/A N/A "$5,963.68 " "$4,659.13 " N/A N/A N/A N/A "$4,798.90 " N/A N/A "$6,522.78 " "$17,081.51 " "$4,659.13 " "$6,289.82 " "$5,730.72 " N/A "$4,798.90 " N/A N/A N/A N/A N/A "$4,659.13 " "$15,000.94 " "$9,551.21 " "$4,659.13 " "$4,659.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,659.13 " "$4,659.13 " "$5,357.99 " "$4,659.13 " N/A "$4,426.17 " "$17,081.51 " 330104 351 3 Other musculoskeletal system & connective tissue diagnoses I N/A "$8,173.31 " N/A "$8,173.31 " N/A N/A N/A N/A "$7,764.64 " N/A "$7,846.38 " N/A N/A N/A N/A N/A "$10,461.83 " "$8,173.31 " N/A N/A N/A N/A "$8,418.51 " N/A N/A "$11,442.63 " "$30,876.68 " "$8,173.31 " "$11,033.97 " "$10,053.17 " N/A "$8,418.51 " N/A N/A N/A N/A N/A "$8,173.31 " "$27,115.82 " "$16,755.28 " "$8,173.31 " "$8,173.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,173.31 " "$8,173.31 " "$9,399.30 " "$8,173.31 " N/A "$7,764.64 " "$30,876.68 " 330104 351 4 Other musculoskeletal system & connective tissue diagnoses I N/A "$21,291.38 " N/A "$21,291.38 " N/A N/A N/A N/A "$20,226.81 " N/A "$20,439.72 " N/A N/A N/A N/A N/A "$27,252.96 " "$21,291.38 " N/A N/A N/A N/A "$21,930.12 " N/A N/A "$29,807.93 " "$82,372.57 " "$21,291.38 " "$28,743.36 " "$26,188.39 " N/A "$21,930.12 " N/A N/A N/A N/A N/A "$21,291.38 " "$72,339.38 " "$43,647.32 " "$21,291.38 " "$21,291.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,291.38 " "$21,291.38 " "$24,485.08 " "$21,291.38 " N/A "$20,226.81 " "$82,372.57 " 330104 361 1 Skin graft for skin & subcutaneous tissue diagnoses I N/A "$9,342.20 " N/A "$9,342.20 " N/A N/A N/A N/A "$8,875.09 " N/A "$8,968.52 " N/A N/A N/A N/A N/A "$11,958.02 " "$9,342.20 " N/A N/A N/A N/A "$9,622.47 " N/A N/A "$13,079.09 " "$35,465.26 " "$9,342.20 " "$12,611.98 " "$11,490.91 " N/A "$9,622.47 " N/A N/A N/A N/A N/A "$9,342.20 " "$31,145.50 " "$19,151.52 " "$9,342.20 " "$9,342.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,342.20 " "$9,342.20 " "$10,743.53 " "$9,342.20 " N/A "$8,875.09 " "$35,465.26 " 330104 361 2 Skin graft for skin & subcutaneous tissue diagnoses I N/A "$13,099.57 " N/A "$13,099.57 " N/A N/A N/A N/A "$12,444.59 " N/A "$12,575.58 " N/A N/A N/A N/A N/A "$16,767.44 " "$13,099.57 " N/A N/A N/A N/A "$13,492.55 " N/A N/A "$18,339.39 " "$50,215.05 " "$13,099.57 " "$17,684.41 " "$16,112.47 " N/A "$13,492.55 " N/A N/A N/A N/A N/A "$13,099.57 " "$44,098.73 " "$26,854.11 " "$13,099.57 " "$13,099.57 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,099.57 " "$13,099.57 " "$15,064.50 " "$13,099.57 " N/A "$12,444.59 " "$50,215.05 " 330104 361 3 Skin graft for skin & subcutaneous tissue diagnoses I N/A "$23,057.66 " N/A "$23,057.66 " N/A N/A N/A N/A "$21,904.78 " N/A "$22,135.36 " N/A N/A N/A N/A N/A "$29,513.81 " "$23,057.66 " N/A N/A N/A N/A "$23,749.39 " N/A N/A "$32,280.73 " "$89,306.25 " "$23,057.66 " "$31,127.84 " "$28,360.93 " N/A "$23,749.39 " N/A N/A N/A N/A N/A "$23,057.66 " "$78,428.52 " "$47,268.21 " "$23,057.66 " "$23,057.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,057.66 " "$23,057.66 " "$26,516.31 " "$23,057.66 " N/A "$21,904.78 " "$89,306.25 " 330104 361 4 Skin graft for skin & subcutaneous tissue diagnoses I N/A "$65,703.99 " N/A "$65,703.99 " N/A N/A N/A N/A "$62,418.79 " N/A "$63,075.83 " N/A N/A N/A N/A N/A "$84,101.10 " "$65,703.99 " N/A N/A N/A N/A "$67,675.11 " N/A N/A "$91,985.58 " "$256,717.37 " "$65,703.99 " "$88,700.38 " "$80,815.90 " N/A "$67,675.11 " N/A N/A N/A N/A N/A "$65,703.99 " "$225,448.54 " "$134,693.17 " "$65,703.99 " "$65,703.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$65,703.99 " "$65,703.99 " "$75,559.58 " "$65,703.99 " N/A "$62,418.79 " "$256,717.37 " 330104 362 1 Mastectomy procedures I N/A "$9,596.96 " N/A "$9,596.96 " N/A N/A N/A N/A "$9,117.12 " N/A "$9,213.08 " N/A N/A N/A N/A N/A "$12,284.11 " "$9,596.96 " N/A N/A N/A N/A "$9,884.87 " N/A N/A "$13,435.75 " "$36,465.34 " "$9,596.96 " "$12,955.90 " "$11,804.27 " N/A "$9,884.87 " N/A N/A N/A N/A N/A "$9,596.96 " "$32,023.77 " "$19,673.78 " "$9,596.96 " "$9,596.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,596.96 " "$9,596.96 " "$11,036.51 " "$9,596.96 " N/A "$9,117.12 " "$36,465.34 " 330104 362 2 Mastectomy procedures I N/A "$12,605.03 " N/A "$12,605.03 " N/A N/A N/A N/A "$11,974.78 " N/A "$12,100.83 " N/A N/A N/A N/A N/A "$16,134.44 " "$12,605.03 " N/A N/A N/A N/A "$12,983.18 " N/A N/A "$17,647.05 " "$48,273.72 " "$12,605.03 " "$17,016.79 " "$15,504.19 " N/A "$12,983.18 " N/A N/A N/A N/A N/A "$12,605.03 " "$42,393.86 " "$25,840.32 " "$12,605.03 " "$12,605.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,605.03 " "$12,605.03 " "$14,495.79 " "$12,605.03 " N/A "$11,974.78 " "$48,273.72 " 330104 362 3 Mastectomy procedures I N/A "$19,232.87 " N/A "$19,232.87 " N/A N/A N/A N/A "$18,271.22 " N/A "$18,463.55 " N/A N/A N/A N/A N/A "$24,618.07 " "$19,232.87 " N/A N/A N/A N/A "$19,809.85 " N/A N/A "$26,926.01 " "$74,291.74 " "$19,232.87 " "$25,964.37 " "$23,656.42 " N/A "$19,809.85 " N/A N/A N/A N/A N/A "$19,232.87 " "$65,242.82 " "$39,427.37 " "$19,232.87 " "$19,232.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,232.87 " "$19,232.87 " "$22,117.79 " "$19,232.87 " N/A "$18,271.22 " "$74,291.74 " 330104 362 4 Mastectomy procedures I N/A "$20,087.06 " N/A "$20,087.06 " N/A N/A N/A N/A "$19,082.71 " N/A "$19,283.58 " N/A N/A N/A N/A N/A "$25,711.43 " "$20,087.06 " N/A N/A N/A N/A "$20,689.67 " N/A N/A "$28,121.88 " "$77,644.94 " "$20,087.06 " "$27,117.53 " "$24,707.08 " N/A "$20,689.67 " N/A N/A N/A N/A N/A "$20,087.06 " "$68,187.59 " "$41,178.47 " "$20,087.06 " "$20,087.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,087.06 " "$20,087.06 " "$23,100.12 " "$20,087.06 " N/A "$19,082.71 " "$77,644.94 " 330104 363 1 Breast procedures except mastectomy I N/A "$6,474.46 " N/A "$6,474.46 " N/A N/A N/A N/A "$6,150.73 " N/A "$6,215.48 " N/A N/A N/A N/A N/A "$8,287.31 " "$6,474.46 " N/A N/A N/A N/A "$6,668.69 " N/A N/A "$9,064.24 " "$24,207.72 " "$6,474.46 " "$8,740.52 " "$7,963.58 " N/A "$6,668.69 " N/A N/A N/A N/A N/A "$6,474.46 " "$21,259.16 " "$13,272.64 " "$6,474.46 " "$6,474.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,474.46 " "$6,474.46 " "$7,445.63 " "$6,474.46 " N/A "$6,150.73 " "$24,207.72 " 330104 363 2 Breast procedures except mastectomy I N/A "$10,650.74 " N/A "$10,650.74 " N/A N/A N/A N/A "$10,118.20 " N/A "$10,224.71 " N/A N/A N/A N/A N/A "$13,632.95 " "$10,650.74 " N/A N/A N/A N/A "$10,970.26 " N/A N/A "$14,911.04 " "$40,602.02 " "$10,650.74 " "$14,378.50 " "$13,100.41 " N/A "$10,970.26 " N/A N/A N/A N/A N/A "$10,650.74 " "$35,656.59 " "$21,834.02 " "$10,650.74 " "$10,650.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,650.74 " "$10,650.74 " "$12,248.35 " "$10,650.74 " N/A "$10,118.20 " "$40,602.02 " 330104 363 3 Breast procedures except mastectomy I N/A "$15,942.79 " N/A "$15,942.79 " N/A N/A N/A N/A "$15,145.65 " N/A "$15,305.08 " N/A N/A N/A N/A N/A "$20,406.77 " "$15,942.79 " N/A N/A N/A N/A "$16,421.07 " N/A N/A "$22,319.91 " "$61,376.32 " "$15,942.79 " "$21,522.77 " "$19,609.63 " N/A "$16,421.07 " N/A N/A N/A N/A N/A "$15,942.79 " "$53,900.53 " "$32,682.72 " "$15,942.79 " "$15,942.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,942.79 " "$15,942.79 " "$18,334.21 " "$15,942.79 " N/A "$15,145.65 " "$61,376.32 " 330104 363 4 Breast procedures except mastectomy I N/A "$16,385.55 " N/A "$16,385.55 " N/A N/A N/A N/A "$15,566.28 " N/A "$15,730.13 " N/A N/A N/A N/A N/A "$20,973.51 " "$16,385.55 " N/A N/A N/A N/A "$16,877.12 " N/A N/A "$22,939.77 " "$63,114.42 " "$16,385.55 " "$22,120.50 " "$20,154.23 " N/A "$16,877.12 " N/A N/A N/A N/A N/A "$16,385.55 " "$55,426.92 " "$33,590.38 " "$16,385.55 " "$16,385.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,385.55 " "$16,385.55 " "$18,843.39 " "$16,385.55 " N/A "$15,566.28 " "$63,114.42 " 330104 364 1 Other skin subcutaneous tissue & related procedures I N/A "$5,549.42 " N/A "$5,549.42 " N/A N/A N/A N/A "$5,271.95 " N/A "$5,327.44 " N/A N/A N/A N/A N/A "$7,103.26 " "$5,549.42 " N/A N/A N/A N/A "$5,715.90 " N/A N/A "$7,769.19 " "$20,576.43 " "$5,549.42 " "$7,491.72 " "$6,825.79 " N/A "$5,715.90 " N/A N/A N/A N/A N/A "$5,549.42 " "$18,070.17 " "$11,376.31 " "$5,549.42 " "$5,549.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,549.42 " "$5,549.42 " "$6,381.83 " "$5,549.42 " N/A "$5,271.95 " "$20,576.43 " 330104 364 2 Other skin subcutaneous tissue & related procedures I N/A "$7,867.46 " N/A "$7,867.46 " N/A N/A N/A N/A "$7,474.09 " N/A "$7,552.76 " N/A N/A N/A N/A N/A "$10,070.35 " "$7,867.46 " N/A N/A N/A N/A "$8,103.48 " N/A N/A "$11,014.44 " "$29,676.05 " "$7,867.46 " "$10,621.07 " "$9,676.98 " N/A "$8,103.48 " N/A N/A N/A N/A N/A "$7,867.46 " "$26,061.43 " "$16,128.29 " "$7,867.46 " "$7,867.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,867.46 " "$7,867.46 " "$9,047.58 " "$7,867.46 " N/A "$7,474.09 " "$29,676.05 " 330104 364 3 Other skin subcutaneous tissue & related procedures I N/A "$14,088.63 " N/A "$14,088.63 " N/A N/A N/A N/A "$13,384.20 " N/A "$13,525.09 " N/A N/A N/A N/A N/A "$18,033.45 " "$14,088.63 " N/A N/A N/A N/A "$14,511.29 " N/A N/A "$19,724.08 " "$54,097.69 " "$14,088.63 " "$19,019.65 " "$17,329.02 " N/A "$14,511.29 " N/A N/A N/A N/A N/A "$14,088.63 " "$47,508.46 " "$28,881.69 " "$14,088.63 " "$14,088.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,088.63 " "$14,088.63 " "$16,201.93 " "$14,088.63 " N/A "$13,384.20 " "$54,097.69 " 330104 364 4 Other skin subcutaneous tissue & related procedures I N/A "$36,473.40 " N/A "$36,473.40 " N/A N/A N/A N/A "$34,649.73 " N/A "$35,014.47 " N/A N/A N/A N/A N/A "$46,685.96 " "$36,473.40 " N/A N/A N/A N/A "$37,567.61 " N/A N/A "$51,062.77 " "$141,970.68 " "$36,473.40 " "$49,239.10 " "$44,862.29 " N/A "$37,567.61 " N/A N/A N/A N/A N/A "$36,473.40 " "$124,678.29 " "$74,770.48 " "$36,473.40 " "$36,473.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$36,473.40 " "$36,473.40 " "$41,944.41 " "$36,473.40 " N/A "$34,649.73 " "$141,970.68 " 330104 380 1 Skin ulcers I N/A "$4,984.05 " N/A "$4,984.05 " N/A N/A N/A N/A "$4,734.84 " N/A "$4,784.68 " N/A N/A N/A N/A N/A "$6,379.58 " "$4,984.05 " N/A N/A N/A N/A "$5,133.57 " N/A N/A "$6,977.66 " "$18,357.01 " "$4,984.05 " "$6,728.46 " "$6,130.38 " N/A "$5,133.57 " N/A N/A N/A N/A N/A "$4,984.05 " "$16,121.08 " "$10,217.30 " "$4,984.05 " "$4,984.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,984.05 " "$4,984.05 " "$5,731.65 " "$4,984.05 " N/A "$4,734.84 " "$18,357.01 " 330104 380 2 Skin ulcers I N/A "$5,990.82 " N/A "$5,990.82 " N/A N/A N/A N/A "$5,691.28 " N/A "$5,751.19 " N/A N/A N/A N/A N/A "$7,668.25 " "$5,990.82 " N/A N/A N/A N/A "$6,170.55 " N/A N/A "$8,387.15 " "$22,309.18 " "$5,990.82 " "$8,087.61 " "$7,368.71 " N/A "$6,170.55 " N/A N/A N/A N/A N/A "$5,990.82 " "$19,591.87 " "$12,281.19 " "$5,990.82 " "$5,990.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,990.82 " "$5,990.82 " "$6,889.45 " "$5,990.82 " N/A "$5,691.28 " "$22,309.18 " 330104 380 3 Skin ulcers I N/A "$9,148.07 " N/A "$9,148.07 " N/A N/A N/A N/A "$8,690.67 " N/A "$8,782.15 " N/A N/A N/A N/A N/A "$11,709.53 " "$9,148.07 " N/A N/A N/A N/A "$9,422.51 " N/A N/A "$12,807.30 " "$34,703.17 " "$9,148.07 " "$12,349.89 " "$11,252.13 " N/A "$9,422.51 " N/A N/A N/A N/A N/A "$9,148.07 " "$30,476.24 " "$18,753.54 " "$9,148.07 " "$9,148.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,148.07 " "$9,148.07 " "$10,520.28 " "$9,148.07 " N/A "$8,690.67 " "$34,703.17 " 330104 380 4 Skin ulcers I N/A "$17,284.70 " N/A "$17,284.70 " N/A N/A N/A N/A "$16,420.47 " N/A "$16,593.32 " N/A N/A N/A N/A N/A "$22,124.42 " "$17,284.70 " N/A N/A N/A N/A "$17,803.25 " N/A N/A "$24,198.59 " "$66,644.10 " "$17,284.70 " "$23,334.35 " "$21,260.19 " N/A "$17,803.25 " N/A N/A N/A N/A N/A "$17,284.70 " "$58,526.68 " "$35,433.64 " "$17,284.70 " "$17,284.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,284.70 " "$17,284.70 " "$19,877.41 " "$17,284.70 " N/A "$16,420.47 " "$66,644.10 " 330104 381 1 Major skin disorders I N/A "$4,357.37 " N/A "$4,357.37 " N/A N/A N/A N/A "$4,139.50 " N/A "$4,183.07 " N/A N/A N/A N/A N/A "$5,577.43 " "$4,357.37 " N/A N/A N/A N/A "$4,488.09 " N/A N/A "$6,100.31 " "$15,896.93 " "$4,357.37 " "$5,882.44 " "$5,359.56 " N/A "$4,488.09 " N/A N/A N/A N/A N/A "$4,357.37 " "$13,960.64 " "$8,932.60 " "$4,357.37 " "$4,357.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,357.37 " "$4,357.37 " "$5,010.97 " "$4,357.37 " N/A "$4,139.50 " "$15,896.93 " 330104 381 2 Major skin disorders I N/A "$6,306.21 " N/A "$6,306.21 " N/A N/A N/A N/A "$5,990.90 " N/A "$6,053.96 " N/A N/A N/A N/A N/A "$8,071.95 " "$6,306.21 " N/A N/A N/A N/A "$6,495.39 " N/A N/A "$8,828.69 " "$23,547.24 " "$6,306.21 " "$8,513.38 " "$7,756.63 " N/A "$6,495.39 " N/A N/A N/A N/A N/A "$6,306.21 " "$20,679.13 " "$12,927.72 " "$6,306.21 " "$6,306.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,306.21 " "$6,306.21 " "$7,252.14 " "$6,306.21 " N/A "$5,990.90 " "$23,547.24 " 330104 381 3 Major skin disorders I N/A "$13,434.70 " N/A "$13,434.70 " N/A N/A N/A N/A "$12,762.97 " N/A "$12,897.32 " N/A N/A N/A N/A N/A "$17,196.42 " "$13,434.70 " N/A N/A N/A N/A "$13,837.74 " N/A N/A "$18,808.58 " "$51,530.65 " "$13,434.70 " "$18,136.85 " "$16,524.69 " N/A "$13,837.74 " N/A N/A N/A N/A N/A "$13,434.70 " "$45,254.09 " "$27,541.14 " "$13,434.70 " "$13,434.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,434.70 " "$13,434.70 " "$15,449.91 " "$13,434.70 " N/A "$12,762.97 " "$51,530.65 " 330104 381 4 Major skin disorders I N/A "$40,516.18 " N/A "$40,516.18 " N/A N/A N/A N/A "$38,490.37 " N/A "$38,895.53 " N/A N/A N/A N/A N/A "$51,860.71 " "$40,516.18 " N/A N/A N/A N/A "$41,731.66 " N/A N/A "$56,722.65 " "$157,840.87 " "$40,516.18 " "$54,696.84 " "$49,834.90 " N/A "$41,731.66 " N/A N/A N/A N/A N/A "$40,516.18 " "$138,615.45 " "$83,058.16 " "$40,516.18 " "$40,516.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$40,516.18 " "$40,516.18 " "$46,593.60 " "$40,516.18 " N/A "$38,490.37 " "$157,840.87 " 330104 382 1 Malignant breast disorders I N/A "$4,548.09 " N/A "$4,548.09 " N/A N/A N/A N/A "$4,320.69 " N/A "$4,366.17 " N/A N/A N/A N/A N/A "$5,821.56 " "$4,548.09 " N/A N/A N/A N/A "$4,684.54 " N/A N/A "$6,367.33 " "$16,645.65 " "$4,548.09 " "$6,139.93 " "$5,594.16 " N/A "$4,684.54 " N/A N/A N/A N/A N/A "$4,548.09 " "$14,618.17 " "$9,323.59 " "$4,548.09 " "$4,548.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,548.09 " "$4,548.09 " "$5,230.31 " "$4,548.09 " N/A "$4,320.69 " "$16,645.65 " 330104 382 2 Malignant breast disorders I N/A "$5,984.69 " N/A "$5,984.69 " N/A N/A N/A N/A "$5,685.46 " N/A "$5,745.30 " N/A N/A N/A N/A N/A "$7,660.41 " "$5,984.69 " N/A N/A N/A N/A "$6,164.23 " N/A N/A "$8,378.57 " "$22,285.12 " "$5,984.69 " "$8,079.33 " "$7,361.17 " N/A "$6,164.23 " N/A N/A N/A N/A N/A "$5,984.69 " "$19,570.73 " "$12,268.62 " "$5,984.69 " "$5,984.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,984.69 " "$5,984.69 " "$6,882.40 " "$5,984.69 " N/A "$5,685.46 " "$22,285.12 " 330104 382 3 Malignant breast disorders I N/A "$10,566.96 " N/A "$10,566.96 " N/A N/A N/A N/A "$10,038.61 " N/A "$10,144.28 " N/A N/A N/A N/A N/A "$13,525.70 " "$10,566.96 " N/A N/A N/A N/A "$10,883.97 " N/A N/A "$14,793.74 " "$40,273.11 " "$10,566.96 " "$14,265.39 " "$12,997.36 " N/A "$10,883.97 " N/A N/A N/A N/A N/A "$10,566.96 " "$35,367.75 " "$21,662.26 " "$10,566.96 " "$10,566.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,566.96 " "$10,566.96 " "$12,152.00 " "$10,566.96 " N/A "$10,038.61 " "$40,273.11 " 330104 382 4 Malignant breast disorders I N/A "$20,018.94 " N/A "$20,018.94 " N/A N/A N/A N/A "$19,017.99 " N/A "$19,218.18 " N/A N/A N/A N/A N/A "$25,624.24 " "$20,018.94 " N/A N/A N/A N/A "$20,619.51 " N/A N/A "$28,026.52 " "$77,377.54 " "$20,018.94 " "$27,025.57 " "$24,623.30 " N/A "$20,619.51 " N/A N/A N/A N/A N/A "$20,018.94 " "$67,952.76 " "$41,038.83 " "$20,018.94 " "$20,018.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,018.94 " "$20,018.94 " "$23,021.78 " "$20,018.94 " N/A "$19,017.99 " "$77,377.54 " 330104 383 1 Cellulitis & other skin infections I N/A "$3,748.39 " N/A "$3,748.39 " N/A N/A N/A N/A "$3,560.98 " N/A "$3,598.46 " N/A N/A N/A N/A N/A "$4,797.95 " "$3,748.39 " N/A N/A N/A N/A "$3,860.85 " N/A N/A "$5,247.75 " "$13,506.37 " "$3,748.39 " "$5,060.33 " "$4,610.53 " N/A "$3,860.85 " N/A N/A N/A N/A N/A "$3,748.39 " "$11,861.26 " "$7,684.21 " "$3,748.39 " "$3,748.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,748.39 " "$3,748.39 " "$4,310.65 " "$3,748.39 " N/A "$3,560.98 " "$13,506.37 " 330104 383 2 Cellulitis & other skin infections I N/A "$4,968.38 " N/A "$4,968.38 " N/A N/A N/A N/A "$4,719.96 " N/A "$4,769.64 " N/A N/A N/A N/A N/A "$6,359.53 " "$4,968.38 " N/A N/A N/A N/A "$5,117.43 " N/A N/A "$6,955.73 " "$18,295.51 " "$4,968.38 " "$6,707.31 " "$6,111.11 " N/A "$5,117.43 " N/A N/A N/A N/A N/A "$4,968.38 " "$16,067.07 " "$10,185.18 " "$4,968.38 " "$4,968.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,968.38 " "$4,968.38 " "$5,713.64 " "$4,968.38 " N/A "$4,719.96 " "$18,295.51 " 330104 383 3 Cellulitis & other skin infections I N/A "$8,358.59 " N/A "$8,358.59 " N/A N/A N/A N/A "$7,940.66 " N/A "$8,024.24 " N/A N/A N/A N/A N/A "$10,698.99 " "$8,358.59 " N/A N/A N/A N/A "$8,609.34 " N/A N/A "$11,702.02 " "$31,604.01 " "$8,358.59 " "$11,284.09 " "$10,281.06 " N/A "$8,609.34 " N/A N/A N/A N/A N/A "$8,358.59 " "$27,754.56 " "$17,135.10 " "$8,358.59 " "$8,358.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,358.59 " "$8,358.59 " "$9,612.38 " "$8,358.59 " N/A "$7,940.66 " "$31,604.01 " 330104 383 4 Cellulitis & other skin infections I N/A "$19,337.08 " N/A "$19,337.08 " N/A N/A N/A N/A "$18,370.23 " N/A "$18,563.60 " N/A N/A N/A N/A N/A "$24,751.47 " "$19,337.08 " N/A N/A N/A N/A "$19,917.20 " N/A N/A "$27,071.92 " "$74,700.86 " "$19,337.08 " "$26,105.06 " "$23,784.61 " N/A "$19,917.20 " N/A N/A N/A N/A N/A "$19,337.08 " "$65,602.11 " "$39,641.02 " "$19,337.08 " "$19,337.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,337.08 " "$19,337.08 " "$22,237.65 " "$19,337.08 " N/A "$18,370.23 " "$74,700.86 " 330104 384 1 Contusion open wound & other trauma to skin & subcutaneous tissue I N/A "$3,119.67 " N/A "$3,119.67 " N/A N/A N/A N/A "$2,963.69 " N/A "$2,994.88 " N/A N/A N/A N/A N/A "$3,993.18 " "$3,119.67 " N/A N/A N/A N/A "$3,213.26 " N/A N/A "$4,367.54 " "$11,038.27 " "$3,119.67 " "$4,211.56 " "$3,837.19 " N/A "$3,213.26 " N/A N/A N/A N/A N/A "$3,119.67 " "$9,693.78 " "$6,395.32 " "$3,119.67 " "$3,119.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,119.67 " "$3,119.67 " "$3,587.62 " "$3,119.67 " N/A "$2,963.69 " "$11,038.27 " 330104 384 2 Contusion open wound & other trauma to skin & subcutaneous tissue I N/A "$4,253.15 " N/A "$4,253.15 " N/A N/A N/A N/A "$4,040.49 " N/A "$4,083.02 " N/A N/A N/A N/A N/A "$5,444.03 " "$4,253.15 " N/A N/A N/A N/A "$4,380.74 " N/A N/A "$5,954.40 " "$15,487.81 " "$4,253.15 " "$5,741.75 " "$5,231.37 " N/A "$4,380.74 " N/A N/A N/A N/A N/A "$4,253.15 " "$13,601.35 " "$8,718.95 " "$4,253.15 " "$4,253.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,253.15 " "$4,253.15 " "$4,891.12 " "$4,253.15 " N/A "$4,040.49 " "$15,487.81 " 330104 384 3 Contusion open wound & other trauma to skin & subcutaneous tissue I N/A "$7,209.45 " N/A "$7,209.45 " N/A N/A N/A N/A "$6,848.97 " N/A "$6,921.07 " N/A N/A N/A N/A N/A "$9,228.09 " "$7,209.45 " N/A N/A N/A N/A "$7,425.73 " N/A N/A "$10,093.22 " "$27,092.97 " "$7,209.45 " "$9,732.75 " "$8,867.62 " N/A "$7,425.73 " N/A N/A N/A N/A N/A "$7,209.45 " "$23,792.98 " "$14,779.36 " "$7,209.45 " "$7,209.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,209.45 " "$7,209.45 " "$8,290.86 " "$7,209.45 " N/A "$6,848.97 " "$27,092.97 " 330104 384 4 Contusion open wound & other trauma to skin & subcutaneous tissue I N/A "$12,839.36 " N/A "$12,839.36 " N/A N/A N/A N/A "$12,197.39 " N/A "$12,325.78 " N/A N/A N/A N/A N/A "$16,434.38 " "$12,839.36 " N/A N/A N/A N/A "$13,224.54 " N/A N/A "$17,975.10 " "$49,193.58 " "$12,839.36 " "$17,333.13 " "$15,792.41 " N/A "$13,224.54 " N/A N/A N/A N/A N/A "$12,839.36 " "$43,201.68 " "$26,320.68 " "$12,839.36 " "$12,839.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,839.36 " "$12,839.36 " "$14,765.26 " "$12,839.36 " N/A "$12,197.39 " "$49,193.58 " 330104 385 1 Other skin subcutaneous tissue & breast disorders I N/A "$3,572.65 " N/A "$3,572.65 " N/A N/A N/A N/A "$3,394.02 " N/A "$3,429.75 " N/A N/A N/A N/A N/A "$4,572.99 " "$3,572.65 " N/A N/A N/A N/A "$3,679.83 " N/A N/A "$5,001.71 " "$12,816.48 " "$3,572.65 " "$4,823.08 " "$4,394.36 " N/A "$3,679.83 " N/A N/A N/A N/A N/A "$3,572.65 " "$11,255.40 " "$7,323.94 " "$3,572.65 " "$3,572.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,572.65 " "$3,572.65 " "$4,108.55 " "$3,572.65 " N/A "$3,394.02 " "$12,816.48 " 330104 385 2 Other skin subcutaneous tissue & breast disorders I N/A "$4,774.93 " N/A "$4,774.93 " N/A N/A N/A N/A "$4,536.18 " N/A "$4,583.93 " N/A N/A N/A N/A N/A "$6,111.90 " "$4,774.93 " N/A N/A N/A N/A "$4,918.17 " N/A N/A "$6,684.90 " "$17,536.09 " "$4,774.93 " "$6,446.15 " "$5,873.16 " N/A "$4,918.17 " N/A N/A N/A N/A N/A "$4,774.93 " "$15,400.15 " "$9,788.60 " "$4,774.93 " "$4,774.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,774.93 " "$4,774.93 " "$5,491.16 " "$4,774.93 " N/A "$4,536.18 " "$17,536.09 " 330104 385 3 Other skin subcutaneous tissue & breast disorders I N/A "$7,684.91 " N/A "$7,684.91 " N/A N/A N/A N/A "$7,300.66 " N/A "$7,377.51 " N/A N/A N/A N/A N/A "$9,836.68 " "$7,684.91 " N/A N/A N/A N/A "$7,915.45 " N/A N/A "$10,758.87 " "$28,959.42 " "$7,684.91 " "$10,374.62 " "$9,452.43 " N/A "$7,915.45 " N/A N/A N/A N/A N/A "$7,684.91 " "$25,432.09 " "$15,754.06 " "$7,684.91 " "$7,684.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,684.91 " "$7,684.91 " "$8,837.64 " "$7,684.91 " N/A "$7,300.66 " "$28,959.42 " 330104 385 4 Other skin subcutaneous tissue & breast disorders I N/A "$20,025.75 " N/A "$20,025.75 " N/A N/A N/A N/A "$19,024.47 " N/A "$19,224.72 " N/A N/A N/A N/A N/A "$25,632.96 " "$20,025.75 " N/A N/A N/A N/A "$20,626.53 " N/A N/A "$28,036.05 " "$77,404.28 " "$20,025.75 " "$27,034.77 " "$24,631.68 " N/A "$20,626.53 " N/A N/A N/A N/A N/A "$20,025.75 " "$67,976.24 " "$41,052.79 " "$20,025.75 " "$20,025.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,025.75 " "$20,025.75 " "$23,029.62 " "$20,025.75 " N/A "$19,024.47 " "$77,404.28 " 330104 401 1 Pituitary & adrenal procedures I N/A "$8,734.60 " N/A "$8,734.60 " N/A N/A N/A N/A "$8,297.87 " N/A "$8,385.21 " N/A N/A N/A N/A N/A "$11,180.28 " "$8,734.60 " N/A N/A N/A N/A "$8,996.63 " N/A N/A "$12,228.43 " "$33,080.05 " "$8,734.60 " "$11,791.70 " "$10,743.55 " N/A "$8,996.63 " N/A N/A N/A N/A N/A "$8,734.60 " "$29,050.82 " "$17,905.92 " "$8,734.60 " "$8,734.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,734.60 " "$8,734.60 " "$10,044.79 " "$8,734.60 " N/A "$8,297.87 " "$33,080.05 " 330104 401 2 Pituitary & adrenal procedures I N/A "$11,838.71 " N/A "$11,838.71 " N/A N/A N/A N/A "$11,246.77 " N/A "$11,365.16 " N/A N/A N/A N/A N/A "$15,153.55 " "$11,838.71 " N/A N/A N/A N/A "$12,193.87 " N/A N/A "$16,574.19 " "$45,265.47 " "$11,838.71 " "$15,982.26 " "$14,561.61 " N/A "$12,193.87 " N/A N/A N/A N/A N/A "$11,838.71 " "$39,752.02 " "$24,269.36 " "$11,838.71 " "$11,838.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,838.71 " "$11,838.71 " "$13,614.52 " "$11,838.71 " N/A "$11,246.77 " "$45,265.47 " 330104 401 3 Pituitary & adrenal procedures I N/A "$21,416.71 " N/A "$21,416.71 " N/A N/A N/A N/A "$20,345.88 " N/A "$20,560.04 " N/A N/A N/A N/A N/A "$27,413.39 " "$21,416.71 " N/A N/A N/A N/A "$22,059.21 " N/A N/A "$29,983.40 " "$82,864.59 " "$21,416.71 " "$28,912.56 " "$26,342.56 " N/A "$22,059.21 " N/A N/A N/A N/A N/A "$21,416.71 " "$72,771.47 " "$43,904.26 " "$21,416.71 " "$21,416.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,416.71 " "$21,416.71 " "$24,629.22 " "$21,416.71 " N/A "$20,345.88 " "$82,864.59 " 330104 401 4 Pituitary & adrenal procedures I N/A "$47,906.25 " N/A "$47,906.25 " N/A N/A N/A N/A "$45,510.93 " N/A "$45,990.00 " N/A N/A N/A N/A N/A "$61,319.99 " "$47,906.25 " N/A N/A N/A N/A "$49,343.43 " N/A N/A "$67,068.74 " "$186,851.10 " "$47,906.25 " "$64,673.43 " "$58,924.68 " N/A "$49,343.43 " N/A N/A N/A N/A N/A "$47,906.25 " "$164,092.16 " "$98,207.80 " "$47,906.25 " "$47,906.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$47,906.25 " "$47,906.25 " "$55,092.18 " "$47,906.25 " N/A "$45,510.93 " "$186,851.10 " 330104 403 1 Procedures for obesity I N/A "$8,073.17 " N/A "$8,073.17 " N/A N/A N/A N/A "$7,669.52 " N/A "$7,750.25 " N/A N/A N/A N/A N/A "$10,333.66 " "$8,073.17 " N/A N/A N/A N/A "$8,315.37 " N/A N/A "$11,302.44 " "$30,483.60 " "$8,073.17 " "$10,898.79 " "$9,930.01 " N/A "$8,315.37 " N/A N/A N/A N/A N/A "$8,073.17 " "$26,770.62 " "$16,550.01 " "$8,073.17 " "$8,073.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,073.17 " "$8,073.17 " "$9,284.15 " "$8,073.17 " N/A "$7,669.52 " "$30,483.60 " 330104 403 2 Procedures for obesity I N/A "$9,037.72 " N/A "$9,037.72 " N/A N/A N/A N/A "$8,585.83 " N/A "$8,676.21 " N/A N/A N/A N/A N/A "$11,568.28 " "$9,037.72 " N/A N/A N/A N/A "$9,308.85 " N/A N/A "$12,652.81 " "$34,269.98 " "$9,037.72 " "$12,200.92 " "$11,116.39 " N/A "$9,308.85 " N/A N/A N/A N/A N/A "$9,037.72 " "$30,095.81 " "$18,527.32 " "$9,037.72 " "$9,037.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,037.72 " "$9,037.72 " "$10,393.38 " "$9,037.72 " N/A "$8,585.83 " "$34,269.98 " 330104 403 3 Procedures for obesity I N/A "$14,616.54 " N/A "$14,616.54 " N/A N/A N/A N/A "$13,885.71 " N/A "$14,031.88 " N/A N/A N/A N/A N/A "$18,709.17 " "$14,616.54 " N/A N/A N/A N/A "$15,055.04 " N/A N/A "$20,463.16 " "$56,170.04 " "$14,616.54 " "$19,732.33 " "$17,978.35 " N/A "$15,055.04 " N/A N/A N/A N/A N/A "$14,616.54 " "$49,328.39 " "$29,963.91 " "$14,616.54 " "$14,616.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,616.54 " "$14,616.54 " "$16,809.02 " "$14,616.54 " N/A "$13,885.71 " "$56,170.04 " 330104 403 4 Procedures for obesity I N/A "$45,106.62 " N/A "$45,106.62 " N/A N/A N/A N/A "$42,851.29 " N/A "$43,302.35 " N/A N/A N/A N/A N/A "$57,736.47 " "$45,106.62 " N/A N/A N/A N/A "$46,459.81 " N/A N/A "$63,149.26 " "$175,860.96 " "$45,106.62 " "$60,893.93 " "$55,481.14 " N/A "$46,459.81 " N/A N/A N/A N/A N/A "$45,106.62 " "$154,440.65 " "$92,468.56 " "$45,106.62 " "$45,106.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$45,106.62 " "$45,106.62 " "$51,872.61 " "$45,106.62 " N/A "$42,851.29 " "$175,860.96 " 330104 404 1 Thyroid parathyroid & thyroglossal procedures I N/A "$4,860.75 " N/A "$4,860.75 " N/A N/A N/A N/A "$4,617.72 " N/A "$4,666.32 " N/A N/A N/A N/A N/A "$6,221.76 " "$4,860.75 " N/A N/A N/A N/A "$5,006.58 " N/A N/A "$6,805.06 " "$17,873.02 " "$4,860.75 " "$6,562.02 " "$5,978.73 " N/A "$5,006.58 " N/A N/A N/A N/A N/A "$4,860.75 " "$15,696.04 " "$9,964.55 " "$4,860.75 " "$4,860.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,860.75 " "$4,860.75 " "$5,589.87 " "$4,860.75 " N/A "$4,617.72 " "$17,873.02 " 330104 404 2 Thyroid parathyroid & thyroglossal procedures I N/A "$6,221.74 " N/A "$6,221.74 " N/A N/A N/A N/A "$5,910.65 " N/A "$5,972.87 " N/A N/A N/A N/A N/A "$7,963.83 " "$6,221.74 " N/A N/A N/A N/A "$6,408.39 " N/A N/A "$8,710.44 " "$23,215.67 " "$6,221.74 " "$8,399.35 " "$7,652.74 " N/A "$6,408.39 " N/A N/A N/A N/A N/A "$6,221.74 " "$20,387.94 " "$12,754.57 " "$6,221.74 " "$6,221.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,221.74 " "$6,221.74 " "$7,155.00 " "$6,221.74 " N/A "$5,910.65 " "$23,215.67 " 330104 404 3 Thyroid parathyroid & thyroglossal procedures I N/A "$15,494.58 " N/A "$15,494.58 " N/A N/A N/A N/A "$14,719.85 " N/A "$14,874.79 " N/A N/A N/A N/A N/A "$19,833.06 " "$15,494.58 " N/A N/A N/A N/A "$15,959.41 " N/A N/A "$21,692.41 " "$59,616.83 " "$15,494.58 " "$20,917.68 " "$19,058.33 " N/A "$15,959.41 " N/A N/A N/A N/A N/A "$15,494.58 " "$52,355.35 " "$31,763.88 " "$15,494.58 " "$15,494.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,494.58 " "$15,494.58 " "$17,818.76 " "$15,494.58 " N/A "$14,719.85 " "$59,616.83 " 330104 404 4 Thyroid parathyroid & thyroglossal procedures I N/A "$18,472.67 " N/A "$18,472.67 " N/A N/A N/A N/A "$17,549.04 " N/A "$17,733.77 " N/A N/A N/A N/A N/A "$23,645.02 " "$18,472.67 " N/A N/A N/A N/A "$19,026.85 " N/A N/A "$25,861.74 " "$71,307.56 " "$18,472.67 " "$24,938.11 " "$22,721.39 " N/A "$19,026.85 " N/A N/A N/A N/A N/A "$18,472.67 " "$62,622.12 " "$37,868.98 " "$18,472.67 " "$18,472.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,472.67 " "$18,472.67 " "$21,243.57 " "$18,472.67 " N/A "$17,549.04 " "$71,307.56 " 330104 405 1 Other procedures for endocrine nutritional & metabolic disorders I N/A "$8,248.92 " N/A "$8,248.92 " N/A N/A N/A N/A "$7,836.47 " N/A "$7,918.96 " N/A N/A N/A N/A N/A "$10,558.62 " "$8,248.92 " N/A N/A N/A N/A "$8,496.39 " N/A N/A "$11,548.49 " "$31,173.49 " "$8,248.92 " "$11,136.04 " "$10,146.17 " N/A "$8,496.39 " N/A N/A N/A N/A N/A "$8,248.92 " "$27,376.48 " "$16,910.28 " "$8,248.92 " "$8,248.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,248.92 " "$8,248.92 " "$9,486.26 " "$8,248.92 " N/A "$7,836.47 " "$31,173.49 " 330104 405 2 Other procedures for endocrine nutritional & metabolic disorders I N/A "$11,844.16 " N/A "$11,844.16 " N/A N/A N/A N/A "$11,251.95 " N/A "$11,370.39 " N/A N/A N/A N/A N/A "$15,160.52 " "$11,844.16 " N/A N/A N/A N/A "$12,199.48 " N/A N/A "$16,581.82 " "$45,286.86 " "$11,844.16 " "$15,989.62 " "$14,568.32 " N/A "$12,199.48 " N/A N/A N/A N/A N/A "$11,844.16 " "$39,770.81 " "$24,280.53 " "$11,844.16 " "$11,844.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,844.16 " "$11,844.16 " "$13,620.78 " "$11,844.16 " N/A "$11,251.95 " "$45,286.86 " 330104 405 3 Other procedures for endocrine nutritional & metabolic disorders I N/A "$20,369.06 " N/A "$20,369.06 " N/A N/A N/A N/A "$19,350.61 " N/A "$19,554.30 " N/A N/A N/A N/A N/A "$26,072.40 " "$20,369.06 " N/A N/A N/A N/A "$20,980.14 " N/A N/A "$28,516.69 " "$78,751.97 " "$20,369.06 " "$27,498.24 " "$25,053.95 " N/A "$20,980.14 " N/A N/A N/A N/A N/A "$20,369.06 " "$69,159.78 " "$41,756.58 " "$20,369.06 " "$20,369.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,369.06 " "$20,369.06 " "$23,424.42 " "$20,369.06 " N/A "$19,350.61 " "$78,751.97 " 330104 405 4 Other procedures for endocrine nutritional & metabolic disorders I N/A "$57,445.42 " N/A "$57,445.42 " N/A N/A N/A N/A "$54,573.15 " N/A "$55,147.60 " N/A N/A N/A N/A N/A "$73,530.14 " "$57,445.42 " N/A N/A N/A N/A "$59,168.78 " N/A N/A "$80,423.59 " "$224,297.79 " "$57,445.42 " "$77,551.32 " "$70,657.87 " N/A "$59,168.78 " N/A N/A N/A N/A N/A "$57,445.42 " "$196,977.75 " "$117,763.11 " "$57,445.42 " "$57,445.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$57,445.42 " "$57,445.42 " "$66,062.23 " "$57,445.42 " N/A "$54,573.15 " "$224,297.79 " 330104 420 1 Diabetes I N/A "$3,411.21 " N/A "$3,411.21 " N/A N/A N/A N/A "$3,240.65 " N/A "$3,274.76 " N/A N/A N/A N/A N/A "$4,366.35 " "$3,411.21 " N/A N/A N/A N/A "$3,513.55 " N/A N/A "$4,775.70 " "$12,182.74 " "$3,411.21 " "$4,605.14 " "$4,195.79 " N/A "$3,513.55 " N/A N/A N/A N/A N/A "$3,411.21 " "$10,698.85 " "$6,992.99 " "$3,411.21 " "$3,411.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,411.21 " "$3,411.21 " "$3,922.90 " "$3,411.21 " N/A "$3,240.65 " "$12,182.74 " 330104 420 2 Diabetes I N/A "$4,606.68 " N/A "$4,606.68 " N/A N/A N/A N/A "$4,376.34 " N/A "$4,422.41 " N/A N/A N/A N/A N/A "$5,896.54 " "$4,606.68 " N/A N/A N/A N/A "$4,744.88 " N/A N/A "$6,449.35 " "$16,875.61 " "$4,606.68 " "$6,219.01 " "$5,666.21 " N/A "$4,744.88 " N/A N/A N/A N/A N/A "$4,606.68 " "$14,820.12 " "$9,443.68 " "$4,606.68 " "$4,606.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,606.68 " "$4,606.68 " "$5,297.68 " "$4,606.68 " N/A "$4,376.34 " "$16,875.61 " 330104 420 3 Diabetes I N/A "$6,964.90 " N/A "$6,964.90 " N/A N/A N/A N/A "$6,616.66 " N/A "$6,686.31 " N/A N/A N/A N/A N/A "$8,915.08 " "$6,964.90 " N/A N/A N/A N/A "$7,173.85 " N/A N/A "$9,750.86 " "$26,133.00 " "$6,964.90 " "$9,402.62 " "$8,566.83 " N/A "$7,173.85 " N/A N/A N/A N/A N/A "$6,964.90 " "$22,949.94 " "$14,278.05 " "$6,964.90 " "$6,964.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,964.90 " "$6,964.90 " "$8,009.64 " "$6,964.90 " N/A "$6,616.66 " "$26,133.00 " 330104 420 4 Diabetes I N/A "$17,609.62 " N/A "$17,609.62 " N/A N/A N/A N/A "$16,729.14 " N/A "$16,905.24 " N/A N/A N/A N/A N/A "$22,540.32 " "$17,609.62 " N/A N/A N/A N/A "$18,137.91 " N/A N/A "$24,653.47 " "$67,919.60 " "$17,609.62 " "$23,772.99 " "$21,659.84 " N/A "$18,137.91 " N/A N/A N/A N/A N/A "$17,609.62 " "$59,646.82 " "$36,099.73 " "$17,609.62 " "$17,609.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,609.62 " "$17,609.62 " "$20,251.07 " "$17,609.62 " N/A "$16,729.14 " "$67,919.60 " 330104 421 1 Malnutrition failure to thrive & other nutritional disorders I N/A "$4,565.12 " N/A "$4,565.12 " N/A N/A N/A N/A "$4,336.87 " N/A "$4,382.52 " N/A N/A N/A N/A N/A "$5,843.36 " "$4,565.12 " N/A N/A N/A N/A "$4,702.08 " N/A N/A "$6,391.17 " "$16,712.50 " "$4,565.12 " "$6,162.92 " "$5,615.10 " N/A "$4,702.08 " N/A N/A N/A N/A N/A "$4,565.12 " "$14,676.88 " "$9,358.50 " "$4,565.12 " "$4,565.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,565.12 " "$4,565.12 " "$5,249.89 " "$4,565.12 " N/A "$4,336.87 " "$16,712.50 " 330104 421 2 Malnutrition failure to thrive & other nutritional disorders I N/A "$6,528.95 " N/A "$6,528.95 " N/A N/A N/A N/A "$6,202.50 " N/A "$6,267.79 " N/A N/A N/A N/A N/A "$8,357.06 " "$6,528.95 " N/A N/A N/A N/A "$6,724.82 " N/A N/A "$9,140.53 " "$24,421.64 " "$6,528.95 " "$8,814.08 " "$8,030.61 " N/A "$6,724.82 " N/A N/A N/A N/A N/A "$6,528.95 " "$21,447.02 " "$13,384.35 " "$6,528.95 " "$6,528.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,528.95 " "$6,528.95 " "$7,508.29 " "$6,528.95 " N/A "$6,202.50 " "$24,421.64 " 330104 421 3 Malnutrition failure to thrive & other nutritional disorders I N/A "$9,759.76 " N/A "$9,759.76 " N/A N/A N/A N/A "$9,271.78 " N/A "$9,369.37 " N/A N/A N/A N/A N/A "$12,492.50 " "$9,759.76 " N/A N/A N/A N/A "$10,052.56 " N/A N/A "$13,663.67 " "$37,104.42 " "$9,759.76 " "$13,175.68 " "$12,004.51 " N/A "$10,052.56 " N/A N/A N/A N/A N/A "$9,759.76 " "$32,585.01 " "$20,007.52 " "$9,759.76 " "$9,759.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,759.76 " "$9,759.76 " "$11,223.73 " "$9,759.76 " N/A "$9,271.78 " "$37,104.42 " 330104 421 4 Malnutrition failure to thrive & other nutritional disorders I N/A "$22,114.24 " N/A "$22,114.24 " N/A N/A N/A N/A "$21,008.52 " N/A "$21,229.67 " N/A N/A N/A N/A N/A "$28,306.22 " "$22,114.24 " N/A N/A N/A N/A "$22,777.66 " N/A N/A "$30,959.93 " "$85,602.76 " "$22,114.24 " "$29,854.22 " "$27,200.51 " N/A "$22,777.66 " N/A N/A N/A N/A N/A "$22,114.24 " "$75,176.13 " "$45,334.18 " "$22,114.24 " "$22,114.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,114.24 " "$22,114.24 " "$25,431.37 " "$22,114.24 " N/A "$21,008.52 " "$85,602.76 " 330104 422 1 Hypovolemia & related electrolyte disorders I N/A "$2,883.30 " N/A "$2,883.30 " N/A N/A N/A N/A "$2,739.14 " N/A "$2,767.97 " N/A N/A N/A N/A N/A "$3,690.63 " "$2,883.30 " N/A N/A N/A N/A "$2,969.80 " N/A N/A "$4,036.62 " "$10,110.39 " "$2,883.30 " "$3,892.46 " "$3,546.46 " N/A "$2,969.80 " N/A N/A N/A N/A N/A "$2,883.30 " "$8,878.92 " "$5,910.77 " "$2,883.30 " "$2,883.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,883.30 " "$2,883.30 " "$3,315.80 " "$2,883.30 " N/A "$2,739.14 " "$10,110.39 " 330104 422 2 Hypovolemia & related electrolyte disorders I N/A "$3,890.76 " N/A "$3,890.76 " N/A N/A N/A N/A "$3,696.22 " N/A "$3,735.13 " N/A N/A N/A N/A N/A "$4,980.17 " "$3,890.76 " N/A N/A N/A N/A "$4,007.48 " N/A N/A "$5,447.06 " "$14,065.24 " "$3,890.76 " "$5,252.53 " "$4,785.64 " N/A "$4,007.48 " N/A N/A N/A N/A N/A "$3,890.76 " "$12,352.06 " "$7,976.06 " "$3,890.76 " "$3,890.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,890.76 " "$3,890.76 " "$4,474.37 " "$3,890.76 " N/A "$3,696.22 " "$14,065.24 " 330104 422 3 Hypovolemia & related electrolyte disorders I N/A "$6,451.98 " N/A "$6,451.98 " N/A N/A N/A N/A "$6,129.38 " N/A "$6,193.90 " N/A N/A N/A N/A N/A "$8,258.53 " "$6,451.98 " N/A N/A N/A N/A "$6,645.54 " N/A N/A "$9,032.77 " "$24,119.48 " "$6,451.98 " "$8,710.17 " "$7,935.93 " N/A "$6,645.54 " N/A N/A N/A N/A N/A "$6,451.98 " "$21,181.67 " "$13,226.56 " "$6,451.98 " "$6,451.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,451.98 " "$6,451.98 " "$7,419.78 " "$6,451.98 " N/A "$6,129.38 " "$24,119.48 " 330104 422 4 Hypovolemia & related electrolyte disorders I N/A "$15,772.50 " N/A "$15,772.50 " N/A N/A N/A N/A "$14,983.87 " N/A "$15,141.60 " N/A N/A N/A N/A N/A "$20,188.79 " "$15,772.50 " N/A N/A N/A N/A "$16,245.67 " N/A N/A "$22,081.49 " "$60,707.82 " "$15,772.50 " "$21,292.87 " "$19,400.17 " N/A "$16,245.67 " N/A N/A N/A N/A N/A "$15,772.50 " "$53,313.45 " "$32,333.62 " "$15,772.50 " "$15,772.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,772.50 " "$15,772.50 " "$18,138.37 " "$15,772.50 " N/A "$14,983.87 " "$60,707.82 " 330104 423 1 Inborn errors of metabolism I N/A "$4,492.92 " N/A "$4,492.92 " N/A N/A N/A N/A "$4,268.27 " N/A "$4,313.20 " N/A N/A N/A N/A N/A "$5,750.94 " "$4,492.92 " N/A N/A N/A N/A "$4,627.71 " N/A N/A "$6,290.09 " "$16,429.06 " "$4,492.92 " "$6,065.44 " "$5,526.29 " N/A "$4,627.71 " N/A N/A N/A N/A N/A "$4,492.92 " "$14,427.96 " "$9,210.48 " "$4,492.92 " "$4,492.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,492.92 " "$4,492.92 " "$5,166.86 " "$4,492.92 " N/A "$4,268.27 " "$16,429.06 " 330104 423 2 Inborn errors of metabolism I N/A "$7,196.50 " N/A "$7,196.50 " N/A N/A N/A N/A "$6,836.68 " N/A "$6,908.64 " N/A N/A N/A N/A N/A "$9,211.52 " "$7,196.50 " N/A N/A N/A N/A "$7,412.40 " N/A N/A "$10,075.10 " "$27,042.16 " "$7,196.50 " "$9,715.28 " "$8,851.70 " N/A "$7,412.40 " N/A N/A N/A N/A N/A "$7,196.50 " "$23,748.36 " "$14,752.83 " "$7,196.50 " "$7,196.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,196.50 " "$7,196.50 " "$8,275.98 " "$7,196.50 " N/A "$6,836.68 " "$27,042.16 " 330104 423 3 Inborn errors of metabolism I N/A "$11,205.22 " N/A "$11,205.22 " N/A N/A N/A N/A "$10,644.96 " N/A "$10,757.01 " N/A N/A N/A N/A N/A "$14,342.68 " "$11,205.22 " N/A N/A N/A N/A "$11,541.37 " N/A N/A "$15,687.30 " "$42,778.65 " "$11,205.22 " "$15,127.04 " "$13,782.42 " N/A "$11,541.37 " N/A N/A N/A N/A N/A "$11,205.22 " "$37,568.10 " "$22,970.70 " "$11,205.22 " "$11,205.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,205.22 " "$11,205.22 " "$12,886.00 " "$11,205.22 " N/A "$10,644.96 " "$42,778.65 " 330104 423 4 Inborn errors of metabolism I N/A "$37,352.12 " N/A "$37,352.12 " N/A N/A N/A N/A "$35,484.51 " N/A "$35,858.04 " N/A N/A N/A N/A N/A "$47,810.71 " "$37,352.12 " N/A N/A N/A N/A "$38,472.68 " N/A N/A "$52,292.97 " "$145,420.14 " "$37,352.12 " "$50,425.36 " "$45,943.11 " N/A "$38,472.68 " N/A N/A N/A N/A N/A "$37,352.12 " "$127,707.60 " "$76,571.85 " "$37,352.12 " "$37,352.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$37,352.12 " "$37,352.12 " "$42,954.94 " "$37,352.12 " N/A "$35,484.51 " "$145,420.14 " 330104 424 1 Other endocrine disorders I N/A "$3,706.16 " N/A "$3,706.16 " N/A N/A N/A N/A "$3,520.85 " N/A "$3,557.92 " N/A N/A N/A N/A N/A "$4,743.89 " "$3,706.16 " N/A N/A N/A N/A "$3,817.35 " N/A N/A "$5,188.63 " "$13,340.59 " "$3,706.16 " "$5,003.32 " "$4,558.58 " N/A "$3,817.35 " N/A N/A N/A N/A N/A "$3,706.16 " "$11,715.67 " "$7,597.63 " "$3,706.16 " "$3,706.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,706.16 " "$3,706.16 " "$4,262.09 " "$3,706.16 " N/A "$3,520.85 " "$13,340.59 " 330104 424 2 Other endocrine disorders I N/A "$5,480.62 " N/A "$5,480.62 " N/A N/A N/A N/A "$5,206.59 " N/A "$5,261.40 " N/A N/A N/A N/A N/A "$7,015.20 " "$5,480.62 " N/A N/A N/A N/A "$5,645.04 " N/A N/A "$7,672.87 " "$20,306.36 " "$5,480.62 " "$7,398.84 " "$6,741.17 " N/A "$5,645.04 " N/A N/A N/A N/A N/A "$5,480.62 " "$17,832.99 " "$11,235.28 " "$5,480.62 " "$5,480.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,480.62 " "$5,480.62 " "$6,302.72 " "$5,480.62 " N/A "$5,206.59 " "$20,306.36 " 330104 424 3 Other endocrine disorders I N/A "$8,381.75 " N/A "$8,381.75 " N/A N/A N/A N/A "$7,962.66 " N/A "$8,046.48 " N/A N/A N/A N/A N/A "$10,728.64 " "$8,381.75 " N/A N/A N/A N/A "$8,633.20 " N/A N/A "$11,734.45 " "$31,694.92 " "$8,381.75 " "$11,315.36 " "$10,309.55 " N/A "$8,633.20 " N/A N/A N/A N/A N/A "$8,381.75 " "$27,834.40 " "$17,182.58 " "$8,381.75 " "$8,381.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,381.75 " "$8,381.75 " "$9,639.01 " "$8,381.75 " N/A "$7,962.66 " "$31,694.92 " 330104 424 4 Other endocrine disorders I N/A "$19,265.56 " N/A "$19,265.56 " N/A N/A N/A N/A "$18,302.28 " N/A "$18,494.94 " N/A N/A N/A N/A N/A "$24,659.92 " "$19,265.56 " N/A N/A N/A N/A "$19,843.53 " N/A N/A "$26,971.79 " "$74,420.09 " "$19,265.56 " "$26,008.51 " "$23,696.64 " N/A "$19,843.53 " N/A N/A N/A N/A N/A "$19,265.56 " "$65,355.54 " "$39,494.40 " "$19,265.56 " "$19,265.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,265.56 " "$19,265.56 " "$22,155.40 " "$19,265.56 " N/A "$18,302.28 " "$74,420.09 " 330104 425 1 Electrolyte disorders except hypovolemia related I N/A "$3,242.28 " N/A "$3,242.28 " N/A N/A N/A N/A "$3,080.17 " N/A "$3,112.59 " N/A N/A N/A N/A N/A "$4,150.12 " "$3,242.28 " N/A N/A N/A N/A "$3,339.55 " N/A N/A "$4,539.19 " "$11,519.59 " "$3,242.28 " "$4,377.08 " "$3,988.01 " N/A "$3,339.55 " N/A N/A N/A N/A N/A "$3,242.28 " "$10,116.48 " "$6,646.68 " "$3,242.28 " "$3,242.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,242.28 " "$3,242.28 " "$3,728.62 " "$3,242.28 " N/A "$3,080.17 " "$11,519.59 " 330104 425 2 Electrolyte disorders except hypovolemia related I N/A "$4,400.28 " N/A "$4,400.28 " N/A N/A N/A N/A "$4,180.27 " N/A "$4,224.27 " N/A N/A N/A N/A N/A "$5,632.36 " "$4,400.28 " N/A N/A N/A N/A "$4,532.29 " N/A N/A "$6,160.39 " "$16,065.39 " "$4,400.28 " "$5,940.38 " "$5,412.34 " N/A "$4,532.29 " N/A N/A N/A N/A N/A "$4,400.28 " "$14,108.59 " "$9,020.57 " "$4,400.28 " "$4,400.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,400.28 " "$4,400.28 " "$5,060.32 " "$4,400.28 " N/A "$4,180.27 " "$16,065.39 " 330104 425 3 Electrolyte disorders except hypovolemia related I N/A "$7,108.63 " N/A "$7,108.63 " N/A N/A N/A N/A "$6,753.20 " N/A "$6,824.29 " N/A N/A N/A N/A N/A "$9,099.05 " "$7,108.63 " N/A N/A N/A N/A "$7,321.89 " N/A N/A "$9,952.08 " "$26,697.22 " "$7,108.63 " "$9,596.65 " "$8,743.62 " N/A "$7,321.89 " N/A N/A N/A N/A N/A "$7,108.63 " "$23,445.43 " "$14,572.69 " "$7,108.63 " "$7,108.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,108.63 " "$7,108.63 " "$8,174.93 " "$7,108.63 " N/A "$6,753.20 " "$26,697.22 " 330104 425 4 Electrolyte disorders except hypovolemia related I N/A "$17,275.85 " N/A "$17,275.85 " N/A N/A N/A N/A "$16,412.06 " N/A "$16,584.82 " N/A N/A N/A N/A N/A "$22,113.09 " "$17,275.85 " N/A N/A N/A N/A "$17,794.12 " N/A N/A "$24,186.19 " "$66,609.34 " "$17,275.85 " "$23,322.40 " "$21,249.29 " N/A "$17,794.12 " N/A N/A N/A N/A N/A "$17,275.85 " "$58,496.15 " "$35,415.49 " "$17,275.85 " "$17,275.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,275.85 " "$17,275.85 " "$19,867.23 " "$17,275.85 " N/A "$16,412.06 " "$66,609.34 " 330104 440 1 Kidney transplant I N/A "$25,552.13 " N/A "$25,552.13 " N/A N/A N/A N/A "$24,274.52 " N/A "$24,530.04 " N/A N/A N/A N/A N/A "$32,706.72 " "$25,552.13 " N/A N/A N/A N/A "$26,318.69 " N/A N/A "$35,772.98 " "$99,098.44 " "$25,552.13 " "$34,495.37 " "$31,429.11 " N/A "$26,318.69 " N/A N/A N/A N/A N/A "$25,552.13 " "$87,028.00 " "$52,381.86 " "$25,552.13 " "$25,552.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,552.13 " "$25,552.13 " "$29,384.94 " "$25,552.13 " N/A "$24,274.52 " "$99,098.44 " 330104 440 2 Kidney transplant I N/A "$31,951.08 " N/A "$31,951.08 " N/A N/A N/A N/A "$30,353.53 " N/A "$30,673.04 " N/A N/A N/A N/A N/A "$40,897.39 " "$31,951.08 " N/A N/A N/A N/A "$32,909.62 " N/A N/A "$44,731.52 " "$124,218.00 " "$31,951.08 " "$43,133.96 " "$39,299.83 " N/A "$32,909.62 " N/A N/A N/A N/A N/A "$31,951.08 " "$109,087.93 " "$65,499.72 " "$31,951.08 " "$31,951.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$31,951.08 " "$31,951.08 " "$36,743.75 " "$31,951.08 " N/A "$30,353.53 " "$124,218.00 " 330104 440 3 Kidney transplant I N/A "$38,946.75 " N/A "$38,946.75 " N/A N/A N/A N/A "$36,999.41 " N/A "$37,388.88 " N/A N/A N/A N/A N/A "$49,851.84 " "$38,946.75 " N/A N/A N/A N/A "$40,115.15 " N/A N/A "$54,525.45 " "$151,679.98 " "$38,946.75 " "$52,578.11 " "$47,904.50 " N/A "$40,115.15 " N/A N/A N/A N/A N/A "$38,946.75 " "$133,204.97 " "$79,840.84 " "$38,946.75 " "$38,946.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$38,946.75 " "$38,946.75 " "$44,788.76 " "$38,946.75 " N/A "$36,999.41 " "$151,679.98 " 330104 440 4 Kidney transplant I N/A "$71,041.67 " N/A "$71,041.67 " N/A N/A N/A N/A "$67,489.59 " N/A "$68,200.01 " N/A N/A N/A N/A N/A "$90,933.34 " "$71,041.67 " N/A N/A N/A N/A "$73,172.92 " N/A N/A "$99,458.34 " "$277,670.83 " "$71,041.67 " "$95,906.26 " "$87,381.26 " N/A "$73,172.92 " N/A N/A N/A N/A N/A "$71,041.67 " "$243,849.82 " "$145,635.43 " "$71,041.67 " "$71,041.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$71,041.67 " "$71,041.67 " "$81,697.92 " "$71,041.67 " N/A "$67,489.59 " "$277,670.83 " 330104 441 1 Major bladder procedures I N/A "$9,029.54 " N/A "$9,029.54 " N/A N/A N/A N/A "$8,578.07 " N/A "$8,668.36 " N/A N/A N/A N/A N/A "$11,557.82 " "$9,029.54 " N/A N/A N/A N/A "$9,300.43 " N/A N/A "$12,641.36 " "$34,237.90 " "$9,029.54 " "$12,189.89 " "$11,106.34 " N/A "$9,300.43 " N/A N/A N/A N/A N/A "$9,029.54 " "$30,067.63 " "$18,510.57 " "$9,029.54 " "$9,029.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,029.54 " "$9,029.54 " "$10,383.98 " "$9,029.54 " N/A "$8,578.07 " "$34,237.90 " 330104 441 2 Major bladder procedures I N/A "$15,472.78 " N/A "$15,472.78 " N/A N/A N/A N/A "$14,699.14 " N/A "$14,853.87 " N/A N/A N/A N/A N/A "$19,805.16 " "$15,472.78 " N/A N/A N/A N/A "$15,936.96 " N/A N/A "$21,661.89 " "$59,531.26 " "$15,472.78 " "$20,888.25 " "$19,031.52 " N/A "$15,936.96 " N/A N/A N/A N/A N/A "$15,472.78 " "$52,280.20 " "$31,719.20 " "$15,472.78 " "$15,472.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,472.78 " "$15,472.78 " "$17,793.70 " "$15,472.78 " N/A "$14,699.14 " "$59,531.26 " 330104 441 3 Major bladder procedures I N/A "$21,749.13 " N/A "$21,749.13 " N/A N/A N/A N/A "$20,661.67 " N/A "$20,879.16 " N/A N/A N/A N/A N/A "$27,838.88 " "$21,749.13 " N/A N/A N/A N/A "$22,401.60 " N/A N/A "$30,448.78 " "$84,169.50 " "$21,749.13 " "$29,361.32 " "$26,751.42 " N/A "$22,401.60 " N/A N/A N/A N/A N/A "$21,749.13 " "$73,917.44 " "$44,585.71 " "$21,749.13 " "$21,749.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,749.13 " "$21,749.13 " "$25,011.49 " "$21,749.13 " N/A "$20,661.67 " "$84,169.50 " 330104 441 4 Major bladder procedures I N/A "$46,377.69 " N/A "$46,377.69 " N/A N/A N/A N/A "$44,058.80 " N/A "$44,522.58 " N/A N/A N/A N/A N/A "$59,363.44 " "$46,377.69 " N/A N/A N/A N/A "$47,769.02 " N/A N/A "$64,928.76 " "$180,850.64 " "$46,377.69 " "$62,609.88 " "$57,044.56 " N/A "$47,769.02 " N/A N/A N/A N/A N/A "$46,377.69 " "$158,822.57 " "$95,074.26 " "$46,377.69 " "$46,377.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$46,377.69 " "$46,377.69 " "$53,334.34 " "$46,377.69 " N/A "$44,058.80 " "$180,850.64 " 330104 442 1 Kidney & urinary tract procedures for malignancy I N/A "$9,122.18 " N/A "$9,122.18 " N/A N/A N/A N/A "$8,666.08 " N/A "$8,757.30 " N/A N/A N/A N/A N/A "$11,676.40 " "$9,122.18 " N/A N/A N/A N/A "$9,395.85 " N/A N/A "$12,771.06 " "$34,601.56 " "$9,122.18 " "$12,314.95 " "$11,220.29 " N/A "$9,395.85 " N/A N/A N/A N/A N/A "$9,122.18 " "$30,387.00 " "$18,700.48 " "$9,122.18 " "$9,122.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,122.18 " "$9,122.18 " "$10,490.51 " "$9,122.18 " N/A "$8,666.08 " "$34,601.56 " 330104 442 2 Kidney & urinary tract procedures for malignancy I N/A "$10,779.48 " N/A "$10,779.48 " N/A N/A N/A N/A "$10,240.51 " N/A "$10,348.30 " N/A N/A N/A N/A N/A "$13,797.74 " "$10,779.48 " N/A N/A N/A N/A "$11,102.87 " N/A N/A "$15,091.28 " "$41,107.40 " "$10,779.48 " "$14,552.30 " "$13,258.76 " N/A "$11,102.87 " N/A N/A N/A N/A N/A "$10,779.48 " "$36,100.42 " "$22,097.94 " "$10,779.48 " "$10,779.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,779.48 " "$10,779.48 " "$12,396.41 " "$10,779.48 " N/A "$10,240.51 " "$41,107.40 " 330104 442 3 Kidney & urinary tract procedures for malignancy I N/A "$19,487.62 " N/A "$19,487.62 " N/A N/A N/A N/A "$18,513.24 " N/A "$18,708.12 " N/A N/A N/A N/A N/A "$24,944.16 " "$19,487.62 " N/A N/A N/A N/A "$20,072.25 " N/A N/A "$27,282.67 " "$75,291.82 " "$19,487.62 " "$26,308.29 " "$23,969.78 " N/A "$20,072.25 " N/A N/A N/A N/A N/A "$19,487.62 " "$66,121.08 " "$39,949.63 " "$19,487.62 " "$19,487.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,487.62 " "$19,487.62 " "$22,410.77 " "$19,487.62 " N/A "$18,513.24 " "$75,291.82 " 330104 442 4 Kidney & urinary tract procedures for malignancy I N/A "$43,738.82 " N/A "$43,738.82 " N/A N/A N/A N/A "$41,551.88 " N/A "$41,989.26 " N/A N/A N/A N/A N/A "$55,985.69 " "$43,738.82 " N/A N/A N/A N/A "$45,050.98 " N/A N/A "$61,234.34 " "$170,491.57 " "$43,738.82 " "$59,047.40 " "$53,798.74 " N/A "$45,050.98 " N/A N/A N/A N/A N/A "$43,738.82 " "$149,725.26 " "$89,664.57 " "$43,738.82 " "$43,738.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,738.82 " "$43,738.82 " "$50,299.64 " "$43,738.82 " N/A "$41,551.88 " "$170,491.57 " 330104 443 1 Kidney & urinary tract procedures for nonmalignancy I N/A "$7,613.38 " N/A "$7,613.38 " N/A N/A N/A N/A "$7,232.71 " N/A "$7,308.85 " N/A N/A N/A N/A N/A "$9,745.13 " "$7,613.38 " N/A N/A N/A N/A "$7,841.78 " N/A N/A "$10,658.73 " "$28,678.65 " "$7,613.38 " "$10,278.07 " "$9,364.46 " N/A "$7,841.78 " N/A N/A N/A N/A N/A "$7,613.38 " "$25,185.52 " "$15,607.43 " "$7,613.38 " "$7,613.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,613.38 " "$7,613.38 " "$8,755.39 " "$7,613.38 " N/A "$7,232.71 " "$28,678.65 " 330104 443 2 Kidney & urinary tract procedures for nonmalignancy I N/A "$8,426.70 " N/A "$8,426.70 " N/A N/A N/A N/A "$8,005.37 " N/A "$8,089.64 " N/A N/A N/A N/A N/A "$10,786.18 " "$8,426.70 " N/A N/A N/A N/A "$8,679.51 " N/A N/A "$11,797.39 " "$31,871.41 " "$8,426.70 " "$11,376.05 " "$10,364.85 " N/A "$8,679.51 " N/A N/A N/A N/A N/A "$8,426.70 " "$27,989.39 " "$17,274.74 " "$8,426.70 " "$8,426.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,426.70 " "$8,426.70 " "$9,690.71 " "$8,426.70 " N/A "$8,005.37 " "$31,871.41 " 330104 443 3 Kidney & urinary tract procedures for nonmalignancy I N/A "$15,782.71 " N/A "$15,782.71 " N/A N/A N/A N/A "$14,993.58 " N/A "$15,151.41 " N/A N/A N/A N/A N/A "$20,201.87 " "$15,782.71 " N/A N/A N/A N/A "$16,256.20 " N/A N/A "$22,095.80 " "$60,747.93 " "$15,782.71 " "$21,306.66 " "$19,412.74 " N/A "$16,256.20 " N/A N/A N/A N/A N/A "$15,782.71 " "$53,348.68 " "$32,354.56 " "$15,782.71 " "$15,782.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,782.71 " "$15,782.71 " "$18,150.12 " "$15,782.71 " N/A "$14,993.58 " "$60,747.93 " 330104 443 4 Kidney & urinary tract procedures for nonmalignancy I N/A "$34,828.37 " N/A "$34,828.37 " N/A N/A N/A N/A "$33,086.95 " N/A "$33,435.23 " N/A N/A N/A N/A N/A "$44,580.31 " "$34,828.37 " N/A N/A N/A N/A "$35,873.22 " N/A N/A "$48,759.71 " "$135,512.97 " "$34,828.37 " "$47,018.29 " "$42,838.89 " N/A "$35,873.22 " N/A N/A N/A N/A N/A "$34,828.37 " "$119,007.15 " "$71,398.15 " "$34,828.37 " "$34,828.37 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,828.37 " "$34,828.37 " "$40,052.62 " "$34,828.37 " N/A "$33,086.95 " "$135,512.97 " 330104 444 1 Renal dialysis access device procedure only I N/A "$6,999.64 " N/A "$6,999.64 " N/A N/A N/A N/A "$6,649.66 " N/A "$6,719.66 " N/A N/A N/A N/A N/A "$8,959.54 " "$6,999.64 " N/A N/A N/A N/A "$7,209.63 " N/A N/A "$9,799.50 " "$26,269.38 " "$6,999.64 " "$9,449.52 " "$8,609.56 " N/A "$7,209.63 " N/A N/A N/A N/A N/A "$6,999.64 " "$23,069.70 " "$14,349.27 " "$6,999.64 " "$6,999.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,999.64 " "$6,999.64 " "$8,049.59 " "$6,999.64 " N/A "$6,649.66 " "$26,269.38 " 330104 444 2 Renal dialysis access device procedure only I N/A "$12,207.23 " N/A "$12,207.23 " N/A N/A N/A N/A "$11,596.86 " N/A "$11,718.94 " N/A N/A N/A N/A N/A "$15,625.25 " "$12,207.23 " N/A N/A N/A N/A "$12,573.44 " N/A N/A "$17,090.12 " "$46,712.11 " "$12,207.23 " "$16,479.76 " "$15,014.89 " N/A "$12,573.44 " N/A N/A N/A N/A N/A "$12,207.23 " "$41,022.45 " "$25,024.81 " "$12,207.23 " "$12,207.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,207.23 " "$12,207.23 " "$14,038.31 " "$12,207.23 " N/A "$11,596.86 " "$46,712.11 " 330104 444 3 Renal dialysis access device procedure only I N/A "$22,327.44 " N/A "$22,327.44 " N/A N/A N/A N/A "$21,211.07 " N/A "$21,434.35 " N/A N/A N/A N/A N/A "$28,579.13 " "$22,327.44 " N/A N/A N/A N/A "$22,997.27 " N/A N/A "$31,258.42 " "$86,439.72 " "$22,327.44 " "$30,142.05 " "$27,462.75 " N/A "$22,997.27 " N/A N/A N/A N/A N/A "$22,327.44 " "$75,911.15 " "$45,771.26 " "$22,327.44 " "$22,327.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,327.44 " "$22,327.44 " "$25,676.56 " "$22,327.44 " N/A "$21,211.07 " "$86,439.72 " 330104 444 4 Renal dialysis access device procedure only I N/A "$42,444.58 " N/A "$42,444.58 " N/A N/A N/A N/A "$40,322.36 " N/A "$40,746.80 " N/A N/A N/A N/A N/A "$54,329.07 " "$42,444.58 " N/A N/A N/A N/A "$43,717.92 " N/A N/A "$59,422.42 " "$165,410.97 " "$42,444.58 " "$57,300.19 " "$52,206.84 " N/A "$43,717.92 " N/A N/A N/A N/A N/A "$42,444.58 " "$145,263.49 " "$87,011.40 " "$42,444.58 " "$42,444.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,444.58 " "$42,444.58 " "$48,811.27 " "$42,444.58 " N/A "$40,322.36 " "$165,410.97 " 330104 445 1 Other bladder procedures I N/A "$5,902.95 " N/A "$5,902.95 " N/A N/A N/A N/A "$5,607.80 " N/A "$5,666.83 " N/A N/A N/A N/A N/A "$7,555.78 " "$5,902.95 " N/A N/A N/A N/A "$6,080.04 " N/A N/A "$8,264.13 " "$21,964.24 " "$5,902.95 " "$7,968.98 " "$7,260.63 " N/A "$6,080.04 " N/A N/A N/A N/A N/A "$5,902.95 " "$19,288.94 " "$12,101.05 " "$5,902.95 " "$5,902.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,902.95 " "$5,902.95 " "$6,788.39 " "$5,902.95 " N/A "$5,607.80 " "$21,964.24 " 330104 445 2 Other bladder procedures I N/A "$8,952.57 " N/A "$8,952.57 " N/A N/A N/A N/A "$8,504.94 " N/A "$8,594.47 " N/A N/A N/A N/A N/A "$11,459.29 " "$8,952.57 " N/A N/A N/A N/A "$9,221.15 " N/A N/A "$12,533.60 " "$33,935.73 " "$8,952.57 " "$12,085.97 " "$11,011.66 " N/A "$9,221.15 " N/A N/A N/A N/A N/A "$8,952.57 " "$29,802.28 " "$18,352.77 " "$8,952.57 " "$8,952.57 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,952.57 " "$8,952.57 " "$10,295.46 " "$8,952.57 " N/A "$8,504.94 " "$33,935.73 " 330104 445 3 Other bladder procedures I N/A "$13,064.83 " N/A "$13,064.83 " N/A N/A N/A N/A "$12,411.58 " N/A "$12,542.23 " N/A N/A N/A N/A N/A "$16,722.98 " "$13,064.83 " N/A N/A N/A N/A "$13,456.77 " N/A N/A "$18,290.76 " "$50,078.67 " "$13,064.83 " "$17,637.51 " "$16,069.74 " N/A "$13,456.77 " N/A N/A N/A N/A N/A "$13,064.83 " "$43,978.96 " "$26,782.89 " "$13,064.83 " "$13,064.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,064.83 " "$13,064.83 " "$15,024.55 " "$13,064.83 " N/A "$12,411.58 " "$50,078.67 " 330104 445 4 Other bladder procedures I N/A "$16,993.84 " N/A "$16,993.84 " N/A N/A N/A N/A "$16,144.15 " N/A "$16,314.09 " N/A N/A N/A N/A N/A "$21,752.12 " "$16,993.84 " N/A N/A N/A N/A "$17,503.66 " N/A N/A "$23,791.38 " "$65,502.30 " "$16,993.84 " "$22,941.69 " "$20,902.43 " N/A "$17,503.66 " N/A N/A N/A N/A N/A "$16,993.84 " "$57,523.96 " "$34,837.38 " "$16,993.84 " "$16,993.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,993.84 " "$16,993.84 " "$19,542.92 " "$16,993.84 " N/A "$16,144.15 " "$65,502.30 " 330104 446 1 Urethral & transurethral procedures I N/A "$4,970.42 " N/A "$4,970.42 " N/A N/A N/A N/A "$4,721.90 " N/A "$4,771.61 " N/A N/A N/A N/A N/A "$6,362.14 " "$4,970.42 " N/A N/A N/A N/A "$5,119.54 " N/A N/A "$6,958.59 " "$18,303.53 " "$4,970.42 " "$6,710.07 " "$6,113.62 " N/A "$5,119.54 " N/A N/A N/A N/A N/A "$4,970.42 " "$16,074.11 " "$10,189.37 " "$4,970.42 " "$4,970.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,970.42 " "$4,970.42 " "$5,715.99 " "$4,970.42 " N/A "$4,721.90 " "$18,303.53 " 330104 446 2 Urethral & transurethral procedures I N/A "$5,690.42 " N/A "$5,690.42 " N/A N/A N/A N/A "$5,405.90 " N/A "$5,462.81 " N/A N/A N/A N/A N/A "$7,283.74 " "$5,690.42 " N/A N/A N/A N/A "$5,861.14 " N/A N/A "$7,966.59 " "$21,129.95 " "$5,690.42 " "$7,682.07 " "$6,999.22 " N/A "$5,861.14 " N/A N/A N/A N/A N/A "$5,690.42 " "$18,556.27 " "$11,665.37 " "$5,690.42 " "$5,690.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,690.42 " "$5,690.42 " "$6,543.99 " "$5,690.42 " N/A "$5,405.90 " "$21,129.95 " 330104 446 3 Urethral & transurethral procedures I N/A "$10,578.54 " N/A "$10,578.54 " N/A N/A N/A N/A "$10,049.61 " N/A "$10,155.40 " N/A N/A N/A N/A N/A "$13,540.53 " "$10,578.54 " N/A N/A N/A N/A "$10,895.89 " N/A N/A "$14,809.95 " "$40,318.57 " "$10,578.54 " "$14,281.02 " "$13,011.60 " N/A "$10,895.89 " N/A N/A N/A N/A N/A "$10,578.54 " "$35,407.67 " "$21,686.00 " "$10,578.54 " "$10,578.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,578.54 " "$10,578.54 " "$12,165.32 " "$10,578.54 " N/A "$10,049.61 " "$40,318.57 " 330104 446 4 Urethral & transurethral procedures I N/A "$22,710.94 " N/A "$22,710.94 " N/A N/A N/A N/A "$21,575.40 " N/A "$21,802.51 " N/A N/A N/A N/A N/A "$29,070.01 " "$22,710.94 " N/A N/A N/A N/A "$23,392.27 " N/A N/A "$31,795.32 " "$87,945.19 " "$22,710.94 " "$30,659.78 " "$27,934.46 " N/A "$23,392.27 " N/A N/A N/A N/A N/A "$22,710.94 " "$77,233.24 " "$46,557.44 " "$22,710.94 " "$22,710.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,710.94 " "$22,710.94 " "$26,117.59 " "$22,710.94 " N/A "$21,575.40 " "$87,945.19 " 330104 447 1 Other kidney urinary tract & related procedures I N/A "$8,459.40 " N/A "$8,459.40 " N/A N/A N/A N/A "$8,036.43 " N/A "$8,121.03 " N/A N/A N/A N/A N/A "$10,828.03 " "$8,459.40 " N/A N/A N/A N/A "$8,713.18 " N/A N/A "$11,843.16 " "$31,999.76 " "$8,459.40 " "$11,420.19 " "$10,405.06 " N/A "$8,713.18 " N/A N/A N/A N/A N/A "$8,459.40 " "$28,102.11 " "$17,341.77 " "$8,459.40 " "$8,459.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,459.40 " "$8,459.40 " "$9,728.31 " "$8,459.40 " N/A "$8,036.43 " "$31,999.76 " 330104 447 2 Other kidney urinary tract & related procedures I N/A "$9,179.40 " N/A "$9,179.40 " N/A N/A N/A N/A "$8,720.43 " N/A "$8,812.23 " N/A N/A N/A N/A N/A "$11,749.64 " "$9,179.40 " N/A N/A N/A N/A "$9,454.79 " N/A N/A "$12,851.16 " "$34,826.18 " "$9,179.40 " "$12,392.19 " "$11,290.67 " N/A "$9,454.79 " N/A N/A N/A N/A N/A "$9,179.40 " "$30,584.26 " "$18,817.78 " "$9,179.40 " "$9,179.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,179.40 " "$9,179.40 " "$10,556.31 " "$9,179.40 " N/A "$8,720.43 " "$34,826.18 " 330104 447 3 Other kidney urinary tract & related procedures I N/A "$20,274.38 " N/A "$20,274.38 " N/A N/A N/A N/A "$19,260.66 " N/A "$19,463.41 " N/A N/A N/A N/A N/A "$25,951.21 " "$20,274.38 " N/A N/A N/A N/A "$20,882.61 " N/A N/A "$28,384.13 " "$78,380.29 " "$20,274.38 " "$27,370.42 " "$24,937.49 " N/A "$20,882.61 " N/A N/A N/A N/A N/A "$20,274.38 " "$68,833.37 " "$41,562.48 " "$20,274.38 " "$20,274.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,274.38 " "$20,274.38 " "$23,315.54 " "$20,274.38 " N/A "$19,260.66 " "$78,380.29 " 330104 447 4 Other kidney urinary tract & related procedures I N/A "$52,285.52 " N/A "$52,285.52 " N/A N/A N/A N/A "$49,671.24 " N/A "$50,194.10 " N/A N/A N/A N/A N/A "$66,925.47 " "$52,285.52 " N/A N/A N/A N/A "$53,854.09 " N/A N/A "$73,199.73 " "$204,042.24 " "$52,285.52 " "$70,585.45 " "$64,311.19 " N/A "$53,854.09 " N/A N/A N/A N/A N/A "$52,285.52 " "$179,189.38 " "$107,185.32 " "$52,285.52 " "$52,285.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$52,285.52 " "$52,285.52 " "$60,128.35 " "$52,285.52 " N/A "$49,671.24 " "$204,042.24 " 330104 461 1 Kidney & urinary tract malignancy I N/A "$3,404.40 " N/A "$3,404.40 " N/A N/A N/A N/A "$3,234.18 " N/A "$3,268.23 " N/A N/A N/A N/A N/A "$4,357.63 " "$3,404.40 " N/A N/A N/A N/A "$3,506.53 " N/A N/A "$4,766.16 " "$12,156.00 " "$3,404.40 " "$4,595.94 " "$4,187.41 " N/A "$3,506.53 " N/A N/A N/A N/A N/A "$3,404.40 " "$10,675.37 " "$6,979.02 " "$3,404.40 " "$3,404.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,404.40 " "$3,404.40 " "$3,915.06 " "$3,404.40 " N/A "$3,234.18 " "$12,156.00 " 330104 461 2 Kidney & urinary tract malignancy I N/A "$5,792.60 " N/A "$5,792.60 " N/A N/A N/A N/A "$5,502.97 " N/A "$5,560.90 " N/A N/A N/A N/A N/A "$7,414.53 " "$5,792.60 " N/A N/A N/A N/A "$5,966.38 " N/A N/A "$8,109.64 " "$21,531.05 " "$5,792.60 " "$7,820.01 " "$7,124.90 " N/A "$5,966.38 " N/A N/A N/A N/A N/A "$5,792.60 " "$18,908.51 " "$11,874.83 " "$5,792.60 " "$5,792.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,792.60 " "$5,792.60 " "$6,661.49 " "$5,792.60 " N/A "$5,502.97 " "$21,531.05 " 330104 461 3 Kidney & urinary tract malignancy I N/A "$10,545.16 " N/A "$10,545.16 " N/A N/A N/A N/A "$10,017.90 " N/A "$10,123.35 " N/A N/A N/A N/A N/A "$13,497.80 " "$10,545.16 " N/A N/A N/A N/A "$10,861.51 " N/A N/A "$14,763.22 " "$40,187.55 " "$10,545.16 " "$14,235.96 " "$12,970.55 " N/A "$10,861.51 " N/A N/A N/A N/A N/A "$10,545.16 " "$35,292.60 " "$21,617.58 " "$10,545.16 " "$10,545.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,545.16 " "$10,545.16 " "$12,126.93 " "$10,545.16 " N/A "$10,017.90 " "$40,187.55 " 330104 461 4 Kidney & urinary tract malignancy I N/A "$16,166.22 " N/A "$16,166.22 " N/A N/A N/A N/A "$15,357.90 " N/A "$15,519.57 " N/A N/A N/A N/A N/A "$20,692.76 " "$16,166.22 " N/A N/A N/A N/A "$16,651.20 " N/A N/A "$22,632.70 " "$62,253.39 " "$16,166.22 " "$21,824.39 " "$19,884.44 " N/A "$16,651.20 " N/A N/A N/A N/A N/A "$16,166.22 " "$54,670.77 " "$33,140.74 " "$16,166.22 " "$16,166.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,166.22 " "$16,166.22 " "$18,591.15 " "$16,166.22 " N/A "$15,357.90 " "$62,253.39 " 330104 462 1 Nephritis & nephrosis I N/A "$4,328.07 " N/A "$4,328.07 " N/A N/A N/A N/A "$4,111.67 " N/A "$4,154.95 " N/A N/A N/A N/A N/A "$5,539.94 " "$4,328.07 " N/A N/A N/A N/A "$4,457.92 " N/A N/A "$6,059.30 " "$15,781.95 " "$4,328.07 " "$5,842.90 " "$5,323.53 " N/A "$4,457.92 " N/A N/A N/A N/A N/A "$4,328.07 " "$13,859.67 " "$8,872.55 " "$4,328.07 " "$4,328.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,328.07 " "$4,328.07 " "$4,977.29 " "$4,328.07 " N/A "$4,111.67 " "$15,781.95 " 330104 462 2 Nephritis & nephrosis I N/A "$5,191.12 " N/A "$5,191.12 " N/A N/A N/A N/A "$4,931.57 " N/A "$4,983.48 " N/A N/A N/A N/A N/A "$6,644.64 " "$5,191.12 " N/A N/A N/A N/A "$5,346.86 " N/A N/A "$7,267.57 " "$19,169.91 " "$5,191.12 " "$7,008.02 " "$6,385.08 " N/A "$5,346.86 " N/A N/A N/A N/A N/A "$5,191.12 " "$16,834.96 " "$10,641.80 " "$5,191.12 " "$5,191.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,191.12 " "$5,191.12 " "$5,969.79 " "$5,191.12 " N/A "$4,931.57 " "$19,169.91 " 330104 462 3 Nephritis & nephrosis I N/A "$8,923.28 " N/A "$8,923.28 " N/A N/A N/A N/A "$8,477.12 " N/A "$8,566.35 " N/A N/A N/A N/A N/A "$11,421.80 " "$8,923.28 " N/A N/A N/A N/A "$9,190.98 " N/A N/A "$12,492.59 " "$33,820.75 " "$8,923.28 " "$12,046.43 " "$10,975.64 " N/A "$9,190.98 " N/A N/A N/A N/A N/A "$8,923.28 " "$29,701.30 " "$18,292.73 " "$8,923.28 " "$8,923.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,923.28 " "$8,923.28 " "$10,261.77 " "$8,923.28 " N/A "$8,477.12 " "$33,820.75 " 330104 462 4 Nephritis & nephrosis I N/A "$27,678.07 " N/A "$27,678.07 " N/A N/A N/A N/A "$26,294.17 " N/A "$26,570.95 " N/A N/A N/A N/A N/A "$35,427.93 " "$27,678.07 " N/A N/A N/A N/A "$28,508.41 " N/A N/A "$38,749.30 " "$107,443.99 " "$27,678.07 " "$37,365.40 " "$34,044.03 " N/A "$28,508.41 " N/A N/A N/A N/A N/A "$27,678.07 " "$94,357.04 " "$56,740.05 " "$27,678.07 " "$27,678.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,678.07 " "$27,678.07 " "$31,829.78 " "$27,678.07 " N/A "$26,294.17 " "$107,443.99 " 330104 463 1 Kidney & urinary tract infections I N/A "$3,692.54 " N/A "$3,692.54 " N/A N/A N/A N/A "$3,507.91 " N/A "$3,544.84 " N/A N/A N/A N/A N/A "$4,726.45 " "$3,692.54 " N/A N/A N/A N/A "$3,803.31 " N/A N/A "$5,169.55 " "$13,287.11 " "$3,692.54 " "$4,984.93 " "$4,541.82 " N/A "$3,803.31 " N/A N/A N/A N/A N/A "$3,692.54 " "$11,668.70 " "$7,569.70 " "$3,692.54 " "$3,692.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,692.54 " "$3,692.54 " "$4,246.42 " "$3,692.54 " N/A "$3,507.91 " "$13,287.11 " 330104 463 2 Kidney & urinary tract infections I N/A "$4,600.54 " N/A "$4,600.54 " N/A N/A N/A N/A "$4,370.52 " N/A "$4,416.52 " N/A N/A N/A N/A N/A "$5,888.70 " "$4,600.54 " N/A N/A N/A N/A "$4,738.56 " N/A N/A "$6,440.76 " "$16,851.55 " "$4,600.54 " "$6,210.74 " "$5,658.67 " N/A "$4,738.56 " N/A N/A N/A N/A N/A "$4,600.54 " "$14,798.99 " "$9,431.12 " "$4,600.54 " "$4,600.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,600.54 " "$4,600.54 " "$5,290.63 " "$4,600.54 " N/A "$4,370.52 " "$16,851.55 " 330104 463 3 Kidney & urinary tract infections I N/A "$7,031.66 " N/A "$7,031.66 " N/A N/A N/A N/A "$6,680.08 " N/A "$6,750.39 " N/A N/A N/A N/A N/A "$9,000.52 " "$7,031.66 " N/A N/A N/A N/A "$7,242.61 " N/A N/A "$9,844.32 " "$26,395.05 " "$7,031.66 " "$9,492.74 " "$8,648.94 " N/A "$7,242.61 " N/A N/A N/A N/A N/A "$7,031.66 " "$23,180.07 " "$14,414.90 " "$7,031.66 " "$7,031.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,031.66 " "$7,031.66 " "$8,086.41 " "$7,031.66 " N/A "$6,680.08 " "$26,395.05 " 330104 463 4 Kidney & urinary tract infections I N/A "$15,164.21 " N/A "$15,164.21 " N/A N/A N/A N/A "$14,406.00 " N/A "$14,557.64 " N/A N/A N/A N/A N/A "$19,410.18 " "$15,164.21 " N/A N/A N/A N/A "$15,619.13 " N/A N/A "$21,229.89 " "$58,319.94 " "$15,164.21 " "$20,471.68 " "$18,651.97 " N/A "$15,619.13 " N/A N/A N/A N/A N/A "$15,164.21 " "$51,216.42 " "$31,086.62 " "$15,164.21 " "$15,164.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,164.21 " "$15,164.21 " "$17,438.84 " "$15,164.21 " N/A "$14,406.00 " "$58,319.94 " 330104 465 1 Urinary stones & acquired upper urinary tract obstruction I N/A "$3,360.81 " N/A "$3,360.81 " N/A N/A N/A N/A "$3,192.77 " N/A "$3,226.37 " N/A N/A N/A N/A N/A "$4,301.83 " "$3,360.81 " N/A N/A N/A N/A "$3,461.63 " N/A N/A "$4,705.13 " "$11,984.87 " "$3,360.81 " "$4,537.09 " "$4,133.79 " N/A "$3,461.63 " N/A N/A N/A N/A N/A "$3,360.81 " "$10,525.08 " "$6,889.65 " "$3,360.81 " "$3,360.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,360.81 " "$3,360.81 " "$3,864.93 " "$3,360.81 " N/A "$3,192.77 " "$11,984.87 " 330104 465 2 Urinary stones & acquired upper urinary tract obstruction I N/A "$3,865.56 " N/A "$3,865.56 " N/A N/A N/A N/A "$3,672.28 " N/A "$3,710.93 " N/A N/A N/A N/A N/A "$4,947.91 " "$3,865.56 " N/A N/A N/A N/A "$3,981.52 " N/A N/A "$5,411.78 " "$13,966.30 " "$3,865.56 " "$5,218.50 " "$4,754.64 " N/A "$3,981.52 " N/A N/A N/A N/A N/A "$3,865.56 " "$12,265.17 " "$7,924.39 " "$3,865.56 " "$3,865.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,865.56 " "$3,865.56 " "$4,445.39 " "$3,865.56 " N/A "$3,672.28 " "$13,966.30 " 330104 465 3 Urinary stones & acquired upper urinary tract obstruction I N/A "$6,238.09 " N/A "$6,238.09 " N/A N/A N/A N/A "$5,926.19 " N/A "$5,988.57 " N/A N/A N/A N/A N/A "$7,984.75 " "$6,238.09 " N/A N/A N/A N/A "$6,425.23 " N/A N/A "$8,733.33 " "$23,279.84 " "$6,238.09 " "$8,421.42 " "$7,672.85 " N/A "$6,425.23 " N/A N/A N/A N/A N/A "$6,238.09 " "$20,444.30 " "$12,788.08 " "$6,238.09 " "$6,238.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,238.09 " "$6,238.09 " "$7,173.80 " "$6,238.09 " N/A "$5,926.19 " "$23,279.84 " 330104 465 4 Urinary stones & acquired upper urinary tract obstruction I N/A "$15,082.47 " N/A "$15,082.47 " N/A N/A N/A N/A "$14,328.34 " N/A "$14,479.17 " N/A N/A N/A N/A N/A "$19,305.56 " "$15,082.47 " N/A N/A N/A N/A "$15,534.94 " N/A N/A "$21,115.45 " "$57,999.06 " "$15,082.47 " "$20,361.33 " "$18,551.43 " N/A "$15,534.94 " N/A N/A N/A N/A N/A "$15,082.47 " "$50,934.63 " "$30,919.05 " "$15,082.47 " "$15,082.47 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,082.47 " "$15,082.47 " "$17,344.84 " "$15,082.47 " N/A "$14,328.34 " "$57,999.06 " 330104 466 1 Malfunction reaction complic of genitourinary device or proc I N/A "$3,729.32 " N/A "$3,729.32 " N/A N/A N/A N/A "$3,542.86 " N/A "$3,580.15 " N/A N/A N/A N/A N/A "$4,773.53 " "$3,729.32 " N/A N/A N/A N/A "$3,841.20 " N/A N/A "$5,221.05 " "$13,431.50 " "$3,729.32 " "$5,034.58 " "$4,587.07 " N/A "$3,841.20 " N/A N/A N/A N/A N/A "$3,729.32 " "$11,795.51 " "$7,645.11 " "$3,729.32 " "$3,729.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,729.32 " "$3,729.32 " "$4,288.72 " "$3,729.32 " N/A "$3,542.86 " "$13,431.50 " 330104 466 2 Malfunction reaction complic of genitourinary device or proc I N/A "$5,061.70 " N/A "$5,061.70 " N/A N/A N/A N/A "$4,808.62 " N/A "$4,859.23 " N/A N/A N/A N/A N/A "$6,478.98 " "$5,061.70 " N/A N/A N/A N/A "$5,213.55 " N/A N/A "$7,086.38 " "$18,661.85 " "$5,061.70 " "$6,833.30 " "$6,225.89 " N/A "$5,213.55 " N/A N/A N/A N/A N/A "$5,061.70 " "$16,388.79 " "$10,376.49 " "$5,061.70 " "$5,061.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,061.70 " "$5,061.70 " "$5,820.96 " "$5,061.70 " N/A "$4,808.62 " "$18,661.85 " 330104 466 3 Malfunction reaction complic of genitourinary device or proc I N/A "$8,233.25 " N/A "$8,233.25 " N/A N/A N/A N/A "$7,821.59 " N/A "$7,903.92 " N/A N/A N/A N/A N/A "$10,538.56 " "$8,233.25 " N/A N/A N/A N/A "$8,480.25 " N/A N/A "$11,526.55 " "$31,111.99 " "$8,233.25 " "$11,114.89 " "$10,126.90 " N/A "$8,480.25 " N/A N/A N/A N/A N/A "$8,233.25 " "$27,322.47 " "$16,878.16 " "$8,233.25 " "$8,233.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,233.25 " "$8,233.25 " "$9,468.24 " "$8,233.25 " N/A "$7,821.59 " "$31,111.99 " 330104 466 4 Malfunction reaction complic of genitourinary device or proc I N/A "$16,163.49 " N/A "$16,163.49 " N/A N/A N/A N/A "$15,355.32 " N/A "$15,516.95 " N/A N/A N/A N/A N/A "$20,689.27 " "$16,163.49 " N/A N/A N/A N/A "$16,648.40 " N/A N/A "$22,628.89 " "$62,242.70 " "$16,163.49 " "$21,820.71 " "$19,881.09 " N/A "$16,648.40 " N/A N/A N/A N/A N/A "$16,163.49 " "$54,661.38 " "$33,135.16 " "$16,163.49 " "$16,163.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,163.49 " "$16,163.49 " "$18,588.01 " "$16,163.49 " N/A "$15,355.32 " "$62,242.70 " 330104 468 1 Other kidney & urinary tract diagnoses signs & symptoms I N/A "$3,738.18 " N/A "$3,738.18 " N/A N/A N/A N/A "$3,551.27 " N/A "$3,588.65 " N/A N/A N/A N/A N/A "$4,784.87 " "$3,738.18 " N/A N/A N/A N/A "$3,850.32 " N/A N/A "$5,233.45 " "$13,466.26 " "$3,738.18 " "$5,046.54 " "$4,597.96 " N/A "$3,850.32 " N/A N/A N/A N/A N/A "$3,738.18 " "$11,826.04 " "$7,663.26 " "$3,738.18 " "$3,738.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,738.18 " "$3,738.18 " "$4,298.90 " "$3,738.18 " N/A "$3,551.27 " "$13,466.26 " 330104 468 2 Other kidney & urinary tract diagnoses signs & symptoms I N/A "$5,259.24 " N/A "$5,259.24 " N/A N/A N/A N/A "$4,996.28 " N/A "$5,048.87 " N/A N/A N/A N/A N/A "$6,731.83 " "$5,259.24 " N/A N/A N/A N/A "$5,417.02 " N/A N/A "$7,362.94 " "$19,437.31 " "$5,259.24 " "$7,099.98 " "$6,468.87 " N/A "$5,417.02 " N/A N/A N/A N/A N/A "$5,259.24 " "$17,069.79 " "$10,781.44 " "$5,259.24 " "$5,259.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,259.24 " "$5,259.24 " "$6,048.13 " "$5,259.24 " N/A "$4,996.28 " "$19,437.31 " 330104 468 3 Other kidney & urinary tract diagnoses signs & symptoms I N/A "$8,409.68 " N/A "$8,409.68 " N/A N/A N/A N/A "$7,989.19 " N/A "$8,073.29 " N/A N/A N/A N/A N/A "$10,764.38 " "$8,409.68 " N/A N/A N/A N/A "$8,661.97 " N/A N/A "$11,773.55 " "$31,804.56 " "$8,409.68 " "$11,353.06 " "$10,343.90 " N/A "$8,661.97 " N/A N/A N/A N/A N/A "$8,409.68 " "$27,930.68 " "$17,239.83 " "$8,409.68 " "$8,409.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,409.68 " "$8,409.68 " "$9,671.13 " "$8,409.68 " N/A "$7,989.19 " "$31,804.56 " 330104 468 4 Other kidney & urinary tract diagnoses signs & symptoms I N/A "$19,439.94 " N/A "$19,439.94 " N/A N/A N/A N/A "$18,467.95 " N/A "$18,662.34 " N/A N/A N/A N/A N/A "$24,883.13 " "$19,439.94 " N/A N/A N/A N/A "$20,023.14 " N/A N/A "$27,215.92 " "$75,104.64 " "$19,439.94 " "$26,243.92 " "$23,911.13 " N/A "$20,023.14 " N/A N/A N/A N/A N/A "$19,439.94 " "$65,956.70 " "$39,851.88 " "$19,439.94 " "$19,439.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,439.94 " "$19,439.94 " "$22,355.93 " "$19,439.94 " N/A "$18,467.95 " "$75,104.64 " 330104 469 1 Acute Kidney Injury # I N/A "$3,894.17 " N/A "$3,894.17 " N/A N/A N/A N/A "$3,699.46 " N/A "$3,738.40 " N/A N/A N/A N/A N/A "$4,984.53 " "$3,894.17 " N/A N/A N/A N/A "$4,010.99 " N/A N/A "$5,451.83 " "$14,078.61 " "$3,894.17 " "$5,257.12 " "$4,789.82 " N/A "$4,010.99 " N/A N/A N/A N/A N/A "$3,894.17 " "$12,363.80 " "$7,983.04 " "$3,894.17 " "$3,894.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,894.17 " "$3,894.17 " "$4,478.29 " "$3,894.17 " N/A "$3,699.46 " "$14,078.61 " 330104 469 2 Acute Kidney Injury # I N/A "$5,379.13 " N/A "$5,379.13 " N/A N/A N/A N/A "$5,110.17 " N/A "$5,163.96 " N/A N/A N/A N/A N/A "$6,885.28 " "$5,379.13 " N/A N/A N/A N/A "$5,540.50 " N/A N/A "$7,530.78 " "$19,907.93 " "$5,379.13 " "$7,261.82 " "$6,616.33 " N/A "$5,540.50 " N/A N/A N/A N/A N/A "$5,379.13 " "$17,483.09 " "$11,027.21 " "$5,379.13 " "$5,379.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,379.13 " "$5,379.13 " "$6,186.00 " "$5,379.13 " N/A "$5,110.17 " "$19,907.93 " 330104 469 3 Acute Kidney Injury # I N/A "$9,559.50 " N/A "$9,559.50 " N/A N/A N/A N/A "$9,081.52 " N/A "$9,177.12 " N/A N/A N/A N/A N/A "$12,236.16 " "$9,559.50 " N/A N/A N/A N/A "$9,846.28 " N/A N/A "$13,383.30 " "$36,318.27 " "$9,559.50 " "$12,905.32 " "$11,758.18 " N/A "$9,846.28 " N/A N/A N/A N/A N/A "$9,559.50 " "$31,894.61 " "$19,596.97 " "$9,559.50 " "$9,559.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,559.50 " "$9,559.50 " "$10,993.42 " "$9,559.50 " N/A "$9,081.52 " "$36,318.27 " 330104 469 4 Acute Kidney Injury # I N/A "$22,795.41 " N/A "$22,795.41 " N/A N/A N/A N/A "$21,655.64 " N/A "$21,883.59 " N/A N/A N/A N/A N/A "$29,178.13 " "$22,795.41 " N/A N/A N/A N/A "$23,479.27 " N/A N/A "$31,913.57 " "$88,276.76 " "$22,795.41 " "$30,773.80 " "$28,038.35 " N/A "$23,479.27 " N/A N/A N/A N/A N/A "$22,795.41 " "$77,524.43 " "$46,730.59 " "$22,795.41 " "$22,795.41 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,795.41 " "$22,795.41 " "$26,214.72 " "$22,795.41 " N/A "$21,655.64 " "$88,276.76 " 330104 470 1 Chronic Kidney Disease # I N/A "$3,568.56 " N/A "$3,568.56 " N/A N/A N/A N/A "$3,390.14 " N/A "$3,425.82 " N/A N/A N/A N/A N/A "$4,567.76 " "$3,568.56 " N/A N/A N/A N/A "$3,675.62 " N/A N/A "$4,995.99 " "$12,800.44 " "$3,568.56 " "$4,817.56 " "$4,389.33 " N/A "$3,675.62 " N/A N/A N/A N/A N/A "$3,568.56 " "$11,241.31 " "$7,315.56 " "$3,568.56 " "$3,568.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,568.56 " "$3,568.56 " "$4,103.85 " "$3,568.56 " N/A "$3,390.14 " "$12,800.44 " 330104 470 2 Chronic Kidney Disease # I N/A "$4,962.25 " N/A "$4,962.25 " N/A N/A N/A N/A "$4,714.14 " N/A "$4,763.76 " N/A N/A N/A N/A N/A "$6,351.68 " "$4,962.25 " N/A N/A N/A N/A "$5,111.12 " N/A N/A "$6,947.15 " "$18,271.44 " "$4,962.25 " "$6,699.04 " "$6,103.57 " N/A "$5,111.12 " N/A N/A N/A N/A N/A "$4,962.25 " "$16,045.93 " "$10,172.61 " "$4,962.25 " "$4,962.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,962.25 " "$4,962.25 " "$5,706.59 " "$4,962.25 " N/A "$4,714.14 " "$18,271.44 " 330104 470 3 Chronic Kidney Disease # I N/A "$8,428.07 " N/A "$8,428.07 " N/A N/A N/A N/A "$8,006.66 " N/A "$8,090.94 " N/A N/A N/A N/A N/A "$10,787.93 " "$8,428.07 " N/A N/A N/A N/A "$8,680.91 " N/A N/A "$11,799.29 " "$31,876.75 " "$8,428.07 " "$11,377.89 " "$10,366.52 " N/A "$8,680.91 " N/A N/A N/A N/A N/A "$8,428.07 " "$27,994.08 " "$17,277.54 " "$8,428.07 " "$8,428.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,428.07 " "$8,428.07 " "$9,692.28 " "$8,428.07 " N/A "$8,006.66 " "$31,876.75 " 330104 470 4 Chronic Kidney Disease # I N/A "$18,401.15 " N/A "$18,401.15 " N/A N/A N/A N/A "$17,481.09 " N/A "$17,665.10 " N/A N/A N/A N/A N/A "$23,553.47 " "$18,401.15 " N/A N/A N/A N/A "$18,953.18 " N/A N/A "$25,761.61 " "$71,026.79 " "$18,401.15 " "$24,841.55 " "$22,633.41 " N/A "$18,953.18 " N/A N/A N/A N/A N/A "$18,401.15 " "$62,375.54 " "$37,722.36 " "$18,401.15 " "$18,401.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,401.15 " "$18,401.15 " "$21,161.32 " "$18,401.15 " N/A "$17,481.09 " "$71,026.79 " 330104 480 1 Major male pelvic procedures I N/A "$7,791.17 " N/A "$7,791.17 " N/A N/A N/A N/A "$7,401.61 " N/A "$7,479.52 " N/A N/A N/A N/A N/A "$9,972.70 " "$7,791.17 " N/A N/A N/A N/A "$8,024.90 " N/A N/A "$10,907.64 " "$29,376.56 " "$7,791.17 " "$10,518.08 " "$9,583.14 " N/A "$8,024.90 " N/A N/A N/A N/A N/A "$7,791.17 " "$25,798.42 " "$15,971.90 " "$7,791.17 " "$7,791.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,791.17 " "$7,791.17 " "$8,959.84 " "$7,791.17 " N/A "$7,401.61 " "$29,376.56 " 330104 480 2 Major male pelvic procedures I N/A "$8,851.76 " N/A "$8,851.76 " N/A N/A N/A N/A "$8,409.17 " N/A "$8,497.69 " N/A N/A N/A N/A N/A "$11,330.25 " "$8,851.76 " N/A N/A N/A N/A "$9,117.31 " N/A N/A "$12,392.46 " "$33,539.98 " "$8,851.76 " "$11,949.87 " "$10,887.66 " N/A "$9,117.31 " N/A N/A N/A N/A N/A "$8,851.76 " "$29,454.73 " "$18,146.10 " "$8,851.76 " "$8,851.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,851.76 " "$8,851.76 " "$10,179.52 " "$8,851.76 " N/A "$8,409.17 " "$33,539.98 " 330104 480 3 Major male pelvic procedures I N/A "$15,002.77 " N/A "$15,002.77 " N/A N/A N/A N/A "$14,252.63 " N/A "$14,402.66 " N/A N/A N/A N/A N/A "$19,203.54 " "$15,002.77 " N/A N/A N/A N/A "$15,452.85 " N/A N/A "$21,003.88 " "$57,686.20 " "$15,002.77 " "$20,253.74 " "$18,453.40 " N/A "$15,452.85 " N/A N/A N/A N/A N/A "$15,002.77 " "$50,659.88 " "$30,755.67 " "$15,002.77 " "$15,002.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,002.77 " "$15,002.77 " "$17,253.18 " "$15,002.77 " N/A "$14,252.63 " "$57,686.20 " 330104 480 4 Major male pelvic procedures I N/A "$18,001.30 " N/A "$18,001.30 " N/A N/A N/A N/A "$17,101.24 " N/A "$17,281.25 " N/A N/A N/A N/A N/A "$23,041.66 " "$18,001.30 " N/A N/A N/A N/A "$18,541.34 " N/A N/A "$25,201.82 " "$69,457.15 " "$18,001.30 " "$24,301.76 " "$22,141.60 " N/A "$18,541.34 " N/A N/A N/A N/A N/A "$18,001.30 " "$60,997.09 " "$36,902.67 " "$18,001.30 " "$18,001.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,001.30 " "$18,001.30 " "$20,701.50 " "$18,001.30 " N/A "$17,101.24 " "$69,457.15 " 330104 481 1 Penis procedures I N/A "$5,362.78 " N/A "$5,362.78 " N/A N/A N/A N/A "$5,094.64 " N/A "$5,148.27 " N/A N/A N/A N/A N/A "$6,864.36 " "$5,362.78 " N/A N/A N/A N/A "$5,523.66 " N/A N/A "$7,507.89 " "$19,843.75 " "$5,362.78 " "$7,239.75 " "$6,596.22 " N/A "$5,523.66 " N/A N/A N/A N/A N/A "$5,362.78 " "$17,426.73 " "$10,993.70 " "$5,362.78 " "$5,362.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,362.78 " "$5,362.78 " "$6,167.20 " "$5,362.78 " N/A "$5,094.64 " "$19,843.75 " 330104 481 2 Penis procedures I N/A "$8,614.71 " N/A "$8,614.71 " N/A N/A N/A N/A "$8,183.97 " N/A "$8,270.12 " N/A N/A N/A N/A N/A "$11,026.83 " "$8,614.71 " N/A N/A N/A N/A "$8,873.15 " N/A N/A "$12,060.59 " "$32,609.43 " "$8,614.71 " "$11,629.86 " "$10,596.09 " N/A "$8,873.15 " N/A N/A N/A N/A N/A "$8,614.71 " "$28,637.52 " "$17,660.15 " "$8,614.71 " "$8,614.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,614.71 " "$8,614.71 " "$9,906.92 " "$8,614.71 " N/A "$8,183.97 " "$32,609.43 " 330104 481 3 Penis procedures I N/A "$13,622.03 " N/A "$13,622.03 " N/A N/A N/A N/A "$12,940.93 " N/A "$13,077.15 " N/A N/A N/A N/A N/A "$17,436.19 " "$13,622.03 " N/A N/A N/A N/A "$14,030.69 " N/A N/A "$19,070.84 " "$52,266.00 " "$13,622.03 " "$18,389.74 " "$16,755.09 " N/A "$14,030.69 " N/A N/A N/A N/A N/A "$13,622.03 " "$45,899.87 " "$27,925.15 " "$13,622.03 " "$13,622.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,622.03 " "$13,622.03 " "$15,665.33 " "$13,622.03 " N/A "$12,940.93 " "$52,266.00 " 330104 481 4 Penis procedures I N/A "$14,383.58 " N/A "$14,383.58 " N/A N/A N/A N/A "$13,664.40 " N/A "$13,808.24 " N/A N/A N/A N/A N/A "$18,410.98 " "$14,383.58 " N/A N/A N/A N/A "$14,815.09 " N/A N/A "$20,137.01 " "$55,255.54 " "$14,383.58 " "$19,417.83 " "$17,691.80 " N/A "$14,815.09 " N/A N/A N/A N/A N/A "$14,383.58 " "$48,525.27 " "$29,486.34 " "$14,383.58 " "$14,383.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,383.58 " "$14,383.58 " "$16,541.12 " "$14,383.58 " N/A "$13,664.40 " "$55,255.54 " 330104 482 1 Transurethral prostatectomy I N/A "$4,428.89 " N/A "$4,428.89 " N/A N/A N/A N/A "$4,207.44 " N/A "$4,251.73 " N/A N/A N/A N/A N/A "$5,668.98 " "$4,428.89 " N/A N/A N/A N/A "$4,561.76 " N/A N/A "$6,200.44 " "$16,177.70 " "$4,428.89 " "$5,979.00 " "$5,447.53 " N/A "$4,561.76 " N/A N/A N/A N/A N/A "$4,428.89 " "$14,207.22 " "$9,079.22 " "$4,428.89 " "$4,428.89 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,428.89 " "$4,428.89 " "$5,093.22 " "$4,428.89 " N/A "$4,207.44 " "$16,177.70 " 330104 482 2 Transurethral prostatectomy I N/A "$6,082.78 " N/A "$6,082.78 " N/A N/A N/A N/A "$5,778.64 " N/A "$5,839.47 " N/A N/A N/A N/A N/A "$7,785.96 " "$6,082.78 " N/A N/A N/A N/A "$6,265.27 " N/A N/A "$8,515.89 " "$22,670.17 " "$6,082.78 " "$8,211.76 " "$7,481.82 " N/A "$6,265.27 " N/A N/A N/A N/A N/A "$6,082.78 " "$19,908.89 " "$12,469.70 " "$6,082.78 " "$6,082.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,082.78 " "$6,082.78 " "$6,995.20 " "$6,082.78 " N/A "$5,778.64 " "$22,670.17 " 330104 482 3 Transurethral prostatectomy I N/A "$16,341.96 " N/A "$16,341.96 " N/A N/A N/A N/A "$15,524.86 " N/A "$15,688.28 " N/A N/A N/A N/A N/A "$20,917.71 " "$16,341.96 " N/A N/A N/A N/A "$16,832.22 " N/A N/A "$22,878.74 " "$62,943.29 " "$16,341.96 " "$22,061.64 " "$20,100.61 " N/A "$16,832.22 " N/A N/A N/A N/A N/A "$16,341.96 " "$55,276.63 " "$33,501.01 " "$16,341.96 " "$16,341.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,341.96 " "$16,341.96 " "$18,793.25 " "$16,341.96 " N/A "$15,524.86 " "$62,943.29 " 330104 482 4 Transurethral prostatectomy I N/A "$18,738.33 " N/A "$18,738.33 " N/A N/A N/A N/A "$17,801.42 " N/A "$17,988.80 " N/A N/A N/A N/A N/A "$23,985.06 " "$18,738.33 " N/A N/A N/A N/A "$19,300.48 " N/A N/A "$26,233.66 " "$72,350.42 " "$18,738.33 " "$25,296.75 " "$23,048.15 " N/A "$19,300.48 " N/A N/A N/A N/A N/A "$18,738.33 " "$63,537.95 " "$38,413.58 " "$18,738.33 " "$18,738.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,738.33 " "$18,738.33 " "$21,549.08 " "$18,738.33 " N/A "$17,801.42 " "$72,350.42 " 330104 483 1 Testes & scrotal procedures I N/A "$4,610.76 " N/A "$4,610.76 " N/A N/A N/A N/A "$4,380.22 " N/A "$4,426.33 " N/A N/A N/A N/A N/A "$5,901.78 " "$4,610.76 " N/A N/A N/A N/A "$4,749.09 " N/A N/A "$6,455.07 " "$16,891.66 " "$4,610.76 " "$6,224.53 " "$5,671.24 " N/A "$4,749.09 " N/A N/A N/A N/A N/A "$4,610.76 " "$14,834.21 " "$9,452.06 " "$4,610.76 " "$4,610.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,610.76 " "$4,610.76 " "$5,302.38 " "$4,610.76 " N/A "$4,380.22 " "$16,891.66 " 330104 483 2 Testes & scrotal procedures I N/A "$9,033.63 " N/A "$9,033.63 " N/A N/A N/A N/A "$8,581.95 " N/A "$8,672.29 " N/A N/A N/A N/A N/A "$11,563.05 " "$9,033.63 " N/A N/A N/A N/A "$9,304.64 " N/A N/A "$12,647.08 " "$34,253.94 " "$9,033.63 " "$12,195.40 " "$11,111.37 " N/A "$9,304.64 " N/A N/A N/A N/A N/A "$9,033.63 " "$30,081.72 " "$18,518.95 " "$9,033.63 " "$9,033.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,033.63 " "$9,033.63 " "$10,388.68 " "$9,033.63 " N/A "$8,581.95 " "$34,253.94 " 330104 483 3 Testes & scrotal procedures I N/A "$21,979.36 " N/A "$21,979.36 " N/A N/A N/A N/A "$20,880.39 " N/A "$21,100.19 " N/A N/A N/A N/A N/A "$28,133.58 " "$21,979.36 " N/A N/A N/A N/A "$22,638.74 " N/A N/A "$30,771.11 " "$85,073.31 " "$21,979.36 " "$29,672.14 " "$27,034.62 " N/A "$22,638.74 " N/A N/A N/A N/A N/A "$21,979.36 " "$74,711.16 " "$45,057.69 " "$21,979.36 " "$21,979.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,979.36 " "$21,979.36 " "$25,276.27 " "$21,979.36 " N/A "$20,880.39 " "$85,073.31 " 330104 483 4 Testes & scrotal procedures I N/A "$29,448.45 " N/A "$29,448.45 " N/A N/A N/A N/A "$27,976.02 " N/A "$28,270.51 " N/A N/A N/A N/A N/A "$37,694.01 " "$29,448.45 " N/A N/A N/A N/A "$30,331.90 " N/A N/A "$41,227.83 " "$114,393.72 " "$29,448.45 " "$39,755.40 " "$36,221.59 " N/A "$30,331.90 " N/A N/A N/A N/A N/A "$29,448.45 " "$100,460.27 " "$60,369.32 " "$29,448.45 " "$29,448.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$29,448.45 " "$29,448.45 " "$33,865.71 " "$29,448.45 " N/A "$27,976.02 " "$114,393.72 " 330104 484 1 Other male reproductive system & related procedures I N/A "$6,291.22 " N/A "$6,291.22 " N/A N/A N/A N/A "$5,976.66 " N/A "$6,039.57 " N/A N/A N/A N/A N/A "$8,052.76 " "$6,291.22 " N/A N/A N/A N/A "$6,479.96 " N/A N/A "$8,807.71 " "$23,488.42 " "$6,291.22 " "$8,493.15 " "$7,738.20 " N/A "$6,479.96 " N/A N/A N/A N/A N/A "$6,291.22 " "$20,627.47 " "$12,897.00 " "$6,291.22 " "$6,291.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,291.22 " "$6,291.22 " "$7,234.90 " "$6,291.22 " N/A "$5,976.66 " "$23,488.42 " 330104 484 2 Other male reproductive system & related procedures I N/A "$8,322.49 " N/A "$8,322.49 " N/A N/A N/A N/A "$7,906.36 " N/A "$7,989.59 " N/A N/A N/A N/A N/A "$10,652.78 " "$8,322.49 " N/A N/A N/A N/A "$8,572.16 " N/A N/A "$11,651.48 " "$31,462.28 " "$8,322.49 " "$11,235.35 " "$10,236.66 " N/A "$8,572.16 " N/A N/A N/A N/A N/A "$8,322.49 " "$27,630.10 " "$17,061.09 " "$8,322.49 " "$8,322.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,322.49 " "$8,322.49 " "$9,570.86 " "$8,322.49 " N/A "$7,906.36 " "$31,462.28 " 330104 484 3 Other male reproductive system & related procedures I N/A "$13,740.55 " N/A "$13,740.55 " N/A N/A N/A N/A "$13,053.52 " N/A "$13,190.93 " N/A N/A N/A N/A N/A "$17,587.91 " "$13,740.55 " N/A N/A N/A N/A "$14,152.77 " N/A N/A "$19,236.77 " "$52,731.28 " "$13,740.55 " "$18,549.74 " "$16,900.88 " N/A "$14,152.77 " N/A N/A N/A N/A N/A "$13,740.55 " "$46,308.48 " "$28,168.13 " "$13,740.55 " "$13,740.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,740.55 " "$13,740.55 " "$15,801.63 " "$13,740.55 " N/A "$13,053.52 " "$52,731.28 " 330104 484 4 Other male reproductive system & related procedures I N/A "$14,938.74 " N/A "$14,938.74 " N/A N/A N/A N/A "$14,191.80 " N/A "$14,341.19 " N/A N/A N/A N/A N/A "$19,121.58 " "$14,938.74 " N/A N/A N/A N/A "$15,386.90 " N/A N/A "$20,914.23 " "$57,434.85 " "$14,938.74 " "$20,167.30 " "$18,374.65 " N/A "$15,386.90 " N/A N/A N/A N/A N/A "$14,938.74 " "$50,439.14 " "$30,624.41 " "$14,938.74 " "$14,938.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,938.74 " "$14,938.74 " "$17,179.55 " "$14,938.74 " N/A "$14,191.80 " "$57,434.85 " 330104 500 1 Malignancy male reproductive system I N/A "$3,181.66 " N/A "$3,181.66 " N/A N/A N/A N/A "$3,022.57 " N/A "$3,054.39 " N/A N/A N/A N/A N/A "$4,072.52 " "$3,181.66 " N/A N/A N/A N/A "$3,277.11 " N/A N/A "$4,454.32 " "$11,281.61 " "$3,181.66 " "$4,295.24 " "$3,913.44 " N/A "$3,277.11 " N/A N/A N/A N/A N/A "$3,181.66 " "$9,907.48 " "$6,522.40 " "$3,181.66 " "$3,181.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,181.66 " "$3,181.66 " "$3,658.91 " "$3,181.66 " N/A "$3,022.57 " "$11,281.61 " 330104 500 2 Malignancy male reproductive system I N/A "$6,729.22 " N/A "$6,729.22 " N/A N/A N/A N/A "$6,392.76 " N/A "$6,460.05 " N/A N/A N/A N/A N/A "$8,613.40 " "$6,729.22 " N/A N/A N/A N/A "$6,931.09 " N/A N/A "$9,420.90 " "$25,207.80 " "$6,729.22 " "$9,084.44 " "$8,276.94 " N/A "$6,931.09 " N/A N/A N/A N/A N/A "$6,729.22 " "$22,137.42 " "$13,794.89 " "$6,729.22 " "$6,729.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,729.22 " "$6,729.22 " "$7,738.60 " "$6,729.22 " N/A "$6,392.76 " "$25,207.80 " 330104 500 3 Malignancy male reproductive system I N/A "$11,068.30 " N/A "$11,068.30 " N/A N/A N/A N/A "$10,514.89 " N/A "$10,625.57 " N/A N/A N/A N/A N/A "$14,167.43 " "$11,068.30 " N/A N/A N/A N/A "$11,400.35 " N/A N/A "$15,495.62 " "$42,241.18 " "$11,068.30 " "$14,942.21 " "$13,614.01 " N/A "$11,400.35 " N/A N/A N/A N/A N/A "$11,068.30 " "$37,096.10 " "$22,690.02 " "$11,068.30 " "$11,068.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,068.30 " "$11,068.30 " "$12,728.55 " "$11,068.30 " N/A "$10,514.89 " "$42,241.18 " 330104 500 4 Malignancy male reproductive system I N/A "$12,853.66 " N/A "$12,853.66 " N/A N/A N/A N/A "$12,210.98 " N/A "$12,339.51 " N/A N/A N/A N/A N/A "$16,452.69 " "$12,853.66 " N/A N/A N/A N/A "$13,239.27 " N/A N/A "$17,995.13 " "$49,249.73 " "$12,853.66 " "$17,352.44 " "$15,810.00 " N/A "$13,239.27 " N/A N/A N/A N/A N/A "$12,853.66 " "$43,250.99 " "$26,350.01 " "$12,853.66 " "$12,853.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,853.66 " "$12,853.66 " "$14,781.71 " "$12,853.66 " N/A "$12,210.98 " "$49,249.73 " 330104 501 1 Male reproductive system diagnoses except malignancy I N/A "$3,600.58 " N/A "$3,600.58 " N/A N/A N/A N/A "$3,420.55 " N/A "$3,456.56 " N/A N/A N/A N/A N/A "$4,608.74 " "$3,600.58 " N/A N/A N/A N/A "$3,708.60 " N/A N/A "$5,040.81 " "$12,926.12 " "$3,600.58 " "$4,860.78 " "$4,428.71 " N/A "$3,708.60 " N/A N/A N/A N/A N/A "$3,600.58 " "$11,351.68 " "$7,381.19 " "$3,600.58 " "$3,600.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,600.58 " "$3,600.58 " "$4,140.67 " "$3,600.58 " N/A "$3,420.55 " "$12,926.12 " 330104 501 2 Male reproductive system diagnoses except malignancy I N/A "$4,979.96 " N/A "$4,979.96 " N/A N/A N/A N/A "$4,730.96 " N/A "$4,780.76 " N/A N/A N/A N/A N/A "$6,374.35 " "$4,979.96 " N/A N/A N/A N/A "$5,129.36 " N/A N/A "$6,971.94 " "$18,340.97 " "$4,979.96 " "$6,722.95 " "$6,125.35 " N/A "$5,129.36 " N/A N/A N/A N/A N/A "$4,979.96 " "$16,106.99 " "$10,208.92 " "$4,979.96 " "$4,979.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,979.96 " "$4,979.96 " "$5,726.95 " "$4,979.96 " N/A "$4,730.96 " "$18,340.97 " 330104 501 3 Male reproductive system diagnoses except malignancy I N/A "$7,955.33 " N/A "$7,955.33 " N/A N/A N/A N/A "$7,557.57 " N/A "$7,637.12 " N/A N/A N/A N/A N/A "$10,182.82 " "$7,955.33 " N/A N/A N/A N/A "$8,193.99 " N/A N/A "$11,137.46 " "$30,021.00 " "$7,955.33 " "$10,739.70 " "$9,785.06 " N/A "$8,193.99 " N/A N/A N/A N/A N/A "$7,955.33 " "$26,364.36 " "$16,308.43 " "$7,955.33 " "$7,955.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,955.33 " "$7,955.33 " "$9,148.63 " "$7,955.33 " N/A "$7,557.57 " "$30,021.00 " 330104 501 4 Male reproductive system diagnoses except malignancy I N/A "$14,834.52 " N/A "$14,834.52 " N/A N/A N/A N/A "$14,092.79 " N/A "$14,241.14 " N/A N/A N/A N/A N/A "$18,988.18 " "$14,834.52 " N/A N/A N/A N/A "$15,279.55 " N/A N/A "$20,768.33 " "$57,025.72 " "$14,834.52 " "$20,026.60 " "$18,246.46 " N/A "$15,279.55 " N/A N/A N/A N/A N/A "$14,834.52 " "$50,079.85 " "$30,410.76 " "$14,834.52 " "$14,834.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,834.52 " "$14,834.52 " "$17,059.70 " "$14,834.52 " N/A "$14,092.79 " "$57,025.72 " 330104 510 1 Pelvic evisceration radical hysterectomy & other radical GYN procs I N/A "$7,966.91 " N/A "$7,966.91 " N/A N/A N/A N/A "$7,568.57 " N/A "$7,648.24 " N/A N/A N/A N/A N/A "$10,197.65 " "$7,966.91 " N/A N/A N/A N/A "$8,205.92 " N/A N/A "$11,153.68 " "$30,066.46 " "$7,966.91 " "$10,755.33 " "$9,799.30 " N/A "$8,205.92 " N/A N/A N/A N/A N/A "$7,966.91 " "$26,404.29 " "$16,332.17 " "$7,966.91 " "$7,966.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,966.91 " "$7,966.91 " "$9,161.95 " "$7,966.91 " N/A "$7,568.57 " "$30,066.46 " 330104 510 2 Pelvic evisceration radical hysterectomy & other radical GYN procs I N/A "$10,074.47 " N/A "$10,074.47 " N/A N/A N/A N/A "$9,570.74 " N/A "$9,671.49 " N/A N/A N/A N/A N/A "$12,895.32 " "$10,074.47 " N/A N/A N/A N/A "$10,376.70 " N/A N/A "$14,104.25 " "$38,339.81 " "$10,074.47 " "$13,600.53 " "$12,391.59 " N/A "$10,376.70 " N/A N/A N/A N/A N/A "$10,074.47 " "$33,669.93 " "$20,652.66 " "$10,074.47 " "$10,074.47 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,074.47 " "$10,074.47 " "$11,585.64 " "$10,074.47 " N/A "$9,570.74 " "$38,339.81 " 330104 510 3 Pelvic evisceration radical hysterectomy & other radical GYN procs I N/A "$18,231.54 " N/A "$18,231.54 " N/A N/A N/A N/A "$17,319.96 " N/A "$17,502.28 " N/A N/A N/A N/A N/A "$23,336.37 " "$18,231.54 " N/A N/A N/A N/A "$18,778.48 " N/A N/A "$25,524.15 " "$70,360.96 " "$18,231.54 " "$24,612.58 " "$22,424.79 " N/A "$18,778.48 " N/A N/A N/A N/A N/A "$18,231.54 " "$61,790.82 " "$37,374.65 " "$18,231.54 " "$18,231.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,231.54 " "$18,231.54 " "$20,966.27 " "$18,231.54 " N/A "$17,319.96 " "$70,360.96 " 330104 510 4 Pelvic evisceration radical hysterectomy & other radical GYN procs I N/A "$43,966.33 " N/A "$43,966.33 " N/A N/A N/A N/A "$41,768.01 " N/A "$42,207.68 " N/A N/A N/A N/A N/A "$56,276.90 " "$43,966.33 " N/A N/A N/A N/A "$45,285.32 " N/A N/A "$61,552.86 " "$171,384.68 " "$43,966.33 " "$59,354.54 " "$54,078.59 " N/A "$45,285.32 " N/A N/A N/A N/A N/A "$43,966.33 " "$150,509.59 " "$90,130.98 " "$43,966.33 " "$43,966.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,966.33 " "$43,966.33 " "$50,561.28 " "$43,966.33 " N/A "$41,768.01 " "$171,384.68 " 330104 511 1 Uterine & adnexa procedures for ovarian & adnexal malignancy I N/A "$9,032.95 " N/A "$9,032.95 " N/A N/A N/A N/A "$8,581.30 " N/A "$8,671.63 " N/A N/A N/A N/A N/A "$11,562.18 " "$9,032.95 " N/A N/A N/A N/A "$9,303.94 " N/A N/A "$12,646.13 " "$34,251.27 " "$9,032.95 " "$12,194.48 " "$11,110.53 " N/A "$9,303.94 " N/A N/A N/A N/A N/A "$9,032.95 " "$30,079.37 " "$18,517.55 " "$9,032.95 " "$9,032.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,032.95 " "$9,032.95 " "$10,387.89 " "$9,032.95 " N/A "$8,581.30 " "$34,251.27 " 330104 511 2 Uterine & adnexa procedures for ovarian & adnexal malignancy I N/A "$10,796.51 " N/A "$10,796.51 " N/A N/A N/A N/A "$10,256.69 " N/A "$10,364.65 " N/A N/A N/A N/A N/A "$13,819.54 " "$10,796.51 " N/A N/A N/A N/A "$11,120.41 " N/A N/A "$15,115.12 " "$41,174.25 " "$10,796.51 " "$14,575.29 " "$13,279.71 " N/A "$11,120.41 " N/A N/A N/A N/A N/A "$10,796.51 " "$36,159.12 " "$22,132.85 " "$10,796.51 " "$10,796.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,796.51 " "$10,796.51 " "$12,415.99 " "$10,796.51 " N/A "$10,256.69 " "$41,174.25 " 330104 511 3 Uterine & adnexa procedures for ovarian & adnexal malignancy I N/A "$17,704.99 " N/A "$17,704.99 " N/A N/A N/A N/A "$16,819.74 " N/A "$16,996.79 " N/A N/A N/A N/A N/A "$22,662.39 " "$17,704.99 " N/A N/A N/A N/A "$18,236.14 " N/A N/A "$24,786.99 " "$68,293.96 " "$17,704.99 " "$23,901.74 " "$21,777.14 " N/A "$18,236.14 " N/A N/A N/A N/A N/A "$17,704.99 " "$59,975.58 " "$36,295.23 " "$17,704.99 " "$17,704.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,704.99 " "$17,704.99 " "$20,360.74 " "$17,704.99 " N/A "$16,819.74 " "$68,293.96 " 330104 511 4 Uterine & adnexa procedures for ovarian & adnexal malignancy I N/A "$42,720.46 " N/A "$42,720.46 " N/A N/A N/A N/A "$40,584.44 " N/A "$41,011.64 " N/A N/A N/A N/A N/A "$54,682.19 " "$42,720.46 " N/A N/A N/A N/A "$44,002.07 " N/A N/A "$59,808.64 " "$166,493.94 " "$42,720.46 " "$57,672.62 " "$52,546.17 " N/A "$44,002.07 " N/A N/A N/A N/A N/A "$42,720.46 " "$146,214.55 " "$87,576.94 " "$42,720.46 " "$42,720.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,720.46 " "$42,720.46 " "$49,128.53 " "$42,720.46 " N/A "$40,584.44 " "$166,493.94 " 330104 512 1 Uterine & adnexa procedures for non-ovarian & non-adnexal malig I N/A "$7,767.33 " N/A "$7,767.33 " N/A N/A N/A N/A "$7,378.96 " N/A "$7,456.63 " N/A N/A N/A N/A N/A "$9,942.18 " "$7,767.33 " N/A N/A N/A N/A "$8,000.35 " N/A N/A "$10,874.26 " "$29,282.97 " "$7,767.33 " "$10,485.89 " "$9,553.81 " N/A "$8,000.35 " N/A N/A N/A N/A N/A "$7,767.33 " "$25,716.23 " "$15,923.02 " "$7,767.33 " "$7,767.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,767.33 " "$7,767.33 " "$8,932.43 " "$7,767.33 " N/A "$7,378.96 " "$29,282.97 " 330104 512 2 Uterine & adnexa procedures for non-ovarian & non-adnexal malig I N/A "$9,548.60 " N/A "$9,548.60 " N/A N/A N/A N/A "$9,071.17 " N/A "$9,166.66 " N/A N/A N/A N/A N/A "$12,222.21 " "$9,548.60 " N/A N/A N/A N/A "$9,835.06 " N/A N/A "$13,368.04 " "$36,275.48 " "$9,548.60 " "$12,890.61 " "$11,744.78 " N/A "$9,835.06 " N/A N/A N/A N/A N/A "$9,548.60 " "$31,857.04 " "$19,574.63 " "$9,548.60 " "$9,548.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,548.60 " "$9,548.60 " "$10,980.89 " "$9,548.60 " N/A "$9,071.17 " "$36,275.48 " 330104 512 3 Uterine & adnexa procedures for non-ovarian & non-adnexal malig I N/A "$16,006.14 " N/A "$16,006.14 " N/A N/A N/A N/A "$15,205.83 " N/A "$15,365.89 " N/A N/A N/A N/A N/A "$20,487.86 " "$16,006.14 " N/A N/A N/A N/A "$16,486.32 " N/A N/A "$22,408.59 " "$61,625.00 " "$16,006.14 " "$21,608.29 " "$19,687.55 " N/A "$16,486.32 " N/A N/A N/A N/A N/A "$16,006.14 " "$54,118.92 " "$32,812.59 " "$16,006.14 " "$16,006.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,006.14 " "$16,006.14 " "$18,407.06 " "$16,006.14 " N/A "$15,205.83 " "$61,625.00 " 330104 512 4 Uterine & adnexa procedures for non-ovarian & non-adnexal malig I N/A "$51,419.06 " N/A "$51,419.06 " N/A N/A N/A N/A "$48,848.11 " N/A "$49,362.30 " N/A N/A N/A N/A N/A "$65,816.40 " "$51,419.06 " N/A N/A N/A N/A "$52,961.64 " N/A N/A "$71,986.69 " "$200,640.92 " "$51,419.06 " "$69,415.74 " "$63,245.45 " N/A "$52,961.64 " N/A N/A N/A N/A N/A "$51,419.06 " "$176,202.34 " "$105,409.08 " "$51,419.06 " "$51,419.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$51,419.06 " "$51,419.06 " "$59,131.92 " "$51,419.06 " N/A "$48,848.11 " "$200,640.92 " 330104 513 1 Uterine & adnexa procedures for non-malignancy except leiomyoma I N/A "$6,252.39 " N/A "$6,252.39 " N/A N/A N/A N/A "$5,939.77 " N/A "$6,002.30 " N/A N/A N/A N/A N/A "$8,003.06 " "$6,252.39 " N/A N/A N/A N/A "$6,439.97 " N/A N/A "$8,753.35 " "$23,336.00 " "$6,252.39 " "$8,440.73 " "$7,690.44 " N/A "$6,439.97 " N/A N/A N/A N/A N/A "$6,252.39 " "$20,493.61 " "$12,817.41 " "$6,252.39 " "$6,252.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,252.39 " "$6,252.39 " "$7,190.25 " "$6,252.39 " N/A "$5,939.77 " "$23,336.00 " 330104 513 2 Uterine & adnexa procedures for non-malignancy except leiomyoma I N/A "$7,379.74 " N/A "$7,379.74 " N/A N/A N/A N/A "$7,010.75 " N/A "$7,084.55 " N/A N/A N/A N/A N/A "$9,446.07 " "$7,379.74 " N/A N/A N/A N/A "$7,601.13 " N/A N/A "$10,331.63 " "$27,761.47 " "$7,379.74 " "$9,962.65 " "$9,077.08 " N/A "$7,601.13 " N/A N/A N/A N/A N/A "$7,379.74 " "$24,380.05 " "$15,128.46 " "$7,379.74 " "$7,379.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,379.74 " "$7,379.74 " "$8,486.70 " "$7,379.74 " N/A "$7,010.75 " "$27,761.47 " 330104 513 3 Uterine & adnexa procedures for non-malignancy except leiomyoma I N/A "$12,910.88 " N/A "$12,910.88 " N/A N/A N/A N/A "$12,265.34 " N/A "$12,394.44 " N/A N/A N/A N/A N/A "$16,525.93 " "$12,910.88 " N/A N/A N/A N/A "$13,298.21 " N/A N/A "$18,075.23 " "$49,474.35 " "$12,910.88 " "$17,429.69 " "$15,880.38 " N/A "$13,298.21 " N/A N/A N/A N/A N/A "$12,910.88 " "$43,448.25 " "$26,467.30 " "$12,910.88 " "$12,910.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,910.88 " "$12,910.88 " "$14,847.51 " "$12,910.88 " N/A "$12,265.34 " "$49,474.35 " 330104 513 4 Uterine & adnexa procedures for non-malignancy except leiomyoma I N/A "$33,015.08 " N/A "$33,015.08 " N/A N/A N/A N/A "$31,364.32 " N/A "$31,694.48 " N/A N/A N/A N/A N/A "$42,259.30 " "$33,015.08 " N/A N/A N/A N/A "$34,005.53 " N/A N/A "$46,221.11 " "$128,394.78 " "$33,015.08 " "$44,570.36 " "$40,608.55 " N/A "$34,005.53 " N/A N/A N/A N/A N/A "$33,015.08 " "$112,755.97 " "$67,680.91 " "$33,015.08 " "$33,015.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$33,015.08 " "$33,015.08 " "$37,967.34 " "$33,015.08 " N/A "$31,364.32 " "$128,394.78 " 330104 514 1 Female reproductive system reconstructive procedures I N/A "$7,080.02 " N/A "$7,080.02 " N/A N/A N/A N/A "$6,726.02 " N/A "$6,796.82 " N/A N/A N/A N/A N/A "$9,062.43 " "$7,080.02 " N/A N/A N/A N/A "$7,292.42 " N/A N/A "$9,912.03 " "$26,584.91 " "$7,080.02 " "$9,558.03 " "$8,708.43 " N/A "$7,292.42 " N/A N/A N/A N/A N/A "$7,080.02 " "$23,346.80 " "$14,514.04 " "$7,080.02 " "$7,080.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,080.02 " "$7,080.02 " "$8,142.03 " "$7,080.02 " N/A "$6,726.02 " "$26,584.91 " 330104 514 2 Female reproductive system reconstructive procedures I N/A "$7,080.02 " N/A "$7,080.02 " N/A N/A N/A N/A "$6,726.02 " N/A "$6,796.82 " N/A N/A N/A N/A N/A "$9,062.43 " "$7,080.02 " N/A N/A N/A N/A "$7,292.42 " N/A N/A "$9,912.03 " "$26,584.91 " "$7,080.02 " "$9,558.03 " "$8,708.43 " N/A "$7,292.42 " N/A N/A N/A N/A N/A "$7,080.02 " "$23,346.80 " "$14,514.04 " "$7,080.02 " "$7,080.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,080.02 " "$7,080.02 " "$8,142.03 " "$7,080.02 " N/A "$6,726.02 " "$26,584.91 " 330104 514 3 Female reproductive system reconstructive procedures I N/A "$7,080.02 " N/A "$7,080.02 " N/A N/A N/A N/A "$6,726.02 " N/A "$6,796.82 " N/A N/A N/A N/A N/A "$9,062.43 " "$7,080.02 " N/A N/A N/A N/A "$7,292.42 " N/A N/A "$9,912.03 " "$26,584.91 " "$7,080.02 " "$9,558.03 " "$8,708.43 " N/A "$7,292.42 " N/A N/A N/A N/A N/A "$7,080.02 " "$23,346.80 " "$14,514.04 " "$7,080.02 " "$7,080.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,080.02 " "$7,080.02 " "$8,142.03 " "$7,080.02 " N/A "$6,726.02 " "$26,584.91 " 330104 514 4 Female reproductive system reconstructive procedures I N/A "$21,595.18 " N/A "$21,595.18 " N/A N/A N/A N/A "$20,515.42 " N/A "$20,731.37 " N/A N/A N/A N/A N/A "$27,641.83 " "$21,595.18 " N/A N/A N/A N/A "$22,243.04 " N/A N/A "$30,233.25 " "$83,565.17 " "$21,595.18 " "$29,153.49 " "$26,562.07 " N/A "$22,243.04 " N/A N/A N/A N/A N/A "$21,595.18 " "$73,386.72 " "$44,270.12 " "$21,595.18 " "$21,595.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,595.18 " "$21,595.18 " "$24,834.46 " "$21,595.18 " N/A "$20,515.42 " "$83,565.17 " 330104 517 1 Dilation & curettage for non-obstetric diagnoses I N/A "$4,855.99 " N/A "$4,855.99 " N/A N/A N/A N/A "$4,613.19 " N/A "$4,661.75 " N/A N/A N/A N/A N/A "$6,215.66 " "$4,855.99 " N/A N/A N/A N/A "$5,001.67 " N/A N/A "$6,798.38 " "$17,854.30 " "$4,855.99 " "$6,555.58 " "$5,972.86 " N/A "$5,001.67 " N/A N/A N/A N/A N/A "$4,855.99 " "$15,679.60 " "$9,954.77 " "$4,855.99 " "$4,855.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,855.99 " "$4,855.99 " "$5,584.38 " "$4,855.99 " N/A "$4,613.19 " "$17,854.30 " 330104 517 2 Dilation & curettage for non-obstetric diagnoses I N/A "$6,673.36 " N/A "$6,673.36 " N/A N/A N/A N/A "$6,339.69 " N/A "$6,406.43 " N/A N/A N/A N/A N/A "$8,541.90 " "$6,673.36 " N/A N/A N/A N/A "$6,873.56 " N/A N/A "$9,342.70 " "$24,988.53 " "$6,673.36 " "$9,009.04 " "$8,208.23 " N/A "$6,873.56 " N/A N/A N/A N/A N/A "$6,673.36 " "$21,944.86 " "$13,680.39 " "$6,673.36 " "$6,673.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,673.36 " "$6,673.36 " "$7,674.36 " "$6,673.36 " N/A "$6,339.69 " "$24,988.53 " 330104 517 3 Dilation & curettage for non-obstetric diagnoses I N/A "$14,175.82 " N/A "$14,175.82 " N/A N/A N/A N/A "$13,467.03 " N/A "$13,608.79 " N/A N/A N/A N/A N/A "$18,145.05 " "$14,175.82 " N/A N/A N/A N/A "$14,601.10 " N/A N/A "$19,846.15 " "$54,439.97 " "$14,175.82 " "$19,137.36 " "$17,436.26 " N/A "$14,601.10 " N/A N/A N/A N/A N/A "$14,175.82 " "$47,809.04 " "$29,060.43 " "$14,175.82 " "$14,175.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,175.82 " "$14,175.82 " "$16,302.20 " "$14,175.82 " N/A "$13,467.03 " "$54,439.97 " 330104 517 4 Dilation & curettage for non-obstetric diagnoses I N/A "$14,952.36 " N/A "$14,952.36 " N/A N/A N/A N/A "$14,204.74 " N/A "$14,354.27 " N/A N/A N/A N/A N/A "$19,139.02 " "$14,952.36 " N/A N/A N/A N/A "$15,400.93 " N/A N/A "$20,933.31 " "$57,488.33 " "$14,952.36 " "$20,185.69 " "$18,391.40 " N/A "$15,400.93 " N/A N/A N/A N/A N/A "$14,952.36 " "$50,486.10 " "$30,652.34 " "$14,952.36 " "$14,952.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,952.36 " "$14,952.36 " "$17,195.22 " "$14,952.36 " N/A "$14,204.74 " "$57,488.33 " 330104 518 1 Other female reproductive system & related procedures I N/A "$5,456.78 " N/A "$5,456.78 " N/A N/A N/A N/A "$5,183.94 " N/A "$5,238.51 " N/A N/A N/A N/A N/A "$6,984.68 " "$5,456.78 " N/A N/A N/A N/A "$5,620.49 " N/A N/A "$7,639.49 " "$20,212.77 " "$5,456.78 " "$7,366.66 " "$6,711.84 " N/A "$5,620.49 " N/A N/A N/A N/A N/A "$5,456.78 " "$17,750.80 " "$11,186.40 " "$5,456.78 " "$5,456.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,456.78 " "$5,456.78 " "$6,275.30 " "$5,456.78 " N/A "$5,183.94 " "$20,212.77 " 330104 518 2 Other female reproductive system & related procedures I N/A "$7,681.50 " N/A "$7,681.50 " N/A N/A N/A N/A "$7,297.42 " N/A "$7,374.24 " N/A N/A N/A N/A N/A "$9,832.32 " "$7,681.50 " N/A N/A N/A N/A "$7,911.94 " N/A N/A "$10,754.10 " "$28,946.05 " "$7,681.50 " "$10,370.02 " "$9,448.24 " N/A "$7,911.94 " N/A N/A N/A N/A N/A "$7,681.50 " "$25,420.35 " "$15,747.07 " "$7,681.50 " "$7,681.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,681.50 " "$7,681.50 " "$8,833.72 " "$7,681.50 " N/A "$7,297.42 " "$28,946.05 " 330104 518 3 Other female reproductive system & related procedures I N/A "$14,740.52 " N/A "$14,740.52 " N/A N/A N/A N/A "$14,003.49 " N/A "$14,150.90 " N/A N/A N/A N/A N/A "$18,867.86 " "$14,740.52 " N/A N/A N/A N/A "$15,182.73 " N/A N/A "$20,636.72 " "$56,656.71 " "$14,740.52 " "$19,899.70 " "$18,130.83 " N/A "$15,182.73 " N/A N/A N/A N/A N/A "$14,740.52 " "$49,755.78 " "$30,218.06 " "$14,740.52 " "$14,740.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,740.52 " "$14,740.52 " "$16,951.59 " "$14,740.52 " N/A "$14,003.49 " "$56,656.71 " 330104 518 4 Other female reproductive system & related procedures I N/A "$41,027.74 " N/A "$41,027.74 " N/A N/A N/A N/A "$38,976.35 " N/A "$39,386.63 " N/A N/A N/A N/A N/A "$52,515.51 " "$41,027.74 " N/A N/A N/A N/A "$42,258.57 " N/A N/A "$57,438.84 " "$159,849.05 " "$41,027.74 " "$55,387.45 " "$50,464.12 " N/A "$42,258.57 " N/A N/A N/A N/A N/A "$41,027.74 " "$140,379.03 " "$84,106.87 " "$41,027.74 " "$41,027.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,027.74 " "$41,027.74 " "$47,181.90 " "$41,027.74 " N/A "$38,976.35 " "$159,849.05 " 330104 519 1 Uterine & adnexa procedures for leiomyoma I N/A "$6,157.71 " N/A "$6,157.71 " N/A N/A N/A N/A "$5,849.83 " N/A "$5,911.40 " N/A N/A N/A N/A N/A "$7,881.87 " "$6,157.71 " N/A N/A N/A N/A "$6,342.44 " N/A N/A "$8,620.80 " "$22,964.31 " "$6,157.71 " "$8,312.91 " "$7,573.98 " N/A "$6,342.44 " N/A N/A N/A N/A N/A "$6,157.71 " "$20,167.20 " "$12,623.31 " "$6,157.71 " "$6,157.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,157.71 " "$6,157.71 " "$7,081.37 " "$6,157.71 " N/A "$5,849.83 " "$22,964.31 " 330104 519 2 Uterine & adnexa procedures for leiomyoma I N/A "$7,631.09 " N/A "$7,631.09 " N/A N/A N/A N/A "$7,249.54 " N/A "$7,325.85 " N/A N/A N/A N/A N/A "$9,767.80 " "$7,631.09 " N/A N/A N/A N/A "$7,860.03 " N/A N/A "$10,683.53 " "$28,748.17 " "$7,631.09 " "$10,301.97 " "$9,386.24 " N/A "$7,860.03 " N/A N/A N/A N/A N/A "$7,631.09 " "$25,246.57 " "$15,643.74 " "$7,631.09 " "$7,631.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,631.09 " "$7,631.09 " "$8,775.76 " "$7,631.09 " N/A "$7,249.54 " "$28,748.17 " 330104 519 3 Uterine & adnexa procedures for leiomyoma I N/A "$13,790.28 " N/A "$13,790.28 " N/A N/A N/A N/A "$13,100.76 " N/A "$13,238.67 " N/A N/A N/A N/A N/A "$17,651.55 " "$13,790.28 " N/A N/A N/A N/A "$14,203.99 " N/A N/A "$19,306.39 " "$52,926.48 " "$13,790.28 " "$18,616.87 " "$16,962.04 " N/A "$14,203.99 " N/A N/A N/A N/A N/A "$13,790.28 " "$46,479.90 " "$28,270.07 " "$13,790.28 " "$13,790.28 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,790.28 " "$13,790.28 " "$15,858.82 " "$13,790.28 " N/A "$13,100.76 " "$52,926.48 " 330104 519 4 Uterine & adnexa procedures for leiomyoma I N/A "$41,510.69 " N/A "$41,510.69 " N/A N/A N/A N/A "$39,435.16 " N/A "$39,850.27 " N/A N/A N/A N/A N/A "$53,133.69 " "$41,510.69 " N/A N/A N/A N/A "$42,756.01 " N/A N/A "$58,114.97 " "$161,744.91 " "$41,510.69 " "$56,039.44 " "$51,058.15 " N/A "$42,756.01 " N/A N/A N/A N/A N/A "$41,510.69 " "$142,043.97 " "$85,096.92 " "$41,510.69 " "$41,510.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,510.69 " "$41,510.69 " "$47,737.30 " "$41,510.69 " N/A "$39,435.16 " "$161,744.91 " 330104 530 1 Female reproductive system malignancy I N/A "$4,464.31 " N/A "$4,464.31 " N/A N/A N/A N/A "$4,241.09 " N/A "$4,285.74 " N/A N/A N/A N/A N/A "$5,714.32 " "$4,464.31 " N/A N/A N/A N/A "$4,598.24 " N/A N/A "$6,250.03 " "$16,316.75 " "$4,464.31 " "$6,026.82 " "$5,491.10 " N/A "$4,598.24 " N/A N/A N/A N/A N/A "$4,464.31 " "$14,329.33 " "$9,151.84 " "$4,464.31 " "$4,464.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,464.31 " "$4,464.31 " "$5,133.96 " "$4,464.31 " N/A "$4,241.09 " "$16,316.75 " 330104 530 2 Female reproductive system malignancy I N/A "$5,636.61 " N/A "$5,636.61 " N/A N/A N/A N/A "$5,354.78 " N/A "$5,411.15 " N/A N/A N/A N/A N/A "$7,214.86 " "$5,636.61 " N/A N/A N/A N/A "$5,805.71 " N/A N/A "$7,891.26 " "$20,918.70 " "$5,636.61 " "$7,609.43 " "$6,933.03 " N/A "$5,805.71 " N/A N/A N/A N/A N/A "$5,636.61 " "$18,370.75 " "$11,555.05 " "$5,636.61 " "$5,636.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,636.61 " "$5,636.61 " "$6,482.10 " "$5,636.61 " N/A "$5,354.78 " "$20,918.70 " 330104 530 3 Female reproductive system malignancy I N/A "$10,197.76 " N/A "$10,197.76 " N/A N/A N/A N/A "$9,687.87 " N/A "$9,789.85 " N/A N/A N/A N/A N/A "$13,053.13 " "$10,197.76 " N/A N/A N/A N/A "$10,503.69 " N/A N/A "$14,276.86 " "$38,823.81 " "$10,197.76 " "$13,766.98 " "$12,543.24 " N/A "$10,503.69 " N/A N/A N/A N/A N/A "$10,197.76 " "$34,094.97 " "$20,905.41 " "$10,197.76 " "$10,197.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,197.76 " "$10,197.76 " "$11,727.42 " "$10,197.76 " N/A "$9,687.87 " "$38,823.81 " 330104 530 4 Female reproductive system malignancy I N/A "$17,385.52 " N/A "$17,385.52 " N/A N/A N/A N/A "$16,516.24 " N/A "$16,690.10 " N/A N/A N/A N/A N/A "$22,253.46 " "$17,385.52 " N/A N/A N/A N/A "$17,907.08 " N/A N/A "$24,339.73 " "$67,039.85 " "$17,385.52 " "$23,470.45 " "$21,384.19 " N/A "$17,907.08 " N/A N/A N/A N/A N/A "$17,385.52 " "$58,874.23 " "$35,640.31 " "$17,385.52 " "$17,385.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,385.52 " "$17,385.52 " "$19,993.35 " "$17,385.52 " N/A "$16,516.24 " "$67,039.85 " 330104 531 1 Female reproductive system infections I N/A "$3,986.12 " N/A "$3,986.12 " N/A N/A N/A N/A "$3,786.82 " N/A "$3,826.68 " N/A N/A N/A N/A N/A "$5,102.24 " "$3,986.12 " N/A N/A N/A N/A "$4,105.71 " N/A N/A "$5,580.57 " "$14,439.60 " "$3,986.12 " "$5,381.27 " "$4,902.93 " N/A "$4,105.71 " N/A N/A N/A N/A N/A "$3,986.12 " "$12,680.82 " "$8,171.56 " "$3,986.12 " "$3,986.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,986.12 " "$3,986.12 " "$4,584.04 " "$3,986.12 " N/A "$3,786.82 " "$14,439.60 " 330104 531 2 Female reproductive system infections I N/A "$5,282.40 " N/A "$5,282.40 " N/A N/A N/A N/A "$5,018.28 " N/A "$5,071.10 " N/A N/A N/A N/A N/A "$6,761.47 " "$5,282.40 " N/A N/A N/A N/A "$5,440.87 " N/A N/A "$7,395.36 " "$19,528.22 " "$5,282.40 " "$7,131.24 " "$6,497.35 " N/A "$5,440.87 " N/A N/A N/A N/A N/A "$5,282.40 " "$17,149.63 " "$10,828.92 " "$5,282.40 " "$5,282.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,282.40 " "$5,282.40 " "$6,074.76 " "$5,282.40 " N/A "$5,018.28 " "$19,528.22 " 330104 531 3 Female reproductive system infections I N/A "$8,202.60 " N/A "$8,202.60 " N/A N/A N/A N/A "$7,792.47 " N/A "$7,874.49 " N/A N/A N/A N/A N/A "$10,499.33 " "$8,202.60 " N/A N/A N/A N/A "$8,448.68 " N/A N/A "$11,483.64 " "$30,991.66 " "$8,202.60 " "$11,073.51 " "$10,089.20 " N/A "$8,448.68 " N/A N/A N/A N/A N/A "$8,202.60 " "$27,216.80 " "$16,815.33 " "$8,202.60 " "$8,202.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,202.60 " "$8,202.60 " "$9,432.99 " "$8,202.60 " N/A "$7,792.47 " "$30,991.66 " 330104 531 4 Female reproductive system infections I N/A "$9,176.00 " N/A "$9,176.00 " N/A N/A N/A N/A "$8,717.20 " N/A "$8,808.96 " N/A N/A N/A N/A N/A "$11,745.28 " "$9,176.00 " N/A N/A N/A N/A "$9,451.28 " N/A N/A "$12,846.40 " "$34,812.81 " "$9,176.00 " "$12,387.60 " "$11,286.48 " N/A "$9,451.28 " N/A N/A N/A N/A N/A "$9,176.00 " "$30,572.52 " "$18,810.79 " "$9,176.00 " "$9,176.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,176.00 " "$9,176.00 " "$10,552.40 " "$9,176.00 " N/A "$8,717.20 " "$34,812.81 " 330104 532 1 Menstrual & other female reproductive system disorders I N/A "$3,057.68 " N/A "$3,057.68 " N/A N/A N/A N/A "$2,904.80 " N/A "$2,935.38 " N/A N/A N/A N/A N/A "$3,913.83 " "$3,057.68 " N/A N/A N/A N/A "$3,149.41 " N/A N/A "$4,280.76 " "$10,794.94 " "$3,057.68 " "$4,127.87 " "$3,760.95 " N/A "$3,149.41 " N/A N/A N/A N/A N/A "$3,057.68 " "$9,480.09 " "$6,268.25 " "$3,057.68 " "$3,057.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,057.68 " "$3,057.68 " "$3,516.34 " "$3,057.68 " N/A "$2,904.80 " "$10,794.94 " 330104 532 2 Menstrual & other female reproductive system disorders I N/A "$4,113.50 " N/A "$4,113.50 " N/A N/A N/A N/A "$3,907.83 " N/A "$3,948.96 " N/A N/A N/A N/A N/A "$5,265.29 " "$4,113.50 " N/A N/A N/A N/A "$4,236.91 " N/A N/A "$5,758.91 " "$14,939.64 " "$4,113.50 " "$5,553.23 " "$5,059.61 " N/A "$4,236.91 " N/A N/A N/A N/A N/A "$4,113.50 " "$13,119.95 " "$8,432.68 " "$4,113.50 " "$4,113.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,113.50 " "$4,113.50 " "$4,730.53 " "$4,113.50 " N/A "$3,907.83 " "$14,939.64 " 330104 532 3 Menstrual & other female reproductive system disorders I N/A "$6,919.95 " N/A "$6,919.95 " N/A N/A N/A N/A "$6,573.95 " N/A "$6,643.15 " N/A N/A N/A N/A N/A "$8,857.53 " "$6,919.95 " N/A N/A N/A N/A "$7,127.54 " N/A N/A "$9,687.92 " "$25,956.52 " "$6,919.95 " "$9,341.93 " "$8,511.53 " N/A "$7,127.54 " N/A N/A N/A N/A N/A "$6,919.95 " "$22,794.95 " "$14,185.89 " "$6,919.95 " "$6,919.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,919.95 " "$6,919.95 " "$7,957.94 " "$6,919.95 " N/A "$6,573.95 " "$25,956.52 " 330104 532 4 Menstrual & other female reproductive system disorders I N/A "$7,315.71 " N/A "$7,315.71 " N/A N/A N/A N/A "$6,949.92 " N/A "$7,023.08 " N/A N/A N/A N/A N/A "$9,364.11 " "$7,315.71 " N/A N/A N/A N/A "$7,535.18 " N/A N/A "$10,241.99 " "$27,510.11 " "$7,315.71 " "$9,876.21 " "$8,998.32 " N/A "$7,535.18 " N/A N/A N/A N/A N/A "$7,315.71 " "$24,159.31 " "$14,997.20 " "$7,315.71 " "$7,315.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,315.71 " "$7,315.71 " "$8,413.06 " "$7,315.71 " N/A "$6,949.92 " "$27,510.11 " 330104 540 1 Cesarean delivery I N/A "$5,764.67 " N/A "$5,764.67 " N/A N/A N/A N/A "$5,476.44 " N/A "$5,534.09 " N/A N/A N/A N/A N/A "$7,378.78 " "$5,764.67 " N/A N/A N/A N/A "$5,937.61 " N/A N/A "$8,070.54 " "$21,421.41 " "$5,764.67 " "$7,782.31 " "$7,090.55 " N/A "$5,937.61 " N/A N/A N/A N/A N/A "$5,764.67 " "$18,812.23 " "$11,817.58 " "$5,764.67 " "$5,764.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,764.67 " "$5,764.67 " "$6,629.37 " "$5,764.67 " N/A "$5,476.44 " "$21,421.41 " 330104 540 2 Cesarean delivery I N/A "$6,565.73 " N/A "$6,565.73 " N/A N/A N/A N/A "$6,237.45 " N/A "$6,303.11 " N/A N/A N/A N/A N/A "$8,404.14 " "$6,565.73 " N/A N/A N/A N/A "$6,762.71 " N/A N/A "$9,192.03 " "$24,566.04 " "$6,565.73 " "$8,863.74 " "$8,075.85 " N/A "$6,762.71 " N/A N/A N/A N/A N/A "$6,565.73 " "$21,573.83 " "$13,459.76 " "$6,565.73 " "$6,565.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,565.73 " "$6,565.73 " "$7,550.59 " "$6,565.73 " N/A "$6,237.45 " "$24,566.04 " 330104 540 3 Cesarean delivery I N/A "$8,321.12 " N/A "$8,321.12 " N/A N/A N/A N/A "$7,905.07 " N/A "$7,988.28 " N/A N/A N/A N/A N/A "$10,651.04 " "$8,321.12 " N/A N/A N/A N/A "$8,570.76 " N/A N/A "$11,649.57 " "$31,456.94 " "$8,321.12 " "$11,233.52 " "$10,234.98 " N/A "$8,570.76 " N/A N/A N/A N/A N/A "$8,321.12 " "$27,625.40 " "$17,058.30 " "$8,321.12 " "$8,321.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,321.12 " "$8,321.12 " "$9,569.29 " "$8,321.12 " N/A "$7,905.07 " "$31,456.94 " 330104 540 4 Cesarean delivery I N/A "$18,737.65 " N/A "$18,737.65 " N/A N/A N/A N/A "$17,800.77 " N/A "$17,988.14 " N/A N/A N/A N/A N/A "$23,984.19 " "$18,737.65 " N/A N/A N/A N/A "$19,299.78 " N/A N/A "$26,232.71 " "$72,347.74 " "$18,737.65 " "$25,295.83 " "$23,047.31 " N/A "$19,299.78 " N/A N/A N/A N/A N/A "$18,737.65 " "$63,535.60 " "$38,412.18 " "$18,737.65 " "$18,737.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,737.65 " "$18,737.65 " "$21,548.30 " "$18,737.65 " N/A "$17,800.77 " "$72,347.74 " 330104 541 1 Vaginal delivery w sterilization &/or D&C I N/A "$5,097.12 " N/A "$5,097.12 " N/A N/A N/A N/A "$4,842.27 " N/A "$4,893.24 " N/A N/A N/A N/A N/A "$6,524.32 " "$5,097.12 " N/A N/A N/A N/A "$5,250.04 " N/A N/A "$7,135.97 " "$18,800.89 " "$5,097.12 " "$6,881.11 " "$6,269.46 " N/A "$5,250.04 " N/A N/A N/A N/A N/A "$5,097.12 " "$16,510.90 " "$10,449.10 " "$5,097.12 " "$5,097.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,097.12 " "$5,097.12 " "$5,861.69 " "$5,097.12 " N/A "$4,842.27 " "$18,800.89 " 330104 541 2 Vaginal delivery w sterilization &/or D&C I N/A "$5,485.39 " N/A "$5,485.39 " N/A N/A N/A N/A "$5,211.12 " N/A "$5,265.98 " N/A N/A N/A N/A N/A "$7,021.30 " "$5,485.39 " N/A N/A N/A N/A "$5,649.95 " N/A N/A "$7,679.55 " "$20,325.07 " "$5,485.39 " "$7,405.28 " "$6,747.03 " N/A "$5,649.95 " N/A N/A N/A N/A N/A "$5,485.39 " "$17,849.43 " "$11,245.05 " "$5,485.39 " "$5,485.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,485.39 " "$5,485.39 " "$6,308.20 " "$5,485.39 " N/A "$5,211.12 " "$20,325.07 " 330104 541 3 Vaginal delivery w sterilization &/or D&C I N/A "$7,090.92 " N/A "$7,090.92 " N/A N/A N/A N/A "$6,736.37 " N/A "$6,807.28 " N/A N/A N/A N/A N/A "$9,076.38 " "$7,090.92 " N/A N/A N/A N/A "$7,303.65 " N/A N/A "$9,927.29 " "$26,627.69 " "$7,090.92 " "$9,572.74 " "$8,721.83 " N/A "$7,303.65 " N/A N/A N/A N/A N/A "$7,090.92 " "$23,384.37 " "$14,536.39 " "$7,090.92 " "$7,090.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,090.92 " "$7,090.92 " "$8,154.56 " "$7,090.92 " N/A "$6,736.37 " "$26,627.69 " 330104 541 4 Vaginal delivery w sterilization &/or D&C I N/A "$7,738.72 " N/A "$7,738.72 " N/A N/A N/A N/A "$7,351.78 " N/A "$7,429.17 " N/A N/A N/A N/A N/A "$9,905.56 " "$7,738.72 " N/A N/A N/A N/A "$7,970.88 " N/A N/A "$10,834.21 " "$29,170.67 " "$7,738.72 " "$10,447.27 " "$9,518.62 " N/A "$7,970.88 " N/A N/A N/A N/A N/A "$7,738.72 " "$25,617.60 " "$15,864.37 " "$7,738.72 " "$7,738.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,738.72 " "$7,738.72 " "$8,899.53 " "$7,738.72 " N/A "$7,351.78 " "$29,170.67 " 330104 542 1 Vaginal delivery w complicating procedures exc sterilization &/or D&C I N/A "$4,361.45 " N/A "$4,361.45 " N/A N/A N/A N/A "$4,143.38 " N/A "$4,186.99 " N/A N/A N/A N/A N/A "$5,582.66 " "$4,361.45 " N/A N/A N/A N/A "$4,492.30 " N/A N/A "$6,106.03 " "$15,912.97 " "$4,361.45 " "$5,887.96 " "$5,364.59 " N/A "$4,492.30 " N/A N/A N/A N/A N/A "$4,361.45 " "$13,974.73 " "$8,940.98 " "$4,361.45 " "$4,361.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,361.45 " "$4,361.45 " "$5,015.67 " "$4,361.45 " N/A "$4,143.38 " "$15,912.97 " 330104 542 2 Vaginal delivery w complicating procedures exc sterilization &/or D&C I N/A "$4,927.51 " N/A "$4,927.51 " N/A N/A N/A N/A "$4,681.13 " N/A "$4,730.41 " N/A N/A N/A N/A N/A "$6,307.21 " "$4,927.51 " N/A N/A N/A N/A "$5,075.33 " N/A N/A "$6,898.51 " "$18,135.07 " "$4,927.51 " "$6,652.14 " "$6,060.84 " N/A "$5,075.33 " N/A N/A N/A N/A N/A "$4,927.51 " "$15,926.17 " "$10,101.39 " "$4,927.51 " "$4,927.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,927.51 " "$4,927.51 " "$5,666.64 " "$4,927.51 " N/A "$4,681.13 " "$18,135.07 " 330104 542 3 Vaginal delivery w complicating procedures exc sterilization &/or D&C I N/A "$8,629.01 " N/A "$8,629.01 " N/A N/A N/A N/A "$8,197.56 " N/A "$8,283.85 " N/A N/A N/A N/A N/A "$11,045.14 " "$8,629.01 " N/A N/A N/A N/A "$8,887.88 " N/A N/A "$12,080.62 " "$32,665.58 " "$8,629.01 " "$11,649.17 " "$10,613.69 " N/A "$8,887.88 " N/A N/A N/A N/A N/A "$8,629.01 " "$28,686.83 " "$17,689.48 " "$8,629.01 " "$8,629.01 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,629.01 " "$8,629.01 " "$9,923.37 " "$8,629.01 " N/A "$8,197.56 " "$32,665.58 " 330104 542 4 Vaginal delivery w complicating procedures exc sterilization &/or D&C I N/A "$10,804.01 " N/A "$10,804.01 " N/A N/A N/A N/A "$10,263.81 " N/A "$10,371.85 " N/A N/A N/A N/A N/A "$13,829.13 " "$10,804.01 " N/A N/A N/A N/A "$11,128.13 " N/A N/A "$15,125.61 " "$41,203.67 " "$10,804.01 " "$14,585.41 " "$13,288.93 " N/A "$11,128.13 " N/A N/A N/A N/A N/A "$10,804.01 " "$36,184.95 " "$22,148.21 " "$10,804.01 " "$10,804.01 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,804.01 " "$10,804.01 " "$12,424.61 " "$10,804.01 " N/A "$10,263.81 " "$41,203.67 " 330104 544 1 D&C aspiration curettage or hysterotomy for obstetric diagnoses I N/A "$3,576.74 " N/A "$3,576.74 " N/A N/A N/A N/A "$3,397.90 " N/A "$3,433.67 " N/A N/A N/A N/A N/A "$4,578.23 " "$3,576.74 " N/A N/A N/A N/A "$3,684.04 " N/A N/A "$5,007.43 " "$12,832.53 " "$3,576.74 " "$4,828.60 " "$4,399.39 " N/A "$3,684.04 " N/A N/A N/A N/A N/A "$3,576.74 " "$11,269.49 " "$7,332.31 " "$3,576.74 " "$3,576.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,576.74 " "$3,576.74 " "$4,113.25 " "$3,576.74 " N/A "$3,397.90 " "$12,832.53 " 330104 544 2 D&C aspiration curettage or hysterotomy for obstetric diagnoses I N/A "$4,523.57 " N/A "$4,523.57 " N/A N/A N/A N/A "$4,297.39 " N/A "$4,342.63 " N/A N/A N/A N/A N/A "$5,790.17 " "$4,523.57 " N/A N/A N/A N/A "$4,659.28 " N/A N/A "$6,333.00 " "$16,549.39 " "$4,523.57 " "$6,106.82 " "$5,563.99 " N/A "$4,659.28 " N/A N/A N/A N/A N/A "$4,523.57 " "$14,533.63 " "$9,273.32 " "$4,523.57 " "$4,523.57 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,523.57 " "$4,523.57 " "$5,202.11 " "$4,523.57 " N/A "$4,297.39 " "$16,549.39 " 330104 544 3 D&C aspiration curettage or hysterotomy for obstetric diagnoses I N/A "$7,796.62 " N/A "$7,796.62 " N/A N/A N/A N/A "$7,406.79 " N/A "$7,484.75 " N/A N/A N/A N/A N/A "$9,979.67 " "$7,796.62 " N/A N/A N/A N/A "$8,030.52 " N/A N/A "$10,915.27 " "$29,397.96 " "$7,796.62 " "$10,525.43 " "$9,589.84 " N/A "$8,030.52 " N/A N/A N/A N/A N/A "$7,796.62 " "$25,817.21 " "$15,983.07 " "$7,796.62 " "$7,796.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,796.62 " "$7,796.62 " "$8,966.11 " "$7,796.62 " N/A "$7,406.79 " "$29,397.96 " 330104 544 4 D&C aspiration curettage or hysterotomy for obstetric diagnoses I N/A "$19,861.59 " N/A "$19,861.59 " N/A N/A N/A N/A "$18,868.51 " N/A "$19,067.13 " N/A N/A N/A N/A N/A "$25,422.83 " "$19,861.59 " N/A N/A N/A N/A "$20,457.44 " N/A N/A "$27,806.23 " "$76,759.84 " "$19,861.59 " "$26,813.15 " "$24,429.76 " N/A "$20,457.44 " N/A N/A N/A N/A N/A "$19,861.59 " "$67,410.30 " "$40,716.26 " "$19,861.59 " "$19,861.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,861.59 " "$19,861.59 " "$22,840.83 " "$19,861.59 " N/A "$18,868.51 " "$76,759.84 " 330104 545 1 Ectopic pregnancy procedure I N/A "$5,042.63 " N/A "$5,042.63 " N/A N/A N/A N/A "$4,790.50 " N/A "$4,840.92 " N/A N/A N/A N/A N/A "$6,454.56 " "$5,042.63 " N/A N/A N/A N/A "$5,193.91 " N/A N/A "$7,059.68 " "$18,586.97 " "$5,042.63 " "$6,807.55 " "$6,202.43 " N/A "$5,193.91 " N/A N/A N/A N/A N/A "$5,042.63 " "$16,323.03 " "$10,337.39 " "$5,042.63 " "$5,042.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,042.63 " "$5,042.63 " "$5,799.02 " "$5,042.63 " N/A "$4,790.50 " "$18,586.97 " 330104 545 2 Ectopic pregnancy procedure I N/A "$5,655.00 " N/A "$5,655.00 " N/A N/A N/A N/A "$5,372.25 " N/A "$5,428.80 " N/A N/A N/A N/A N/A "$7,238.40 " "$5,655.00 " N/A N/A N/A N/A "$5,824.65 " N/A N/A "$7,917.01 " "$20,990.90 " "$5,655.00 " "$7,634.26 " "$6,955.65 " N/A "$5,824.65 " N/A N/A N/A N/A N/A "$5,655.00 " "$18,434.16 " "$11,592.76 " "$5,655.00 " "$5,655.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,655.00 " "$5,655.00 " "$6,503.25 " "$5,655.00 " N/A "$5,372.25 " "$20,990.90 " 330104 545 3 Ectopic pregnancy procedure I N/A "$7,809.56 " N/A "$7,809.56 " N/A N/A N/A N/A "$7,419.08 " N/A "$7,497.18 " N/A N/A N/A N/A N/A "$9,996.24 " "$7,809.56 " N/A N/A N/A N/A "$8,043.85 " N/A N/A "$10,933.38 " "$29,448.76 " "$7,809.56 " "$10,542.91 " "$9,605.76 " N/A "$8,043.85 " N/A N/A N/A N/A N/A "$7,809.56 " "$25,861.83 " "$16,009.60 " "$7,809.56 " "$7,809.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,809.56 " "$7,809.56 " "$8,980.99 " "$7,809.56 " N/A "$7,419.08 " "$29,448.76 " 330104 545 4 Ectopic pregnancy procedure I N/A "$8,312.27 " N/A "$8,312.27 " N/A N/A N/A N/A "$7,896.65 " N/A "$7,979.78 " N/A N/A N/A N/A N/A "$10,639.70 " "$8,312.27 " N/A N/A N/A N/A "$8,561.64 " N/A N/A "$11,637.17 " "$31,422.17 " "$8,312.27 " "$11,221.56 " "$10,224.09 " N/A "$8,561.64 " N/A N/A N/A N/A N/A "$8,312.27 " "$27,594.87 " "$17,040.15 " "$8,312.27 " "$8,312.27 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,312.27 " "$8,312.27 " "$9,559.11 " "$8,312.27 " N/A "$7,896.65 " "$31,422.17 " 330104 546 1 Other O.R. proc for obstetric diagnoses except delivery diagnoses I N/A "$4,227.26 " N/A "$4,227.26 " N/A N/A N/A N/A "$4,015.90 " N/A "$4,058.17 " N/A N/A N/A N/A N/A "$5,410.89 " "$4,227.26 " N/A N/A N/A N/A "$4,354.08 " N/A N/A "$5,918.17 " "$15,386.20 " "$4,227.26 " "$5,706.80 " "$5,199.53 " N/A "$4,354.08 " N/A N/A N/A N/A N/A "$4,227.26 " "$13,512.12 " "$8,665.88 " "$4,227.26 " "$4,227.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,227.26 " "$4,227.26 " "$4,861.35 " "$4,227.26 " N/A "$4,015.90 " "$15,386.20 " 330104 546 2 Other O.R. proc for obstetric diagnoses except delivery diagnoses I N/A "$5,617.54 " N/A "$5,617.54 " N/A N/A N/A N/A "$5,336.66 " N/A "$5,392.84 " N/A N/A N/A N/A N/A "$7,190.45 " "$5,617.54 " N/A N/A N/A N/A "$5,786.07 " N/A N/A "$7,864.55 " "$20,843.83 " "$5,617.54 " "$7,583.68 " "$6,909.57 " N/A "$5,786.07 " N/A N/A N/A N/A N/A "$5,617.54 " "$18,305.00 " "$11,515.96 " "$5,617.54 " "$5,617.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,617.54 " "$5,617.54 " "$6,460.17 " "$5,617.54 " N/A "$5,336.66 " "$20,843.83 " 330104 546 3 Other O.R. proc for obstetric diagnoses except delivery diagnoses I N/A "$11,709.97 " N/A "$11,709.97 " N/A N/A N/A N/A "$11,124.47 " N/A "$11,241.57 " N/A N/A N/A N/A N/A "$14,988.76 " "$11,709.97 " N/A N/A N/A N/A "$12,061.27 " N/A N/A "$16,393.96 " "$44,760.09 " "$11,709.97 " "$15,808.46 " "$14,403.26 " N/A "$12,061.27 " N/A N/A N/A N/A N/A "$11,709.97 " "$39,308.19 " "$24,005.44 " "$11,709.97 " "$11,709.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,709.97 " "$11,709.97 " "$13,466.46 " "$11,709.97 " N/A "$11,124.47 " "$44,760.09 " 330104 546 4 Other O.R. proc for obstetric diagnoses except delivery diagnoses I N/A "$29,650.76 " N/A "$29,650.76 " N/A N/A N/A N/A "$28,168.22 " N/A "$28,464.73 " N/A N/A N/A N/A N/A "$37,952.97 " "$29,650.76 " N/A N/A N/A N/A "$30,540.28 " N/A N/A "$41,511.06 " "$115,187.90 " "$29,650.76 " "$40,028.52 " "$36,470.43 " N/A "$30,540.28 " N/A N/A N/A N/A N/A "$29,650.76 " "$101,157.72 " "$60,784.05 " "$29,650.76 " "$29,650.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$29,650.76 " "$29,650.76 " "$34,098.37 " "$29,650.76 " N/A "$28,168.22 " "$115,187.90 " 330104 560 1 Vaginal delivery I N/A "$3,914.60 " N/A "$3,914.60 " N/A N/A N/A N/A "$3,718.87 " N/A "$3,758.02 " N/A N/A N/A N/A N/A "$5,010.69 " "$3,914.60 " N/A N/A N/A N/A "$4,032.04 " N/A N/A "$5,480.44 " "$14,158.83 " "$3,914.60 " "$5,284.71 " "$4,814.96 " N/A "$4,032.04 " N/A N/A N/A N/A N/A "$3,914.60 " "$12,434.25 " "$8,024.93 " "$3,914.60 " "$3,914.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,914.60 " "$3,914.60 " "$4,501.79 " "$3,914.60 " N/A "$3,718.87 " "$14,158.83 " 330104 560 2 Vaginal delivery I N/A "$4,294.02 " N/A "$4,294.02 " N/A N/A N/A N/A "$4,079.32 " N/A "$4,122.26 " N/A N/A N/A N/A N/A "$5,496.34 " "$4,294.02 " N/A N/A N/A N/A "$4,422.84 " N/A N/A "$6,011.62 " "$15,648.25 " "$4,294.02 " "$5,796.92 " "$5,281.64 " N/A "$4,422.84 " N/A N/A N/A N/A N/A "$4,294.02 " "$13,742.25 " "$8,802.73 " "$4,294.02 " "$4,294.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,294.02 " "$4,294.02 " "$4,938.12 " "$4,294.02 " N/A "$4,079.32 " "$15,648.25 " 330104 560 3 Vaginal delivery I N/A "$5,255.84 " N/A "$5,255.84 " N/A N/A N/A N/A "$4,993.04 " N/A "$5,045.60 " N/A N/A N/A N/A N/A "$6,727.47 " "$5,255.84 " N/A N/A N/A N/A "$5,413.51 " N/A N/A "$7,358.17 " "$19,423.94 " "$5,255.84 " "$7,095.38 " "$6,464.68 " N/A "$5,413.51 " N/A N/A N/A N/A N/A "$5,255.84 " "$17,058.05 " "$10,774.46 " "$5,255.84 " "$5,255.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,255.84 " "$5,255.84 " "$6,044.21 " "$5,255.84 " N/A "$4,993.04 " "$19,423.94 " 330104 560 4 Vaginal delivery I N/A "$11,864.60 " N/A "$11,864.60 " N/A N/A N/A N/A "$11,271.37 " N/A "$11,390.01 " N/A N/A N/A N/A N/A "$15,186.68 " "$11,864.60 " N/A N/A N/A N/A "$12,220.53 " N/A N/A "$16,610.43 " "$45,367.08 " "$11,864.60 " "$16,017.20 " "$14,593.45 " N/A "$12,220.53 " N/A N/A N/A N/A N/A "$11,864.60 " "$39,841.26 " "$24,322.42 " "$11,864.60 " "$11,864.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,864.60 " "$11,864.60 " "$13,644.28 " "$11,864.60 " N/A "$11,271.37 " "$45,367.08 " 330104 561 1 Postpartum & post abortion diagnoses w/o procedure I N/A "$2,889.43 " N/A "$2,889.43 " N/A N/A N/A N/A "$2,744.96 " N/A "$2,773.86 " N/A N/A N/A N/A N/A "$3,698.47 " "$2,889.43 " N/A N/A N/A N/A "$2,976.12 " N/A N/A "$4,045.21 " "$10,134.46 " "$2,889.43 " "$3,900.73 " "$3,554.00 " N/A "$2,976.12 " N/A N/A N/A N/A N/A "$2,889.43 " "$8,900.06 " "$5,923.34 " "$2,889.43 " "$2,889.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,889.43 " "$2,889.43 " "$3,322.85 " "$2,889.43 " N/A "$2,744.96 " "$10,134.46 " 330104 561 2 Postpartum & post abortion diagnoses w/o procedure I N/A "$3,363.53 " N/A "$3,363.53 " N/A N/A N/A N/A "$3,195.35 " N/A "$3,228.99 " N/A N/A N/A N/A N/A "$4,305.32 " "$3,363.53 " N/A N/A N/A N/A "$3,464.44 " N/A N/A "$4,708.94 " "$11,995.56 " "$3,363.53 " "$4,540.77 " "$4,137.14 " N/A "$3,464.44 " N/A N/A N/A N/A N/A "$3,363.53 " "$10,534.47 " "$6,895.24 " "$3,363.53 " "$3,363.53 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,363.53 " "$3,363.53 " "$3,868.06 " "$3,363.53 " N/A "$3,195.35 " "$11,995.56 " 330104 561 3 Postpartum & post abortion diagnoses w/o procedure I N/A "$4,896.86 " N/A "$4,896.86 " N/A N/A N/A N/A "$4,652.01 " N/A "$4,700.98 " N/A N/A N/A N/A N/A "$6,267.98 " "$4,896.86 " N/A N/A N/A N/A "$5,043.76 " N/A N/A "$6,855.60 " "$18,014.74 " "$4,896.86 " "$6,610.76 " "$6,023.13 " N/A "$5,043.76 " N/A N/A N/A N/A N/A "$4,896.86 " "$15,820.50 " "$10,038.55 " "$4,896.86 " "$4,896.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,896.86 " "$4,896.86 " "$5,631.38 " "$4,896.86 " N/A "$4,652.01 " "$18,014.74 " 330104 561 4 Postpartum & post abortion diagnoses w/o procedure I N/A "$10,237.95 " N/A "$10,237.95 " N/A N/A N/A N/A "$9,726.05 " N/A "$9,828.43 " N/A N/A N/A N/A N/A "$13,104.57 " "$10,237.95 " N/A N/A N/A N/A "$10,545.09 " N/A N/A "$14,333.13 " "$38,981.57 " "$10,237.95 " "$13,821.23 " "$12,592.68 " N/A "$10,545.09 " N/A N/A N/A N/A N/A "$10,237.95 " "$34,233.52 " "$20,987.80 " "$10,237.95 " "$10,237.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,237.95 " "$10,237.95 " "$11,773.64 " "$10,237.95 " N/A "$9,726.05 " "$38,981.57 " 330104 563 1 Preterm labor I N/A "$2,678.27 " N/A "$2,678.27 " N/A N/A N/A N/A "$2,544.36 " N/A "$2,571.14 " N/A N/A N/A N/A N/A "$3,428.18 " "$2,678.27 " N/A N/A N/A N/A "$2,758.62 " N/A N/A "$3,749.58 " "$9,305.52 " "$2,678.27 " "$3,615.66 " "$3,294.27 " N/A "$2,758.62 " N/A N/A N/A N/A N/A "$2,678.27 " "$8,172.08 " "$5,490.45 " "$2,678.27 " "$2,678.27 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,678.27 " "$2,678.27 " "$3,080.01 " "$2,678.27 " N/A "$2,544.36 " "$9,305.52 " 330104 563 2 Preterm labor I N/A "$3,160.54 " N/A "$3,160.54 " N/A N/A N/A N/A "$3,002.51 " N/A "$3,034.12 " N/A N/A N/A N/A N/A "$4,045.49 " "$3,160.54 " N/A N/A N/A N/A "$3,255.36 " N/A N/A "$4,424.76 " "$11,198.71 " "$3,160.54 " "$4,266.73 " "$3,887.47 " N/A "$3,255.36 " N/A N/A N/A N/A N/A "$3,160.54 " "$9,834.68 " "$6,479.11 " "$3,160.54 " "$3,160.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,160.54 " "$3,160.54 " "$3,634.62 " "$3,160.54 " N/A "$3,002.51 " "$11,198.71 " 330104 563 3 Preterm labor I N/A "$4,358.05 " N/A "$4,358.05 " N/A N/A N/A N/A "$4,140.14 " N/A "$4,183.72 " N/A N/A N/A N/A N/A "$5,578.30 " "$4,358.05 " N/A N/A N/A N/A "$4,488.79 " N/A N/A "$6,101.27 " "$15,899.60 " "$4,358.05 " "$5,883.36 " "$5,360.40 " N/A "$4,488.79 " N/A N/A N/A N/A N/A "$4,358.05 " "$13,962.99 " "$8,934.00 " "$4,358.05 " "$4,358.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,358.05 " "$4,358.05 " "$5,011.75 " "$4,358.05 " N/A "$4,140.14 " "$15,899.60 " 330104 563 4 Preterm labor I N/A "$4,358.05 " N/A "$4,358.05 " N/A N/A N/A N/A "$4,140.14 " N/A "$4,183.72 " N/A N/A N/A N/A N/A "$5,578.30 " "$4,358.05 " N/A N/A N/A N/A "$4,488.79 " N/A N/A "$6,101.27 " "$15,899.60 " "$4,358.05 " "$5,883.36 " "$5,360.40 " N/A "$4,488.79 " N/A N/A N/A N/A N/A "$4,358.05 " "$13,962.99 " "$8,934.00 " "$4,358.05 " "$4,358.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,358.05 " "$4,358.05 " "$5,011.75 " "$4,358.05 " N/A "$4,140.14 " "$15,899.60 " 330104 564 1 Abortion w/o D&C aspiration curettage or hysterotomy I N/A "$2,793.39 " N/A "$2,793.39 " N/A N/A N/A N/A "$2,653.72 " N/A "$2,681.65 " N/A N/A N/A N/A N/A "$3,575.54 " "$2,793.39 " N/A N/A N/A N/A "$2,877.19 " N/A N/A "$3,910.74 " "$9,757.43 " "$2,793.39 " "$3,771.07 " "$3,435.87 " N/A "$2,877.19 " N/A N/A N/A N/A N/A "$2,793.39 " "$8,568.95 " "$5,726.44 " "$2,793.39 " "$2,793.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,793.39 " "$2,793.39 " "$3,212.40 " "$2,793.39 " N/A "$2,653.72 " "$9,757.43 " 330104 564 2 Abortion w/o D&C aspiration curettage or hysterotomy I N/A "$3,184.38 " N/A "$3,184.38 " N/A N/A N/A N/A "$3,025.16 " N/A "$3,057.01 " N/A N/A N/A N/A N/A "$4,076.01 " "$3,184.38 " N/A N/A N/A N/A "$3,279.91 " N/A N/A "$4,458.13 " "$11,292.30 " "$3,184.38 " "$4,298.92 " "$3,916.79 " N/A "$3,279.91 " N/A N/A N/A N/A N/A "$3,184.38 " "$9,916.87 " "$6,527.98 " "$3,184.38 " "$3,184.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,184.38 " "$3,184.38 " "$3,662.04 " "$3,184.38 " N/A "$3,025.16 " "$11,292.30 " 330104 564 3 Abortion w/o D&C aspiration curettage or hysterotomy I N/A "$4,417.99 " N/A "$4,417.99 " N/A N/A N/A N/A "$4,197.09 " N/A "$4,241.27 " N/A N/A N/A N/A N/A "$5,655.03 " "$4,417.99 " N/A N/A N/A N/A "$4,550.53 " N/A N/A "$6,185.19 " "$16,134.92 " "$4,417.99 " "$5,964.29 " "$5,434.13 " N/A "$4,550.53 " N/A N/A N/A N/A N/A "$4,417.99 " "$14,169.64 " "$9,056.88 " "$4,417.99 " "$4,417.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,417.99 " "$4,417.99 " "$5,080.69 " "$4,417.99 " N/A "$4,197.09 " "$16,134.92 " 330104 564 4 Abortion w/o D&C aspiration curettage or hysterotomy I N/A "$5,248.34 " N/A "$5,248.34 " N/A N/A N/A N/A "$4,985.93 " N/A "$5,038.41 " N/A N/A N/A N/A N/A "$6,717.88 " "$5,248.34 " N/A N/A N/A N/A "$5,405.79 " N/A N/A "$7,347.68 " "$19,394.52 " "$5,248.34 " "$7,085.26 " "$6,455.46 " N/A "$5,405.79 " N/A N/A N/A N/A N/A "$5,248.34 " "$17,032.22 " "$10,759.10 " "$5,248.34 " "$5,248.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,248.34 " "$5,248.34 " "$6,035.59 " "$5,248.34 " N/A "$4,985.93 " "$19,394.52 " 330104 565 1 False labor I N/A "$1,858.13 " N/A "$1,858.13 " N/A N/A N/A N/A "$1,765.23 " N/A "$1,783.81 " N/A N/A N/A N/A N/A "$2,378.41 " "$1,858.13 " N/A N/A N/A N/A "$1,913.88 " N/A N/A "$2,601.39 " "$6,086.02 " "$1,858.13 " "$2,508.48 " "$2,285.51 " N/A "$1,913.88 " N/A N/A N/A N/A N/A "$1,858.13 " "$5,344.73 " "$3,809.18 " "$1,858.13 " "$1,858.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,858.13 " "$1,858.13 " "$2,136.85 " "$1,858.13 " N/A "$1,765.23 " "$6,086.02 " 330104 565 2 False labor I N/A "$2,231.42 " N/A "$2,231.42 " N/A N/A N/A N/A "$2,119.85 " N/A "$2,142.16 " N/A N/A N/A N/A N/A "$2,856.22 " "$2,231.42 " N/A N/A N/A N/A "$2,298.36 " N/A N/A "$3,123.99 " "$7,551.38 " "$2,231.42 " "$3,012.41 " "$2,744.64 " N/A "$2,298.36 " N/A N/A N/A N/A N/A "$2,231.42 " "$6,631.60 " "$4,574.41 " "$2,231.42 " "$2,231.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,231.42 " "$2,231.42 " "$2,566.13 " "$2,231.42 " N/A "$2,119.85 " "$7,551.38 " 330104 565 3 False labor I N/A "$2,265.48 " N/A "$2,265.48 " N/A N/A N/A N/A "$2,152.20 " N/A "$2,174.86 " N/A N/A N/A N/A N/A "$2,899.81 " "$2,265.48 " N/A N/A N/A N/A "$2,333.44 " N/A N/A "$3,171.67 " "$7,685.08 " "$2,265.48 " "$3,058.39 " "$2,786.54 " N/A "$2,333.44 " N/A N/A N/A N/A N/A "$2,265.48 " "$6,749.01 " "$4,644.23 " "$2,265.48 " "$2,265.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,265.48 " "$2,265.48 " "$2,605.30 " "$2,265.48 " N/A "$2,152.20 " "$7,685.08 " 330104 565 4 False labor I N/A "$2,265.48 " N/A "$2,265.48 " N/A N/A N/A N/A "$2,152.20 " N/A "$2,174.86 " N/A N/A N/A N/A N/A "$2,899.81 " "$2,265.48 " N/A N/A N/A N/A "$2,333.44 " N/A N/A "$3,171.67 " "$7,685.08 " "$2,265.48 " "$3,058.39 " "$2,786.54 " N/A "$2,333.44 " N/A N/A N/A N/A N/A "$2,265.48 " "$6,749.01 " "$4,644.23 " "$2,265.48 " "$2,265.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,265.48 " "$2,265.48 " "$2,605.30 " "$2,265.48 " N/A "$2,152.20 " "$7,685.08 " 330104 566 1 Other antepartum diagnoses I N/A "$2,628.54 " N/A "$2,628.54 " N/A N/A N/A N/A "$2,497.12 " N/A "$2,523.40 " N/A N/A N/A N/A N/A "$3,364.54 " "$2,628.54 " N/A N/A N/A N/A "$2,707.40 " N/A N/A "$3,679.96 " "$9,110.32 " "$2,628.54 " "$3,548.53 " "$3,233.11 " N/A "$2,707.40 " N/A N/A N/A N/A N/A "$2,628.54 " "$8,000.66 " "$5,388.51 " "$2,628.54 " "$2,628.54 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,628.54 " "$2,628.54 " "$3,022.82 " "$2,628.54 " N/A "$2,497.12 " "$9,110.32 " 330104 566 2 Other antepartum diagnoses I N/A "$3,345.14 " N/A "$3,345.14 " N/A N/A N/A N/A "$3,177.88 " N/A "$3,211.33 " N/A N/A N/A N/A N/A "$4,281.78 " "$3,345.14 " N/A N/A N/A N/A "$3,445.49 " N/A N/A "$4,683.20 " "$11,923.37 " "$3,345.14 " "$4,515.94 " "$4,114.52 " N/A "$3,445.49 " N/A N/A N/A N/A N/A "$3,345.14 " "$10,471.07 " "$6,857.54 " "$3,345.14 " "$3,345.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,345.14 " "$3,345.14 " "$3,846.91 " "$3,345.14 " N/A "$3,177.88 " "$11,923.37 " 330104 566 3 Other antepartum diagnoses I N/A "$4,776.97 " N/A "$4,776.97 " N/A N/A N/A N/A "$4,538.12 " N/A "$4,585.89 " N/A N/A N/A N/A N/A "$6,114.52 " "$4,776.97 " N/A N/A N/A N/A "$4,920.28 " N/A N/A "$6,687.76 " "$17,544.11 " "$4,776.97 " "$6,448.91 " "$5,875.67 " N/A "$4,920.28 " N/A N/A N/A N/A N/A "$4,776.97 " "$15,407.20 " "$9,792.79 " "$4,776.97 " "$4,776.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,776.97 " "$4,776.97 " "$5,493.51 " "$4,776.97 " N/A "$4,538.12 " "$17,544.11 " 330104 566 4 Other antepartum diagnoses I N/A "$9,584.02 " N/A "$9,584.02 " N/A N/A N/A N/A "$9,104.82 " N/A "$9,200.66 " N/A N/A N/A N/A N/A "$12,267.55 " "$9,584.02 " N/A N/A N/A N/A "$9,871.54 " N/A N/A "$13,417.63 " "$36,414.53 " "$9,584.02 " "$12,938.43 " "$11,788.35 " N/A "$9,871.54 " N/A N/A N/A N/A N/A "$9,584.02 " "$31,979.15 " "$19,647.24 " "$9,584.02 " "$9,584.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,584.02 " "$9,584.02 " "$11,021.62 " "$9,584.02 " N/A "$9,104.82 " "$36,414.53 " 330104 580 1 Neonate transferred <5 days old not born here I N/A "$2,384.68 " N/A "$2,384.68 " N/A N/A N/A N/A "$2,265.45 " N/A "$2,289.30 " N/A N/A N/A N/A N/A "$3,052.39 " "$2,384.68 " N/A N/A N/A N/A "$2,456.22 " N/A N/A "$3,338.56 " "$8,153.03 " "$2,384.68 " "$3,219.32 " "$2,933.16 " N/A "$2,456.22 " N/A N/A N/A N/A N/A "$2,384.68 " "$7,159.97 " "$4,888.60 " "$2,384.68 " "$2,384.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,384.68 " "$2,384.68 " "$2,742.38 " "$2,384.68 " N/A "$2,265.45 " "$8,153.03 " 330104 580 2 Neonate transferred <5 days old not born here I N/A "$2,937.12 " N/A "$2,937.12 " N/A N/A N/A N/A "$2,790.26 " N/A "$2,819.63 " N/A N/A N/A N/A N/A "$3,759.51 " "$2,937.12 " N/A N/A N/A N/A "$3,025.23 " N/A N/A "$4,111.96 " "$10,321.64 " "$2,937.12 " "$3,965.11 " "$3,612.65 " N/A "$3,025.23 " N/A N/A N/A N/A N/A "$2,937.12 " "$9,064.44 " "$6,021.09 " "$2,937.12 " "$2,937.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,937.12 " "$2,937.12 " "$3,377.68 " "$2,937.12 " N/A "$2,790.26 " "$10,321.64 " 330104 580 3 Neonate transferred <5 days old not born here I N/A "$3,998.39 " N/A "$3,998.39 " N/A N/A N/A N/A "$3,798.47 " N/A "$3,838.45 " N/A N/A N/A N/A N/A "$5,117.93 " "$3,998.39 " N/A N/A N/A N/A "$4,118.34 " N/A N/A "$5,597.74 " "$14,487.73 " "$3,998.39 " "$5,397.82 " "$4,918.01 " N/A "$4,118.34 " N/A N/A N/A N/A N/A "$3,998.39 " "$12,723.09 " "$8,196.69 " "$3,998.39 " "$3,998.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,998.39 " "$3,998.39 " "$4,598.14 " "$3,998.39 " N/A "$3,798.47 " "$14,487.73 " 330104 580 4 Neonate transferred <5 days old not born here I N/A "$7,890.62 " N/A "$7,890.62 " N/A N/A N/A N/A "$7,496.09 " N/A "$7,575.00 " N/A N/A N/A N/A N/A "$10,099.99 " "$7,890.62 " N/A N/A N/A N/A "$8,127.34 " N/A N/A "$11,046.87 " "$29,766.97 " "$7,890.62 " "$10,652.34 " "$9,705.46 " N/A "$8,127.34 " N/A N/A N/A N/A N/A "$7,890.62 " "$26,141.28 " "$16,175.77 " "$7,890.62 " "$7,890.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,890.62 " "$7,890.62 " "$9,074.21 " "$7,890.62 " N/A "$7,496.09 " "$29,766.97 " 330104 581 1 Neonate transferred < 5 days old born here I N/A "$1,237.58 " N/A "$1,237.58 " N/A N/A N/A N/A "$1,175.70 " N/A "$1,188.08 " N/A N/A N/A N/A N/A "$1,584.11 " "$1,237.58 " N/A N/A N/A N/A "$1,274.71 " N/A N/A "$1,732.62 " "$3,650.01 " "$1,237.58 " "$1,670.74 " "$1,522.23 " N/A "$1,274.71 " N/A N/A N/A N/A N/A "$1,237.58 " "$3,205.43 " "$2,537.05 " "$1,237.58 " "$1,237.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,237.58 " "$1,237.58 " "$1,423.22 " "$1,237.58 " N/A "$1,175.70 " "$3,650.01 " 330104 581 2 Neonate transferred < 5 days old born here I N/A "$1,573.40 " N/A "$1,573.40 " N/A N/A N/A N/A "$1,494.73 " N/A "$1,510.47 " N/A N/A N/A N/A N/A "$2,013.96 " "$1,573.40 " N/A N/A N/A N/A "$1,620.61 " N/A N/A "$2,202.76 " "$4,968.29 " "$1,573.40 " "$2,124.09 " "$1,935.29 " N/A "$1,620.61 " N/A N/A N/A N/A N/A "$1,573.40 " "$4,363.14 " "$3,225.48 " "$1,573.40 " "$1,573.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,573.40 " "$1,573.40 " "$1,809.41 " "$1,573.40 " N/A "$1,494.73 " "$4,968.29 " 330104 581 3 Neonate transferred < 5 days old born here I N/A "$2,174.20 " N/A "$2,174.20 " N/A N/A N/A N/A "$2,065.49 " N/A "$2,087.23 " N/A N/A N/A N/A N/A "$2,782.98 " "$2,174.20 " N/A N/A N/A N/A "$2,239.43 " N/A N/A "$3,043.88 " "$7,326.76 " "$2,174.20 " "$2,935.17 " "$2,674.27 " N/A "$2,239.43 " N/A N/A N/A N/A N/A "$2,174.20 " "$6,434.34 " "$4,457.11 " "$2,174.20 " "$2,174.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,174.20 " "$2,174.20 " "$2,500.33 " "$2,174.20 " N/A "$2,065.49 " "$7,326.76 " 330104 581 4 Neonate transferred < 5 days old born here I N/A "$3,676.87 " N/A "$3,676.87 " N/A N/A N/A N/A "$3,493.03 " N/A "$3,529.80 " N/A N/A N/A N/A N/A "$4,706.40 " "$3,676.87 " N/A N/A N/A N/A "$3,787.18 " N/A N/A "$5,147.62 " "$13,225.60 " "$3,676.87 " "$4,963.78 " "$4,522.55 " N/A "$3,787.18 " N/A N/A N/A N/A N/A "$3,676.87 " "$11,614.69 " "$7,537.59 " "$3,676.87 " "$3,676.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,676.87 " "$3,676.87 " "$4,228.40 " "$3,676.87 " N/A "$3,493.03 " "$13,225.60 " 330104 583 1 Neonate w ECMO I N/A "$97,848.63 " N/A "$97,848.63 " N/A N/A N/A N/A "$92,956.20 " N/A "$93,934.69 " N/A N/A N/A N/A N/A "$125,246.25 " "$97,848.63 " N/A N/A N/A N/A "$100,784.09 " N/A N/A "$136,988.09 " "$382,903.43 " "$97,848.63 " "$132,095.66 " "$120,353.82 " N/A "$100,784.09 " N/A N/A N/A N/A N/A "$97,848.63 " "$336,264.82 " "$200,589.70 " "$97,848.63 " "$97,848.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$97,848.63 " "$97,848.63 " "$112,525.93 " "$97,848.63 " N/A "$92,956.20 " "$382,903.43 " 330104 583 2 Neonate w ECMO I N/A "$97,848.63 " N/A "$97,848.63 " N/A N/A N/A N/A "$92,956.20 " N/A "$93,934.69 " N/A N/A N/A N/A N/A "$125,246.25 " "$97,848.63 " N/A N/A N/A N/A "$100,784.09 " N/A N/A "$136,988.09 " "$382,903.43 " "$97,848.63 " "$132,095.66 " "$120,353.82 " N/A "$100,784.09 " N/A N/A N/A N/A N/A "$97,848.63 " "$336,264.82 " "$200,589.70 " "$97,848.63 " "$97,848.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$97,848.63 " "$97,848.63 " "$112,525.93 " "$97,848.63 " N/A "$92,956.20 " "$382,903.43 " 330104 583 3 Neonate w ECMO I N/A "$99,707.56 " N/A "$99,707.56 " N/A N/A N/A N/A "$94,722.18 " N/A "$95,719.26 " N/A N/A N/A N/A N/A "$127,625.68 " "$99,707.56 " N/A N/A N/A N/A "$102,698.79 " N/A N/A "$139,590.58 " "$390,200.78 " "$99,707.56 " "$134,605.21 " "$122,640.30 " N/A "$102,698.79 " N/A N/A N/A N/A N/A "$99,707.56 " "$342,673.33 " "$204,400.50 " "$99,707.56 " "$99,707.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$99,707.56 " "$99,707.56 " "$114,663.69 " "$99,707.56 " N/A "$94,722.18 " "$390,200.78 " 330104 583 4 Neonate w ECMO I N/A "$175,272.35 " N/A "$175,272.35 " N/A N/A N/A N/A "$166,508.73 " N/A "$168,261.45 " N/A N/A N/A N/A N/A "$224,348.60 " "$175,272.35 " N/A N/A N/A N/A "$180,530.52 " N/A N/A "$245,381.29 " "$686,835.62 " "$175,272.35 " "$236,617.67 " "$215,584.99 " N/A "$180,530.52 " N/A N/A N/A N/A N/A "$175,272.35 " "$603,177.29 " "$359,308.31 " "$175,272.35 " "$175,272.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$175,272.35 " "$175,272.35 " "$201,563.20 " "$175,272.35 " N/A "$166,508.73 " "$686,835.62 " 330104 588 1 Neonate bwt <1500g w major procedure I N/A "$131,805.21 " N/A "$131,805.21 " N/A N/A N/A N/A "$125,214.95 " N/A "$126,533.00 " N/A N/A N/A N/A N/A "$168,710.67 " "$131,805.21 " N/A N/A N/A N/A "$135,759.36 " N/A N/A "$184,527.29 " "$516,202.33 " "$131,805.21 " "$177,937.03 " "$162,120.41 " N/A "$135,759.36 " N/A N/A N/A N/A N/A "$131,805.21 " "$453,327.57 " "$270,200.68 " "$131,805.21 " "$131,805.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$131,805.21 " "$131,805.21 " "$151,575.99 " "$131,805.21 " N/A "$125,214.95 " "$516,202.33 " 330104 588 2 Neonate bwt <1500g w major procedure I N/A "$131,805.21 " N/A "$131,805.21 " N/A N/A N/A N/A "$125,214.95 " N/A "$126,533.00 " N/A N/A N/A N/A N/A "$168,710.67 " "$131,805.21 " N/A N/A N/A N/A "$135,759.36 " N/A N/A "$184,527.29 " "$516,202.33 " "$131,805.21 " "$177,937.03 " "$162,120.41 " N/A "$135,759.36 " N/A N/A N/A N/A N/A "$131,805.21 " "$453,327.57 " "$270,200.68 " "$131,805.21 " "$131,805.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$131,805.21 " "$131,805.21 " "$151,575.99 " "$131,805.21 " N/A "$125,214.95 " "$516,202.33 " 330104 588 3 Neonate bwt <1500g w major procedure I N/A "$172,196.84 " N/A "$172,196.84 " N/A N/A N/A N/A "$163,587.00 " N/A "$165,308.97 " N/A N/A N/A N/A N/A "$220,411.96 " "$172,196.84 " N/A N/A N/A N/A "$177,362.75 " N/A N/A "$241,075.58 " "$674,762.51 " "$172,196.84 " "$232,465.74 " "$211,802.12 " N/A "$177,362.75 " N/A N/A N/A N/A N/A "$172,196.84 " "$592,574.72 " "$353,003.53 " "$172,196.84 " "$172,196.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$172,196.84 " "$172,196.84 " "$198,026.37 " "$172,196.84 " N/A "$163,587.00 " "$674,762.51 " 330104 588 4 Neonate bwt <1500g w major procedure I N/A "$172,196.84 " N/A "$172,196.84 " N/A N/A N/A N/A "$163,587.00 " N/A "$165,308.97 " N/A N/A N/A N/A N/A "$220,411.96 " "$172,196.84 " N/A N/A N/A N/A "$177,362.75 " N/A N/A "$241,075.58 " "$674,762.51 " "$172,196.84 " "$232,465.74 " "$211,802.12 " N/A "$177,362.75 " N/A N/A N/A N/A N/A "$172,196.84 " "$592,574.72 " "$353,003.53 " "$172,196.84 " "$172,196.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$172,196.84 " "$172,196.84 " "$198,026.37 " "$172,196.84 " N/A "$163,587.00 " "$674,762.51 " 330104 589 1 Neonate bwt <500g or GA <24 weeks I N/A "$82,994.93 " N/A "$82,994.93 " N/A N/A N/A N/A "$78,845.19 " N/A "$79,675.13 " N/A N/A N/A N/A N/A "$106,233.51 " "$82,994.93 " N/A N/A N/A N/A "$85,484.78 " N/A N/A "$116,192.90 " "$324,594.19 " "$82,994.93 " "$112,043.16 " "$102,083.77 " N/A "$85,484.78 " N/A N/A N/A N/A N/A "$82,994.93 " "$285,057.79 " "$170,139.61 " "$82,994.93 " "$82,994.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$82,994.93 " "$82,994.93 " "$95,444.17 " "$82,994.93 " N/A "$78,845.19 " "$324,594.19 " 330104 589 2 Neonate bwt <500g or GA <24 weeks I N/A "$82,994.93 " N/A "$82,994.93 " N/A N/A N/A N/A "$78,845.19 " N/A "$79,675.13 " N/A N/A N/A N/A N/A "$106,233.51 " "$82,994.93 " N/A N/A N/A N/A "$85,484.78 " N/A N/A "$116,192.90 " "$324,594.19 " "$82,994.93 " "$112,043.16 " "$102,083.77 " N/A "$85,484.78 " N/A N/A N/A N/A N/A "$82,994.93 " "$285,057.79 " "$170,139.61 " "$82,994.93 " "$82,994.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$82,994.93 " "$82,994.93 " "$95,444.17 " "$82,994.93 " N/A "$78,845.19 " "$324,594.19 " 330104 589 3 Neonate bwt <500g or GA <24 weeks I N/A "$30,278.80 " N/A "$30,278.80 " N/A N/A N/A N/A "$28,764.86 " N/A "$29,067.65 " N/A N/A N/A N/A N/A "$38,756.86 " "$30,278.80 " N/A N/A N/A N/A "$31,187.16 " N/A N/A "$42,390.32 " "$117,653.33 " "$30,278.80 " "$40,876.38 " "$37,242.92 " N/A "$31,187.16 " N/A N/A N/A N/A N/A "$30,278.80 " "$103,322.85 " "$62,071.54 " "$30,278.80 " "$30,278.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$30,278.80 " "$30,278.80 " "$34,820.62 " "$30,278.80 " N/A "$28,764.86 " "$117,653.33 " 330104 589 4 Neonate bwt <500g or GA <24 weeks I N/A "$1,080.91 " N/A "$1,080.91 " N/A N/A N/A N/A "$1,026.87 " N/A "$1,037.68 " N/A N/A N/A N/A N/A "$1,383.57 " "$1,080.91 " N/A N/A N/A N/A "$1,113.34 " N/A N/A "$1,513.28 " "$3,034.99 " "$1,080.91 " "$1,459.23 " "$1,329.52 " N/A "$1,113.34 " N/A N/A N/A N/A N/A "$1,080.91 " "$2,665.32 " "$2,215.87 " "$1,080.91 " "$1,080.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,080.91 " "$1,080.91 " "$1,243.05 " "$1,080.91 " N/A "$1,026.87 " "$3,034.99 " 330104 591 1 Neonate birthwt 500-749g w/o major procedure I N/A "$60,860.15 " N/A "$60,860.15 " N/A N/A N/A N/A "$57,817.14 " N/A "$58,425.74 " N/A N/A N/A N/A N/A "$77,900.99 " "$60,860.15 " N/A N/A N/A N/A "$62,685.95 " N/A N/A "$85,204.21 " "$237,702.56 " "$60,860.15 " "$82,161.20 " "$74,857.99 " N/A "$62,685.95 " N/A N/A N/A N/A N/A "$60,860.15 " "$208,749.78 " "$124,763.31 " "$60,860.15 " "$60,860.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$60,860.15 " "$60,860.15 " "$69,989.17 " "$60,860.15 " N/A "$57,817.14 " "$237,702.56 " 330104 591 2 Neonate birthwt 500-749g w/o major procedure I N/A "$75,386.21 " N/A "$75,386.21 " N/A N/A N/A N/A "$71,616.90 " N/A "$72,370.76 " N/A N/A N/A N/A N/A "$96,494.35 " "$75,386.21 " N/A N/A N/A N/A "$77,647.79 " N/A N/A "$105,540.69 " "$294,725.61 " "$75,386.21 " "$101,771.38 " "$92,725.04 " N/A "$77,647.79 " N/A N/A N/A N/A N/A "$75,386.21 " "$258,827.28 " "$154,541.73 " "$75,386.21 " "$75,386.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$75,386.21 " "$75,386.21 " "$86,694.14 " "$75,386.21 " N/A "$71,616.90 " "$294,725.61 " 330104 591 3 Neonate birthwt 500-749g w/o major procedure I N/A "$80,787.24 " N/A "$80,787.24 " N/A N/A N/A N/A "$76,747.88 " N/A "$77,555.75 " N/A N/A N/A N/A N/A "$103,407.67 " "$80,787.24 " N/A N/A N/A N/A "$83,210.86 " N/A N/A "$113,102.14 " "$315,927.75 " "$80,787.24 " "$109,062.78 " "$99,368.31 " N/A "$83,210.86 " N/A N/A N/A N/A N/A "$80,787.24 " "$277,446.95 " "$165,613.85 " "$80,787.24 " "$80,787.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$80,787.24 " "$80,787.24 " "$92,905.33 " "$80,787.24 " N/A "$76,747.88 " "$315,927.75 " 330104 591 4 Neonate birthwt 500-749g w/o major procedure I N/A "$132,282.03 " N/A "$132,282.03 " N/A N/A N/A N/A "$125,667.93 " N/A "$126,990.75 " N/A N/A N/A N/A N/A "$169,321.00 " "$132,282.03 " N/A N/A N/A N/A "$136,250.49 " N/A N/A "$185,194.84 " "$518,074.13 " "$132,282.03 " "$178,580.74 " "$162,706.90 " N/A "$136,250.49 " N/A N/A N/A N/A N/A "$132,282.03 " "$454,971.38 " "$271,178.16 " "$132,282.03 " "$132,282.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$132,282.03 " "$132,282.03 " "$152,124.33 " "$132,282.03 " N/A "$125,667.93 " "$518,074.13 " 330104 593 1 Neonate birthwt 750-999g w/o major procedure I N/A "$73,893.75 " N/A "$73,893.75 " N/A N/A N/A N/A "$70,199.07 " N/A "$70,938.00 " N/A N/A N/A N/A N/A "$94,584.00 " "$73,893.75 " N/A N/A N/A N/A "$76,110.57 " N/A N/A "$103,451.25 " "$288,866.87 " "$73,893.75 " "$99,756.57 " "$90,889.32 " N/A "$76,110.57 " N/A N/A N/A N/A N/A "$73,893.75 " "$253,682.15 " "$151,482.19 " "$73,893.75 " "$73,893.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$73,893.75 " "$73,893.75 " "$84,977.82 " "$73,893.75 " N/A "$70,199.07 " "$288,866.87 " 330104 593 2 Neonate birthwt 750-999g w/o major procedure I N/A "$76,204.98 " N/A "$76,204.98 " N/A N/A N/A N/A "$72,394.73 " N/A "$73,156.78 " N/A N/A N/A N/A N/A "$97,542.37 " "$76,204.98 " N/A N/A N/A N/A "$78,491.13 " N/A N/A "$106,686.97 " "$297,939.75 " "$76,204.98 " "$102,876.72 " "$93,732.13 " N/A "$78,491.13 " N/A N/A N/A N/A N/A "$76,204.98 " "$261,649.93 " "$156,220.21 " "$76,204.98 " "$76,204.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$76,204.98 " "$76,204.98 " "$87,635.73 " "$76,204.98 " N/A "$72,394.73 " "$297,939.75 " 330104 593 3 Neonate birthwt 750-999g w/o major procedure I N/A "$93,070.19 " N/A "$93,070.19 " N/A N/A N/A N/A "$88,416.68 " N/A "$89,347.38 " N/A N/A N/A N/A N/A "$119,129.85 " "$93,070.19 " N/A N/A N/A N/A "$95,862.30 " N/A N/A "$130,298.27 " "$364,145.32 " "$93,070.19 " "$125,644.76 " "$114,476.34 " N/A "$95,862.30 " N/A N/A N/A N/A N/A "$93,070.19 " "$319,791.49 " "$190,793.89 " "$93,070.19 " "$93,070.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$93,070.19 " "$93,070.19 " "$107,030.72 " "$93,070.19 " N/A "$88,416.68 " "$364,145.32 " 330104 593 4 Neonate birthwt 750-999g w/o major procedure I N/A "$119,076.77 " N/A "$119,076.77 " N/A N/A N/A N/A "$113,122.93 " N/A "$114,313.70 " N/A N/A N/A N/A N/A "$152,418.27 " "$119,076.77 " N/A N/A N/A N/A "$122,649.07 " N/A N/A "$166,707.48 " "$466,235.97 " "$119,076.77 " "$160,753.64 " "$146,464.43 " N/A "$122,649.07 " N/A N/A N/A N/A N/A "$119,076.77 " "$409,447.24 " "$244,107.38 " "$119,076.77 " "$119,076.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$119,076.77 " "$119,076.77 " "$136,938.29 " "$119,076.77 " N/A "$113,122.93 " "$466,235.97 " 330104 602 1 Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom I N/A "$44,534.43 " N/A "$44,534.43 " N/A N/A N/A N/A "$42,307.71 " N/A "$42,753.05 " N/A N/A N/A N/A N/A "$57,004.07 " "$44,534.43 " N/A N/A N/A N/A "$45,870.46 " N/A N/A "$62,348.20 " "$173,614.80 " "$44,534.43 " "$60,121.48 " "$54,777.35 " N/A "$45,870.46 " N/A N/A N/A N/A N/A "$44,534.43 " "$152,468.07 " "$91,295.58 " "$44,534.43 " "$44,534.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$44,534.43 " "$44,534.43 " "$51,214.59 " "$44,534.43 " N/A "$42,307.71 " "$173,614.80 " 330104 602 2 Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom I N/A "$64,910.42 " N/A "$64,910.42 " N/A N/A N/A N/A "$61,664.90 " N/A "$62,314.00 " N/A N/A N/A N/A N/A "$83,085.33 " "$64,910.42 " N/A N/A N/A N/A "$66,857.73 " N/A N/A "$90,874.58 " "$253,602.16 " "$64,910.42 " "$87,629.06 " "$79,839.81 " N/A "$66,857.73 " N/A N/A N/A N/A N/A "$64,910.42 " "$222,712.77 " "$133,066.35 " "$64,910.42 " "$64,910.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$64,910.42 " "$64,910.42 " "$74,646.98 " "$64,910.42 " N/A "$61,664.90 " "$253,602.16 " 330104 602 3 Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom I N/A "$76,341.21 " N/A "$76,341.21 " N/A N/A N/A N/A "$72,524.15 " N/A "$73,287.57 " N/A N/A N/A N/A N/A "$97,716.75 " "$76,341.21 " N/A N/A N/A N/A "$78,631.45 " N/A N/A "$106,877.70 " "$298,474.55 " "$76,341.21 " "$103,060.64 " "$93,899.69 " N/A "$78,631.45 " N/A N/A N/A N/A N/A "$76,341.21 " "$262,119.59 " "$156,499.49 " "$76,341.21 " "$76,341.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$76,341.21 " "$76,341.21 " "$87,792.40 " "$76,341.21 " N/A "$72,524.15 " "$298,474.55 " 330104 602 4 Neonate bwt 1000-1249g w resp dist synd/oth maj resp or maj anom I N/A "$103,312.34 " N/A "$103,312.34 " N/A N/A N/A N/A "$98,146.72 " N/A "$99,179.85 " N/A N/A N/A N/A N/A "$132,239.79 " "$103,312.34 " N/A N/A N/A N/A "$106,411.71 " N/A N/A "$144,637.27 " "$404,351.58 " "$103,312.34 " "$139,471.66 " "$127,074.18 " N/A "$106,411.71 " N/A N/A N/A N/A N/A "$103,312.34 " "$355,100.53 " "$211,790.29 " "$103,312.34 " "$103,312.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$103,312.34 " "$103,312.34 " "$118,809.19 " "$103,312.34 " N/A "$98,146.72 " "$404,351.58 " 330104 603 1 Neonate birthwt 1000-1249g w or w/o other significant condition I N/A "$35,553.14 " N/A "$35,553.14 " N/A N/A N/A N/A "$33,775.48 " N/A "$34,131.01 " N/A N/A N/A N/A N/A "$45,508.02 " "$35,553.14 " N/A N/A N/A N/A "$36,619.73 " N/A N/A "$49,774.39 " "$138,358.11 " "$35,553.14 " "$47,996.73 " "$43,730.36 " N/A "$36,619.73 " N/A N/A N/A N/A N/A "$35,553.14 " "$121,505.74 " "$72,883.93 " "$35,553.14 " "$35,553.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$35,553.14 " "$35,553.14 " "$40,886.11 " "$35,553.14 " N/A "$33,775.48 " "$138,358.11 " 330104 603 2 Neonate birthwt 1000-1249g w or w/o other significant condition I N/A "$47,298.64 " N/A "$47,298.64 " N/A N/A N/A N/A "$44,933.71 " N/A "$45,406.69 " N/A N/A N/A N/A N/A "$60,542.26 " "$47,298.64 " N/A N/A N/A N/A "$48,717.60 " N/A N/A "$66,218.09 " "$184,465.89 " "$47,298.64 " "$63,853.16 " "$58,177.32 " N/A "$48,717.60 " N/A N/A N/A N/A N/A "$47,298.64 " "$161,997.48 " "$96,962.21 " "$47,298.64 " "$47,298.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$47,298.64 " "$47,298.64 " "$54,393.43 " "$47,298.64 " N/A "$44,933.71 " "$184,465.89 " 330104 603 3 Neonate birthwt 1000-1249g w or w/o other significant condition I N/A "$61,467.08 " N/A "$61,467.08 " N/A N/A N/A N/A "$58,393.72 " N/A "$59,008.39 " N/A N/A N/A N/A N/A "$78,677.86 " "$61,467.08 " N/A N/A N/A N/A "$63,311.09 " N/A N/A "$86,053.91 " "$240,085.09 " "$61,467.08 " "$82,980.55 " "$75,604.51 " N/A "$63,311.09 " N/A N/A N/A N/A N/A "$61,467.08 " "$210,842.12 " "$126,007.51 " "$61,467.08 " "$61,467.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$61,467.08 " "$61,467.08 " "$70,687.14 " "$61,467.08 " N/A "$58,393.72 " "$240,085.09 " 330104 603 4 Neonate birthwt 1000-1249g w or w/o other significant condition I N/A "$95,194.10 " N/A "$95,194.10 " N/A N/A N/A N/A "$90,434.39 " N/A "$91,386.33 " N/A N/A N/A N/A N/A "$121,848.44 " "$95,194.10 " N/A N/A N/A N/A "$98,049.92 " N/A N/A "$133,271.73 " "$372,482.85 " "$95,194.10 " "$128,512.03 " "$117,088.74 " N/A "$98,049.92 " N/A N/A N/A N/A N/A "$95,194.10 " "$327,113.49 " "$195,147.90 " "$95,194.10 " "$95,194.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$95,194.10 " "$95,194.10 " "$109,473.21 " "$95,194.10 " N/A "$90,434.39 " "$372,482.85 " 330104 607 1 Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom I N/A "$41,458.92 " N/A "$41,458.92 " N/A N/A N/A N/A "$39,385.98 " N/A "$39,800.57 " N/A N/A N/A N/A N/A "$53,067.42 " "$41,458.92 " N/A N/A N/A N/A "$42,702.69 " N/A N/A "$58,042.49 " "$161,541.69 " "$41,458.92 " "$55,969.55 " "$50,994.48 " N/A "$42,702.69 " N/A N/A N/A N/A N/A "$41,458.92 " "$141,865.50 " "$84,990.79 " "$41,458.92 " "$41,458.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,458.92 " "$41,458.92 " "$47,677.76 " "$41,458.92 " N/A "$39,385.98 " "$161,541.69 " 330104 607 2 Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom I N/A "$51,248.77 " N/A "$51,248.77 " N/A N/A N/A N/A "$48,686.33 " N/A "$49,198.82 " N/A N/A N/A N/A N/A "$65,598.43 " "$51,248.77 " N/A N/A N/A N/A "$52,786.23 " N/A N/A "$71,748.28 " "$199,972.42 " "$51,248.77 " "$69,185.84 " "$63,035.99 " N/A "$52,786.23 " N/A N/A N/A N/A N/A "$51,248.77 " "$175,615.27 " "$105,059.98 " "$51,248.77 " "$51,248.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$51,248.77 " "$51,248.77 " "$58,936.09 " "$51,248.77 " N/A "$48,686.33 " "$199,972.42 " 330104 607 3 Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom I N/A "$62,629.16 " N/A "$62,629.16 " N/A N/A N/A N/A "$59,497.70 " N/A "$60,124.00 " N/A N/A N/A N/A N/A "$80,165.33 " "$62,629.16 " N/A N/A N/A N/A "$64,508.04 " N/A N/A "$87,680.83 " "$244,646.93 " "$62,629.16 " "$84,549.37 " "$77,033.87 " N/A "$64,508.04 " N/A N/A N/A N/A N/A "$62,629.16 " "$214,848.32 " "$128,389.78 " "$62,629.16 " "$62,629.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$62,629.16 " "$62,629.16 " "$72,023.54 " "$62,629.16 " N/A "$59,497.70 " "$244,646.93 " 330104 607 4 Neonate bwt 1250-1499g w resp dist synd/oth maj resp or maj anom I N/A "$84,402.92 " N/A "$84,402.92 " N/A N/A N/A N/A "$80,182.77 " N/A "$81,026.80 " N/A N/A N/A N/A N/A "$108,035.74 " "$84,402.92 " N/A N/A N/A N/A "$86,935.01 " N/A N/A "$118,164.09 " "$330,121.34 " "$84,402.92 " "$113,943.94 " "$103,815.59 " N/A "$86,935.01 " N/A N/A N/A N/A N/A "$84,402.92 " "$289,911.72 " "$173,025.99 " "$84,402.92 " "$84,402.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$84,402.92 " "$84,402.92 " "$97,063.36 " "$84,402.92 " N/A "$80,182.77 " "$330,121.34 " 330104 608 1 Neonate bwt 1250-1499g w or w/o other significant condition I N/A "$29,219.57 " N/A "$29,219.57 " N/A N/A N/A N/A "$27,758.59 " N/A "$28,050.79 " N/A N/A N/A N/A N/A "$37,401.05 " "$29,219.57 " N/A N/A N/A N/A "$30,096.16 " N/A N/A "$40,907.40 " "$113,495.26 " "$29,219.57 " "$39,446.42 " "$35,940.07 " N/A "$30,096.16 " N/A N/A N/A N/A N/A "$29,219.57 " "$99,671.25 " "$59,900.12 " "$29,219.57 " "$29,219.57 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$29,219.57 " "$29,219.57 " "$33,602.51 " "$29,219.57 " N/A "$27,758.59 " "$113,495.26 " 330104 608 2 Neonate bwt 1250-1499g w or w/o other significant condition I N/A "$39,039.39 " N/A "$39,039.39 " N/A N/A N/A N/A "$37,087.42 " N/A "$37,477.81 " N/A N/A N/A N/A N/A "$49,970.42 " "$39,039.39 " N/A N/A N/A N/A "$40,210.57 " N/A N/A "$54,655.15 " "$152,043.64 " "$39,039.39 " "$52,703.18 " "$48,018.45 " N/A "$40,210.57 " N/A N/A N/A N/A N/A "$39,039.39 " "$133,524.34 " "$80,030.75 " "$39,039.39 " "$39,039.39 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$39,039.39 " "$39,039.39 " "$44,895.30 " "$39,039.39 " N/A "$37,087.42 " "$152,043.64 " 330104 608 3 Neonate bwt 1250-1499g w or w/o other significant condition I N/A "$46,788.44 " N/A "$46,788.44 " N/A N/A N/A N/A "$44,449.02 " N/A "$44,916.90 " N/A N/A N/A N/A N/A "$59,889.20 " "$46,788.44 " N/A N/A N/A N/A "$48,192.09 " N/A N/A "$65,503.81 " "$182,463.06 " "$46,788.44 " "$63,164.39 " "$57,549.78 " N/A "$48,192.09 " N/A N/A N/A N/A N/A "$46,788.44 " "$160,238.60 " "$95,916.30 " "$46,788.44 " "$46,788.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$46,788.44 " "$46,788.44 " "$53,806.70 " "$46,788.44 " N/A "$44,449.02 " "$182,463.06 " 330104 608 4 Neonate bwt 1250-1499g w or w/o other significant condition I N/A "$49,232.49 " N/A "$49,232.49 " N/A N/A N/A N/A "$46,770.87 " N/A "$47,263.19 " N/A N/A N/A N/A N/A "$63,017.59 " "$49,232.49 " N/A N/A N/A N/A "$50,709.47 " N/A N/A "$68,925.49 " "$192,057.38 " "$49,232.49 " "$66,463.87 " "$60,555.97 " N/A "$50,709.47 " N/A N/A N/A N/A N/A "$49,232.49 " "$168,664.30 " "$100,926.61 " "$49,232.49 " "$49,232.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$49,232.49 " "$49,232.49 " "$56,617.37 " "$49,232.49 " N/A "$46,770.87 " "$192,057.38 " 330104 609 1 Neonate bwt 1500-2499g w major procedure I N/A "$24,610.06 " N/A "$24,610.06 " N/A N/A N/A N/A "$23,379.56 " N/A "$23,625.66 " N/A N/A N/A N/A N/A "$31,500.88 " "$24,610.06 " N/A N/A N/A N/A "$25,348.36 " N/A N/A "$34,454.08 " "$95,400.30 " "$24,610.06 " "$33,223.58 " "$30,270.37 " N/A "$25,348.36 " N/A N/A N/A N/A N/A "$24,610.06 " "$83,780.30 " "$50,450.62 " "$24,610.06 " "$24,610.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,610.06 " "$24,610.06 " "$28,301.57 " "$24,610.06 " N/A "$23,379.56 " "$95,400.30 " 330104 609 2 Neonate bwt 1500-2499g w major procedure I N/A "$24,796.70 " N/A "$24,796.70 " N/A N/A N/A N/A "$23,556.87 " N/A "$23,804.83 " N/A N/A N/A N/A N/A "$31,739.78 " "$24,796.70 " N/A N/A N/A N/A "$25,540.60 " N/A N/A "$34,715.38 " "$96,132.97 " "$24,796.70 " "$33,475.55 " "$30,499.94 " N/A "$25,540.60 " N/A N/A N/A N/A N/A "$24,796.70 " "$84,423.73 " "$50,833.24 " "$24,796.70 " "$24,796.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,796.70 " "$24,796.70 " "$28,516.21 " "$24,796.70 " N/A "$23,556.87 " "$96,132.97 " 330104 609 3 Neonate bwt 1500-2499g w major procedure I N/A "$49,918.44 " N/A "$49,918.44 " N/A N/A N/A N/A "$47,422.51 " N/A "$47,921.70 " N/A N/A N/A N/A N/A "$63,895.60 " "$49,918.44 " N/A N/A N/A N/A "$51,415.99 " N/A N/A "$69,885.81 " "$194,750.09 " "$49,918.44 " "$67,389.89 " "$61,399.68 " N/A "$51,415.99 " N/A N/A N/A N/A N/A "$49,918.44 " "$171,029.04 " "$102,332.79 " "$49,918.44 " "$49,918.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$49,918.44 " "$49,918.44 " "$57,406.20 " "$49,918.44 " N/A "$47,422.51 " "$194,750.09 " 330104 609 4 Neonate bwt 1500-2499g w major procedure I N/A "$109,051.92 " N/A "$109,051.92 " N/A N/A N/A N/A "$103,599.32 " N/A "$104,689.84 " N/A N/A N/A N/A N/A "$139,586.46 " "$109,051.92 " N/A N/A N/A N/A "$112,323.48 " N/A N/A "$152,672.69 " "$426,882.71 " "$109,051.92 " "$147,220.09 " "$134,133.86 " N/A "$112,323.48 " N/A N/A N/A N/A N/A "$109,051.92 " "$374,887.31 " "$223,556.43 " "$109,051.92 " "$109,051.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$109,051.92 " "$109,051.92 " "$125,409.71 " "$109,051.92 " N/A "$103,599.32 " "$426,882.71 " 330104 611 1 Neonate birthwt 1500-1999g w major anomaly I N/A "$17,371.21 " N/A "$17,371.21 " N/A N/A N/A N/A "$16,502.65 " N/A "$16,676.37 " N/A N/A N/A N/A N/A "$22,235.15 " "$17,371.21 " N/A N/A N/A N/A "$17,892.35 " N/A N/A "$24,319.70 " "$66,983.70 " "$17,371.21 " "$23,451.14 " "$21,366.59 " N/A "$17,892.35 " N/A N/A N/A N/A N/A "$17,371.21 " "$58,824.92 " "$35,610.99 " "$17,371.21 " "$17,371.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,371.21 " "$17,371.21 " "$19,976.90 " "$17,371.21 " N/A "$16,502.65 " "$66,983.70 " 330104 611 2 Neonate birthwt 1500-1999g w major anomaly I N/A "$27,792.51 " N/A "$27,792.51 " N/A N/A N/A N/A "$26,402.88 " N/A "$26,680.81 " N/A N/A N/A N/A N/A "$35,574.41 " "$27,792.51 " N/A N/A N/A N/A "$28,626.29 " N/A N/A "$38,909.51 " "$107,893.23 " "$27,792.51 " "$37,519.89 " "$34,184.79 " N/A "$28,626.29 " N/A N/A N/A N/A N/A "$27,792.51 " "$94,751.56 " "$56,974.65 " "$27,792.51 " "$27,792.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,792.51 " "$27,792.51 " "$31,961.39 " "$27,792.51 " N/A "$26,402.88 " "$107,893.23 " 330104 611 3 Neonate birthwt 1500-1999g w major anomaly I N/A "$42,988.84 " N/A "$42,988.84 " N/A N/A N/A N/A "$40,839.40 " N/A "$41,269.29 " N/A N/A N/A N/A N/A "$55,025.72 " "$42,988.84 " N/A N/A N/A N/A "$44,278.51 " N/A N/A "$60,184.38 " "$167,547.49 " "$42,988.84 " "$58,034.94 " "$52,876.28 " N/A "$44,278.51 " N/A N/A N/A N/A N/A "$42,988.84 " "$147,139.78 " "$88,127.13 " "$42,988.84 " "$42,988.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$42,988.84 " "$42,988.84 " "$49,437.17 " "$42,988.84 " N/A "$40,839.40 " "$167,547.49 " 330104 611 4 Neonate birthwt 1500-1999g w major anomaly I N/A "$56,257.45 " N/A "$56,257.45 " N/A N/A N/A N/A "$53,444.58 " N/A "$54,007.15 " N/A N/A N/A N/A N/A "$72,009.54 " "$56,257.45 " N/A N/A N/A N/A "$57,945.17 " N/A N/A "$78,760.43 " "$219,634.34 " "$56,257.45 " "$75,947.56 " "$69,196.66 " N/A "$57,945.17 " N/A N/A N/A N/A N/A "$56,257.45 " "$192,882.32 " "$115,327.77 " "$56,257.45 " "$56,257.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$56,257.45 " "$56,257.45 " "$64,696.07 " "$56,257.45 " N/A "$53,444.58 " "$219,634.34 " 330104 612 1 Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond I N/A "$24,272.88 " N/A "$24,272.88 " N/A N/A N/A N/A "$23,059.23 " N/A "$23,301.96 " N/A N/A N/A N/A N/A "$31,069.28 " "$24,272.88 " N/A N/A N/A N/A "$25,001.07 " N/A N/A "$33,982.03 " "$94,076.67 " "$24,272.88 " "$32,768.39 " "$29,855.64 " N/A "$25,001.07 " N/A N/A N/A N/A N/A "$24,272.88 " "$82,617.89 " "$49,759.40 " "$24,272.88 " "$24,272.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,272.88 " "$24,272.88 " "$27,913.81 " "$24,272.88 " N/A "$23,059.23 " "$94,076.67 " 330104 612 2 Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond I N/A "$31,301.92 " N/A "$31,301.92 " N/A N/A N/A N/A "$29,736.83 " N/A "$30,049.85 " N/A N/A N/A N/A N/A "$40,066.46 " "$31,301.92 " N/A N/A N/A N/A "$32,240.98 " N/A N/A "$43,822.69 " "$121,669.67 " "$31,301.92 " "$42,257.60 " "$38,501.37 " N/A "$32,240.98 " N/A N/A N/A N/A N/A "$31,301.92 " "$106,850.00 " "$64,168.94 " "$31,301.92 " "$31,301.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$31,301.92 " "$31,301.92 " "$35,997.21 " "$31,301.92 " N/A "$29,736.83 " "$121,669.67 " 330104 612 3 Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond I N/A "$43,514.71 " N/A "$43,514.71 " N/A N/A N/A N/A "$41,338.97 " N/A "$41,774.12 " N/A N/A N/A N/A N/A "$55,698.83 " "$43,514.71 " N/A N/A N/A N/A "$44,820.15 " N/A N/A "$60,920.59 " "$169,611.82 " "$43,514.71 " "$58,744.86 " "$53,523.09 " N/A "$44,820.15 " N/A N/A N/A N/A N/A "$43,514.71 " "$148,952.67 " "$89,205.16 " "$43,514.71 " "$43,514.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,514.71 " "$43,514.71 " "$50,041.92 " "$43,514.71 " N/A "$41,338.97 " "$169,611.82 " 330104 612 4 Neonate bwt 1500-1999g w resp dist synd/oth maj resp cond I N/A "$58,027.82 " N/A "$58,027.82 " N/A N/A N/A N/A "$55,126.43 " N/A "$55,706.71 " N/A N/A N/A N/A N/A "$74,275.62 " "$58,027.82 " N/A N/A N/A N/A "$59,768.66 " N/A N/A "$81,238.95 " "$226,584.06 " "$58,027.82 " "$78,337.56 " "$71,374.22 " N/A "$59,768.66 " N/A N/A N/A N/A N/A "$58,027.82 " "$198,985.55 " "$118,957.04 " "$58,027.82 " "$58,027.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$58,027.82 " "$58,027.82 " "$66,732.00 " "$58,027.82 " N/A "$55,126.43 " "$226,584.06 " 330104 613 1 Neonate birthwt 1500-1999g w congenital/perinatal infection I N/A "$18,454.96 " N/A "$18,454.96 " N/A N/A N/A N/A "$17,532.22 " N/A "$17,716.76 " N/A N/A N/A N/A N/A "$23,622.35 " "$18,454.96 " N/A N/A N/A N/A "$19,008.61 " N/A N/A "$25,836.95 " "$71,238.03 " "$18,454.96 " "$24,914.20 " "$22,699.60 " N/A "$19,008.61 " N/A N/A N/A N/A N/A "$18,454.96 " "$62,561.06 " "$37,832.67 " "$18,454.96 " "$18,454.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,454.96 " "$18,454.96 " "$21,223.21 " "$18,454.96 " N/A "$17,532.22 " "$71,238.03 " 330104 613 2 Neonate birthwt 1500-1999g w congenital/perinatal infection I N/A "$27,742.78 " N/A "$27,742.78 " N/A N/A N/A N/A "$26,355.65 " N/A "$26,633.07 " N/A N/A N/A N/A N/A "$35,510.76 " "$27,742.78 " N/A N/A N/A N/A "$28,575.07 " N/A N/A "$38,839.90 " "$107,698.02 " "$27,742.78 " "$37,452.76 " "$34,123.62 " N/A "$28,575.07 " N/A N/A N/A N/A N/A "$27,742.78 " "$94,580.13 " "$56,872.71 " "$27,742.78 " "$27,742.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,742.78 " "$27,742.78 " "$31,904.20 " "$27,742.78 " N/A "$26,355.65 " "$107,698.02 " 330104 613 3 Neonate birthwt 1500-1999g w congenital/perinatal infection I N/A "$34,691.45 " N/A "$34,691.45 " N/A N/A N/A N/A "$32,956.88 " N/A "$33,303.79 " N/A N/A N/A N/A N/A "$44,405.06 " "$34,691.45 " N/A N/A N/A N/A "$35,732.19 " N/A N/A "$48,568.03 " "$134,975.50 " "$34,691.45 " "$46,833.46 " "$42,670.48 " N/A "$35,732.19 " N/A N/A N/A N/A N/A "$34,691.45 " "$118,535.14 " "$71,117.47 " "$34,691.45 " "$34,691.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,691.45 " "$34,691.45 " "$39,895.17 " "$34,691.45 " N/A "$32,956.88 " "$134,975.50 " 330104 613 4 Neonate birthwt 1500-1999g w congenital/perinatal infection I N/A "$35,579.70 " N/A "$35,579.70 " N/A N/A N/A N/A "$33,800.72 " N/A "$34,156.51 " N/A N/A N/A N/A N/A "$45,542.02 " "$35,579.70 " N/A N/A N/A N/A "$36,647.09 " N/A N/A "$49,811.58 " "$138,462.39 " "$35,579.70 " "$48,032.60 " "$43,763.03 " N/A "$36,647.09 " N/A N/A N/A N/A N/A "$35,579.70 " "$121,597.32 " "$72,938.39 " "$35,579.70 " "$35,579.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$35,579.70 " "$35,579.70 " "$40,916.66 " "$35,579.70 " N/A "$33,800.72 " "$138,462.39 " 330104 614 1 Neonate bwt 1500-1999g w or w/o other significant condition I N/A "$13,894.50 " N/A "$13,894.50 " N/A N/A N/A N/A "$13,199.77 " N/A "$13,338.72 " N/A N/A N/A N/A N/A "$17,784.96 " "$13,894.50 " N/A N/A N/A N/A "$14,311.33 " N/A N/A "$19,452.30 " "$53,335.60 " "$13,894.50 " "$18,757.57 " "$17,090.23 " N/A "$14,311.33 " N/A N/A N/A N/A N/A "$13,894.50 " "$46,839.19 " "$28,483.72 " "$13,894.50 " "$13,894.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,894.50 " "$13,894.50 " "$15,978.67 " "$13,894.50 " N/A "$13,199.77 " "$53,335.60 " 330104 614 2 Neonate bwt 1500-1999g w or w/o other significant condition I N/A "$22,774.98 " N/A "$22,774.98 " N/A N/A N/A N/A "$21,636.23 " N/A "$21,863.98 " N/A N/A N/A N/A N/A "$29,151.97 " "$22,774.98 " N/A N/A N/A N/A "$23,458.22 " N/A N/A "$31,884.97 " "$88,196.54 " "$22,774.98 " "$30,746.22 " "$28,013.22 " N/A "$23,458.22 " N/A N/A N/A N/A N/A "$22,774.98 " "$77,453.98 " "$46,688.70 " "$22,774.98 " "$22,774.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,774.98 " "$22,774.98 " "$26,191.22 " "$22,774.98 " N/A "$21,636.23 " "$88,196.54 " 330104 614 3 Neonate bwt 1500-1999g w or w/o other significant condition I N/A "$34,612.43 " N/A "$34,612.43 " N/A N/A N/A N/A "$32,881.81 " N/A "$33,227.94 " N/A N/A N/A N/A N/A "$44,303.92 " "$34,612.43 " N/A N/A N/A N/A "$35,650.81 " N/A N/A "$48,457.41 " "$134,665.31 " "$34,612.43 " "$46,726.79 " "$42,573.29 " N/A "$35,650.81 " N/A N/A N/A N/A N/A "$34,612.43 " "$118,262.74 " "$70,955.49 " "$34,612.43 " "$34,612.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,612.43 " "$34,612.43 " "$39,804.30 " "$34,612.43 " N/A "$32,881.81 " "$134,665.31 " 330104 614 4 Neonate bwt 1500-1999g w or w/o other significant condition I N/A "$34,612.43 " N/A "$34,612.43 " N/A N/A N/A N/A "$32,881.81 " N/A "$33,227.94 " N/A N/A N/A N/A N/A "$44,303.92 " "$34,612.43 " N/A N/A N/A N/A "$35,650.81 " N/A N/A "$48,457.41 " "$134,665.31 " "$34,612.43 " "$46,726.79 " "$42,573.29 " N/A "$35,650.81 " N/A N/A N/A N/A N/A "$34,612.43 " "$118,262.74 " "$70,955.49 " "$34,612.43 " "$34,612.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,612.43 " "$34,612.43 " "$39,804.30 " "$34,612.43 " N/A "$32,881.81 " "$134,665.31 " 330104 621 1 Neonate bwt 2000-2499g w major anomaly I N/A "$6,490.81 " N/A "$6,490.81 " N/A N/A N/A N/A "$6,166.27 " N/A "$6,231.17 " N/A N/A N/A N/A N/A "$8,308.23 " "$6,490.81 " N/A N/A N/A N/A "$6,685.53 " N/A N/A "$9,087.13 " "$24,271.90 " "$6,490.81 " "$8,762.59 " "$7,983.69 " N/A "$6,685.53 " N/A N/A N/A N/A N/A "$6,490.81 " "$21,315.52 " "$13,306.15 " "$6,490.81 " "$6,490.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,490.81 " "$6,490.81 " "$7,464.43 " "$6,490.81 " N/A "$6,166.27 " "$24,271.90 " 330104 621 2 Neonate bwt 2000-2499g w major anomaly I N/A "$14,571.58 " N/A "$14,571.58 " N/A N/A N/A N/A "$13,843.01 " N/A "$13,988.72 " N/A N/A N/A N/A N/A "$18,651.63 " "$14,571.58 " N/A N/A N/A N/A "$15,008.73 " N/A N/A "$20,400.22 " "$55,993.56 " "$14,571.58 " "$19,671.64 " "$17,923.05 " N/A "$15,008.73 " N/A N/A N/A N/A N/A "$14,571.58 " "$49,173.40 " "$29,871.75 " "$14,571.58 " "$14,571.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,571.58 " "$14,571.58 " "$16,757.32 " "$14,571.58 " N/A "$13,843.01 " "$55,993.56 " 330104 621 3 Neonate bwt 2000-2499g w major anomaly I N/A "$27,406.97 " N/A "$27,406.97 " N/A N/A N/A N/A "$26,036.62 " N/A "$26,310.69 " N/A N/A N/A N/A N/A "$35,080.92 " "$27,406.97 " N/A N/A N/A N/A "$28,229.17 " N/A N/A "$38,369.75 " "$106,379.74 " "$27,406.97 " "$36,999.40 " "$33,710.57 " N/A "$28,229.17 " N/A N/A N/A N/A N/A "$27,406.97 " "$93,422.42 " "$56,184.28 " "$27,406.97 " "$27,406.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,406.97 " "$27,406.97 " "$31,518.01 " "$27,406.97 " N/A "$26,036.62 " "$106,379.74 " 330104 621 4 Neonate bwt 2000-2499g w major anomaly I N/A "$46,573.87 " N/A "$46,573.87 " N/A N/A N/A N/A "$44,245.17 " N/A "$44,710.91 " N/A N/A N/A N/A N/A "$59,614.55 " "$46,573.87 " N/A N/A N/A N/A "$47,971.08 " N/A N/A "$65,203.41 " "$181,620.75 " "$46,573.87 " "$62,874.72 " "$57,285.86 " N/A "$47,971.08 " N/A N/A N/A N/A N/A "$46,573.87 " "$159,498.88 " "$95,476.43 " "$46,573.87 " "$46,573.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$46,573.87 " "$46,573.87 " "$53,559.95 " "$46,573.87 " N/A "$44,245.17 " "$181,620.75 " 330104 622 1 Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond I N/A "$13,504.18 " N/A "$13,504.18 " N/A N/A N/A N/A "$12,828.97 " N/A "$12,964.02 " N/A N/A N/A N/A N/A "$17,285.35 " "$13,504.18 " N/A N/A N/A N/A "$13,909.31 " N/A N/A "$18,905.86 " "$51,803.40 " "$13,504.18 " "$18,230.65 " "$16,610.15 " N/A "$13,909.31 " N/A N/A N/A N/A N/A "$13,504.18 " "$45,493.62 " "$27,683.58 " "$13,504.18 " "$13,504.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,504.18 " "$13,504.18 " "$15,529.81 " "$13,504.18 " N/A "$12,828.97 " "$51,803.40 " 330104 622 2 Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond I N/A "$18,225.41 " N/A "$18,225.41 " N/A N/A N/A N/A "$17,314.14 " N/A "$17,496.39 " N/A N/A N/A N/A N/A "$23,328.52 " "$18,225.41 " N/A N/A N/A N/A "$18,772.17 " N/A N/A "$25,515.57 " "$70,336.90 " "$18,225.41 " "$24,604.30 " "$22,417.25 " N/A "$18,772.17 " N/A N/A N/A N/A N/A "$18,225.41 " "$61,769.68 " "$37,362.08 " "$18,225.41 " "$18,225.41 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,225.41 " "$18,225.41 " "$20,959.22 " "$18,225.41 " N/A "$17,314.14 " "$70,336.90 " 330104 622 3 Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond I N/A "$24,869.59 " N/A "$24,869.59 " N/A N/A N/A N/A "$23,626.11 " N/A "$23,874.80 " N/A N/A N/A N/A N/A "$31,833.07 " "$24,869.59 " N/A N/A N/A N/A "$25,615.68 " N/A N/A "$34,817.42 " "$96,419.09 " "$24,869.59 " "$33,573.94 " "$30,589.59 " N/A "$25,615.68 " N/A N/A N/A N/A N/A "$24,869.59 " "$84,675.00 " "$50,982.66 " "$24,869.59 " "$24,869.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,869.59 " "$24,869.59 " "$28,600.03 " "$24,869.59 " N/A "$23,626.11 " "$96,419.09 " 330104 622 4 Neonate bwt 2000-2499g w resp dist synd/oth maj resp cond I N/A "$35,517.72 " N/A "$35,517.72 " N/A N/A N/A N/A "$33,741.83 " N/A "$34,097.01 " N/A N/A N/A N/A N/A "$45,462.68 " "$35,517.72 " N/A N/A N/A N/A "$36,583.25 " N/A N/A "$49,724.80 " "$138,219.06 " "$35,517.72 " "$47,948.92 " "$43,686.79 " N/A "$36,583.25 " N/A N/A N/A N/A N/A "$35,517.72 " "$121,383.63 " "$72,811.32 " "$35,517.72 " "$35,517.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$35,517.72 " "$35,517.72 " "$40,845.37 " "$35,517.72 " N/A "$33,741.83 " "$138,219.06 " 330104 623 1 Neonate bwt 2000-2499g w congenital/perinatal infection I N/A "$10,218.20 " N/A "$10,218.20 " N/A N/A N/A N/A "$9,707.29 " N/A "$9,809.47 " N/A N/A N/A N/A N/A "$13,079.29 " "$10,218.20 " N/A N/A N/A N/A "$10,524.74 " N/A N/A "$14,305.47 " "$38,904.03 " "$10,218.20 " "$13,794.56 " "$12,568.38 " N/A "$10,524.74 " N/A N/A N/A N/A N/A "$10,218.20 " "$34,165.42 " "$20,947.30 " "$10,218.20 " "$10,218.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,218.20 " "$10,218.20 " "$11,750.92 " "$10,218.20 " N/A "$9,707.29 " "$38,904.03 " 330104 623 2 Neonate bwt 2000-2499g w congenital/perinatal infection I N/A "$15,008.90 " N/A "$15,008.90 " N/A N/A N/A N/A "$14,258.45 " N/A "$14,408.54 " N/A N/A N/A N/A N/A "$19,211.39 " "$15,008.90 " N/A N/A N/A N/A "$15,459.17 " N/A N/A "$21,012.46 " "$57,710.27 " "$15,008.90 " "$20,262.01 " "$18,460.95 " N/A "$15,459.17 " N/A N/A N/A N/A N/A "$15,008.90 " "$50,681.01 " "$30,768.24 " "$15,008.90 " "$15,008.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,008.90 " "$15,008.90 " "$17,260.23 " "$15,008.90 " N/A "$14,258.45 " "$57,710.27 " 330104 623 3 Neonate bwt 2000-2499g w congenital/perinatal infection I N/A "$21,595.18 " N/A "$21,595.18 " N/A N/A N/A N/A "$20,515.42 " N/A "$20,731.37 " N/A N/A N/A N/A N/A "$27,641.83 " "$21,595.18 " N/A N/A N/A N/A "$22,243.04 " N/A N/A "$30,233.25 " "$83,565.17 " "$21,595.18 " "$29,153.49 " "$26,562.07 " N/A "$22,243.04 " N/A N/A N/A N/A N/A "$21,595.18 " "$73,386.72 " "$44,270.12 " "$21,595.18 " "$21,595.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,595.18 " "$21,595.18 " "$24,834.46 " "$21,595.18 " N/A "$20,515.42 " "$83,565.17 " 330104 623 4 Neonate bwt 2000-2499g w congenital/perinatal infection I N/A "$21,595.18 " N/A "$21,595.18 " N/A N/A N/A N/A "$20,515.42 " N/A "$20,731.37 " N/A N/A N/A N/A N/A "$27,641.83 " "$21,595.18 " N/A N/A N/A N/A "$22,243.04 " N/A N/A "$30,233.25 " "$83,565.17 " "$21,595.18 " "$29,153.49 " "$26,562.07 " N/A "$22,243.04 " N/A N/A N/A N/A N/A "$21,595.18 " "$73,386.72 " "$44,270.12 " "$21,595.18 " "$21,595.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,595.18 " "$21,595.18 " "$24,834.46 " "$21,595.18 " N/A "$20,515.42 " "$83,565.17 " 330104 625 1 Neonate bwt 2000-2499g w other significant condition I N/A "$11,205.22 " N/A "$11,205.22 " N/A N/A N/A N/A "$10,644.96 " N/A "$10,757.01 " N/A N/A N/A N/A N/A "$14,342.68 " "$11,205.22 " N/A N/A N/A N/A "$11,541.37 " N/A N/A "$15,687.30 " "$42,778.65 " "$11,205.22 " "$15,127.04 " "$13,782.42 " N/A "$11,541.37 " N/A N/A N/A N/A N/A "$11,205.22 " "$37,568.10 " "$22,970.70 " "$11,205.22 " "$11,205.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,205.22 " "$11,205.22 " "$12,886.00 " "$11,205.22 " N/A "$10,644.96 " "$42,778.65 " 330104 625 2 Neonate bwt 2000-2499g w other significant condition I N/A "$17,931.82 " N/A "$17,931.82 " N/A N/A N/A N/A "$17,035.23 " N/A "$17,214.55 " N/A N/A N/A N/A N/A "$22,952.73 " "$17,931.82 " N/A N/A N/A N/A "$18,469.78 " N/A N/A "$25,104.55 " "$69,184.40 " "$17,931.82 " "$24,207.96 " "$22,056.14 " N/A "$18,469.78 " N/A N/A N/A N/A N/A "$17,931.82 " "$60,757.57 " "$36,760.23 " "$17,931.82 " "$17,931.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,931.82 " "$17,931.82 " "$20,621.59 " "$17,931.82 " N/A "$17,035.23 " "$69,184.40 " 330104 625 3 Neonate bwt 2000-2499g w other significant condition I N/A "$22,747.73 " N/A "$22,747.73 " N/A N/A N/A N/A "$21,610.34 " N/A "$21,837.82 " N/A N/A N/A N/A N/A "$29,117.09 " "$22,747.73 " N/A N/A N/A N/A "$23,430.16 " N/A N/A "$31,846.82 " "$88,089.58 " "$22,747.73 " "$30,709.43 " "$27,979.71 " N/A "$23,430.16 " N/A N/A N/A N/A N/A "$22,747.73 " "$77,360.05 " "$46,632.84 " "$22,747.73 " "$22,747.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,747.73 " "$22,747.73 " "$26,159.89 " "$22,747.73 " N/A "$21,610.34 " "$88,089.58 " 330104 625 4 Neonate bwt 2000-2499g w other significant condition I N/A "$22,747.73 " N/A "$22,747.73 " N/A N/A N/A N/A "$21,610.34 " N/A "$21,837.82 " N/A N/A N/A N/A N/A "$29,117.09 " "$22,747.73 " N/A N/A N/A N/A "$23,430.16 " N/A N/A "$31,846.82 " "$88,089.58 " "$22,747.73 " "$30,709.43 " "$27,979.71 " N/A "$23,430.16 " N/A N/A N/A N/A N/A "$22,747.73 " "$77,360.05 " "$46,632.84 " "$22,747.73 " "$22,747.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,747.73 " "$22,747.73 " "$26,159.89 " "$22,747.73 " N/A "$21,610.34 " "$88,089.58 " 330104 626 1 Neonate bwt 2000-2499g normal newborn or neonate w other problem I N/A "$1,726.67 " N/A "$1,726.67 " N/A N/A N/A N/A "$1,640.33 " N/A "$1,657.60 " N/A N/A N/A N/A N/A "$2,210.13 " "$1,726.67 " N/A N/A N/A N/A "$1,778.47 " N/A N/A "$2,417.33 " "$5,569.94 " "$1,726.67 " "$2,331.00 " "$2,123.80 " N/A "$1,778.47 " N/A N/A N/A N/A N/A "$1,726.67 " "$4,891.51 " "$3,539.67 " "$1,726.67 " "$1,726.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,726.67 " "$1,726.67 " "$1,985.67 " "$1,726.67 " N/A "$1,640.33 " "$5,569.94 " 330104 626 2 Neonate bwt 2000-2499g normal newborn or neonate w other problem I N/A "$3,145.56 " N/A "$3,145.56 " N/A N/A N/A N/A "$2,988.28 " N/A "$3,019.73 " N/A N/A N/A N/A N/A "$4,026.31 " "$3,145.56 " N/A N/A N/A N/A "$3,239.92 " N/A N/A "$4,403.78 " "$11,139.88 " "$3,145.56 " "$4,246.50 " "$3,869.03 " N/A "$3,239.92 " N/A N/A N/A N/A N/A "$3,145.56 " "$9,783.02 " "$6,448.39 " "$3,145.56 " "$3,145.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,145.56 " "$3,145.56 " "$3,617.39 " "$3,145.56 " N/A "$2,988.28 " "$11,139.88 " 330104 626 3 Neonate bwt 2000-2499g normal newborn or neonate w other problem I N/A "$9,421.22 " N/A "$9,421.22 " N/A N/A N/A N/A "$8,950.16 " N/A "$9,044.37 " N/A N/A N/A N/A N/A "$12,059.16 " "$9,421.22 " N/A N/A N/A N/A "$9,703.86 " N/A N/A "$13,189.71 " "$35,775.45 " "$9,421.22 " "$12,718.65 " "$11,588.10 " N/A "$9,703.86 " N/A N/A N/A N/A N/A "$9,421.22 " "$31,417.91 " "$19,313.50 " "$9,421.22 " "$9,421.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,421.22 " "$9,421.22 " "$10,834.40 " "$9,421.22 " N/A "$8,950.16 " "$35,775.45 " 330104 626 4 Neonate bwt 2000-2499g normal newborn or neonate w other problem I N/A "$9,431.44 " N/A "$9,431.44 " N/A N/A N/A N/A "$8,959.87 " N/A "$9,054.18 " N/A N/A N/A N/A N/A "$12,072.24 " "$9,431.44 " N/A N/A N/A N/A "$9,714.38 " N/A N/A "$13,204.01 " "$35,815.56 " "$9,431.44 " "$12,732.44 " "$11,600.67 " N/A "$9,714.38 " N/A N/A N/A N/A N/A "$9,431.44 " "$31,453.13 " "$19,334.45 " "$9,431.44 " "$9,431.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,431.44 " "$9,431.44 " "$10,846.15 " "$9,431.44 " N/A "$8,959.87 " "$35,815.56 " 330104 630 1 Neonate birthwt >2499g w major cardiovascular procedure I N/A "$23,800.14 " N/A "$23,800.14 " N/A N/A N/A N/A "$22,610.14 " N/A "$22,848.14 " N/A N/A N/A N/A N/A "$30,464.18 " "$23,800.14 " N/A N/A N/A N/A "$24,514.15 " N/A N/A "$33,320.20 " "$92,220.91 " "$23,800.14 " "$32,130.19 " "$29,274.18 " N/A "$24,514.15 " N/A N/A N/A N/A N/A "$23,800.14 " "$80,988.17 " "$48,790.29 " "$23,800.14 " "$23,800.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,800.14 " "$23,800.14 " "$27,370.16 " "$23,800.14 " N/A "$22,610.14 " "$92,220.91 " 330104 630 2 Neonate birthwt >2499g w major cardiovascular procedure I N/A "$24,739.48 " N/A "$24,739.48 " N/A N/A N/A N/A "$23,502.51 " N/A "$23,749.90 " N/A N/A N/A N/A N/A "$31,666.54 " "$24,739.48 " N/A N/A N/A N/A "$25,481.67 " N/A N/A "$34,635.28 " "$95,908.36 " "$24,739.48 " "$33,398.30 " "$30,429.56 " N/A "$25,481.67 " N/A N/A N/A N/A N/A "$24,739.48 " "$84,226.48 " "$50,715.94 " "$24,739.48 " "$24,739.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,739.48 " "$24,739.48 " "$28,450.41 " "$24,739.48 " N/A "$23,502.51 " "$95,908.36 " 330104 630 3 Neonate birthwt >2499g w major cardiovascular procedure I N/A "$40,670.80 " N/A "$40,670.80 " N/A N/A N/A N/A "$38,637.26 " N/A "$39,043.97 " N/A N/A N/A N/A N/A "$52,058.63 " "$40,670.80 " N/A N/A N/A N/A "$41,890.93 " N/A N/A "$56,939.13 " "$158,447.87 " "$40,670.80 " "$54,905.59 " "$50,025.09 " N/A "$41,890.93 " N/A N/A N/A N/A N/A "$40,670.80 " "$139,148.52 " "$83,375.15 " "$40,670.80 " "$40,670.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$40,670.80 " "$40,670.80 " "$46,771.43 " "$40,670.80 " N/A "$38,637.26 " "$158,447.87 " 330104 630 4 Neonate birthwt >2499g w major cardiovascular procedure I N/A "$83,612.08 " N/A "$83,612.08 " N/A N/A N/A N/A "$79,431.47 " N/A "$80,267.59 " N/A N/A N/A N/A N/A "$107,023.46 " "$83,612.08 " N/A N/A N/A N/A "$86,120.44 " N/A N/A "$117,056.91 " "$327,016.83 " "$83,612.08 " "$112,876.30 " "$102,842.85 " N/A "$86,120.44 " N/A N/A N/A N/A N/A "$83,612.08 " "$287,185.35 " "$171,404.76 " "$83,612.08 " "$83,612.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$83,612.08 " "$83,612.08 " "$96,153.89 " "$83,612.08 " N/A "$79,431.47 " "$327,016.83 " 330104 631 1 Neonate birthwt >2499g w other major procedure I N/A "$11,397.99 " N/A "$11,397.99 " N/A N/A N/A N/A "$10,828.09 " N/A "$10,942.07 " N/A N/A N/A N/A N/A "$14,589.43 " "$11,397.99 " N/A N/A N/A N/A "$11,739.93 " N/A N/A "$15,957.19 " "$43,535.39 " "$11,397.99 " "$15,387.29 " "$14,019.53 " N/A "$11,739.93 " N/A N/A N/A N/A N/A "$11,397.99 " "$38,232.67 " "$23,365.88 " "$11,397.99 " "$11,397.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,397.99 " "$11,397.99 " "$13,107.69 " "$11,397.99 " N/A "$10,828.09 " "$43,535.39 " 330104 631 2 Neonate birthwt >2499g w other major procedure I N/A "$20,293.45 " N/A "$20,293.45 " N/A N/A N/A N/A "$19,278.78 " N/A "$19,481.72 " N/A N/A N/A N/A N/A "$25,975.62 " "$20,293.45 " N/A N/A N/A N/A "$20,902.26 " N/A N/A "$28,410.84 " "$78,455.16 " "$20,293.45 " "$27,396.16 " "$24,960.95 " N/A "$20,902.26 " N/A N/A N/A N/A N/A "$20,293.45 " "$68,899.12 " "$41,601.58 " "$20,293.45 " "$20,293.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,293.45 " "$20,293.45 " "$23,337.47 " "$20,293.45 " N/A "$19,278.78 " "$78,455.16 " 330104 631 3 Neonate birthwt >2499g w other major procedure I N/A "$33,521.87 " N/A "$33,521.87 " N/A N/A N/A N/A "$31,845.78 " N/A "$32,181.00 " N/A N/A N/A N/A N/A "$42,908.00 " "$33,521.87 " N/A N/A N/A N/A "$34,527.53 " N/A N/A "$46,930.62 " "$130,384.24 " "$33,521.87 " "$45,254.53 " "$41,231.90 " N/A "$34,527.53 " N/A N/A N/A N/A N/A "$33,521.87 " "$114,503.11 " "$68,719.84 " "$33,521.87 " "$33,521.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$33,521.87 " "$33,521.87 " "$38,550.15 " "$33,521.87 " N/A "$31,845.78 " "$130,384.24 " 330104 631 4 Neonate birthwt >2499g w other major procedure I N/A "$71,922.43 " N/A "$71,922.43 " N/A N/A N/A N/A "$68,326.31 " N/A "$69,045.54 " N/A N/A N/A N/A N/A "$92,060.71 " "$71,922.43 " N/A N/A N/A N/A "$74,080.11 " N/A N/A "$100,691.41 " "$281,128.32 " "$71,922.43 " "$97,095.28 " "$88,464.59 " N/A "$74,080.11 " N/A N/A N/A N/A N/A "$71,922.43 " "$246,886.17 " "$147,440.99 " "$71,922.43 " "$71,922.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$71,922.43 " "$71,922.43 " "$82,710.80 " "$71,922.43 " N/A "$68,326.31 " "$281,128.32 " 330104 633 1 Neonate birthwt >2499g w major anomaly I N/A "$2,227.33 " N/A "$2,227.33 " N/A N/A N/A N/A "$2,115.96 " N/A "$2,138.24 " N/A N/A N/A N/A N/A "$2,850.98 " "$2,227.33 " N/A N/A N/A N/A "$2,294.15 " N/A N/A "$3,118.26 " "$7,535.33 " "$2,227.33 " "$3,006.90 " "$2,739.62 " N/A "$2,294.15 " N/A N/A N/A N/A N/A "$2,227.33 " "$6,617.51 " "$4,566.03 " "$2,227.33 " "$2,227.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,227.33 " "$2,227.33 " "$2,561.43 " "$2,227.33 " N/A "$2,115.96 " "$7,535.33 " 330104 633 2 Neonate birthwt >2499g w major anomaly I N/A "$6,509.88 " N/A "$6,509.88 " N/A N/A N/A N/A "$6,184.38 " N/A "$6,249.48 " N/A N/A N/A N/A N/A "$8,332.64 " "$6,509.88 " N/A N/A N/A N/A "$6,705.17 " N/A N/A "$9,113.83 " "$24,346.77 " "$6,509.88 " "$8,788.34 " "$8,007.15 " N/A "$6,705.17 " N/A N/A N/A N/A N/A "$6,509.88 " "$21,381.27 " "$13,345.25 " "$6,509.88 " "$6,509.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,509.88 " "$6,509.88 " "$7,486.36 " "$6,509.88 " N/A "$6,184.38 " "$24,346.77 " 330104 633 3 Neonate birthwt >2499g w major anomaly I N/A "$16,631.46 " N/A "$16,631.46 " N/A N/A N/A N/A "$15,799.88 " N/A "$15,966.20 " N/A N/A N/A N/A N/A "$21,288.27 " "$16,631.46 " N/A N/A N/A N/A "$17,130.40 " N/A N/A "$23,284.04 " "$64,079.74 " "$16,631.46 " "$22,452.47 " "$20,456.69 " N/A "$17,130.40 " N/A N/A N/A N/A N/A "$16,631.46 " "$56,274.66 " "$34,094.49 " "$16,631.46 " "$16,631.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,631.46 " "$16,631.46 " "$19,126.18 " "$16,631.46 " N/A "$15,799.88 " "$64,079.74 " 330104 633 4 Neonate birthwt >2499g w major anomaly I N/A "$36,777.21 " N/A "$36,777.21 " N/A N/A N/A N/A "$34,938.35 " N/A "$35,306.12 " N/A N/A N/A N/A N/A "$47,074.83 " "$36,777.21 " N/A N/A N/A N/A "$37,880.52 " N/A N/A "$51,488.09 " "$143,163.29 " "$36,777.21 " "$49,649.23 " "$45,235.97 " N/A "$37,880.52 " N/A N/A N/A N/A N/A "$36,777.21 " "$125,725.63 " "$75,393.28 " "$36,777.21 " "$36,777.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$36,777.21 " "$36,777.21 " "$42,293.79 " "$36,777.21 " N/A "$34,938.35 " "$143,163.29 " 330104 634 1 Neonate birthwt >2499g w resp dist synd/oth maj resp cond I N/A "$5,785.11 " N/A "$5,785.11 " N/A N/A N/A N/A "$5,495.85 " N/A "$5,553.70 " N/A N/A N/A N/A N/A "$7,404.94 " "$5,785.11 " N/A N/A N/A N/A "$5,958.66 " N/A N/A "$8,099.15 " "$21,501.63 " "$5,785.11 " "$7,809.90 " "$7,115.68 " N/A "$5,958.66 " N/A N/A N/A N/A N/A "$5,785.11 " "$18,882.68 " "$11,859.47 " "$5,785.11 " "$5,785.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,785.11 " "$5,785.11 " "$6,652.87 " "$5,785.11 " N/A "$5,495.85 " "$21,501.63 " 330104 634 2 Neonate birthwt >2499g w resp dist synd/oth maj resp cond I N/A "$9,388.52 " N/A "$9,388.52 " N/A N/A N/A N/A "$8,919.10 " N/A "$9,012.98 " N/A N/A N/A N/A N/A "$12,017.31 " "$9,388.52 " N/A N/A N/A N/A "$9,670.18 " N/A N/A "$13,143.93 " "$35,647.09 " "$9,388.52 " "$12,674.51 " "$11,547.88 " N/A "$9,670.18 " N/A N/A N/A N/A N/A "$9,388.52 " "$31,305.19 " "$19,246.47 " "$9,388.52 " "$9,388.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,388.52 " "$9,388.52 " "$10,796.80 " "$9,388.52 " N/A "$8,919.10 " "$35,647.09 " 330104 634 3 Neonate birthwt >2499g w resp dist synd/oth maj resp cond I N/A "$15,649.20 " N/A "$15,649.20 " N/A N/A N/A N/A "$14,866.74 " N/A "$15,023.24 " N/A N/A N/A N/A N/A "$20,030.98 " "$15,649.20 " N/A N/A N/A N/A "$16,118.68 " N/A N/A "$21,908.88 " "$60,223.83 " "$15,649.20 " "$21,126.42 " "$19,248.52 " N/A "$16,118.68 " N/A N/A N/A N/A N/A "$15,649.20 " "$52,888.41 " "$32,080.87 " "$15,649.20 " "$15,649.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,649.20 " "$15,649.20 " "$17,996.58 " "$15,649.20 " N/A "$14,866.74 " "$60,223.83 " 330104 634 4 Neonate birthwt >2499g w resp dist synd/oth maj resp cond I N/A "$27,782.97 " N/A "$27,782.97 " N/A N/A N/A N/A "$26,393.82 " N/A "$26,671.65 " N/A N/A N/A N/A N/A "$35,562.21 " "$27,782.97 " N/A N/A N/A N/A "$28,616.46 " N/A N/A "$38,896.16 " "$107,855.79 " "$27,782.97 " "$37,507.01 " "$34,173.06 " N/A "$28,616.46 " N/A N/A N/A N/A N/A "$27,782.97 " "$94,718.68 " "$56,955.10 " "$27,782.97 " "$27,782.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,782.97 " "$27,782.97 " "$31,950.42 " "$27,782.97 " N/A "$26,393.82 " "$107,855.79 " 330104 636 1 Neonate birthwt >2499g w congenital/perinatal infection I N/A "$7,033.70 " N/A "$7,033.70 " N/A N/A N/A N/A "$6,682.02 " N/A "$6,752.35 " N/A N/A N/A N/A N/A "$9,003.14 " "$7,033.70 " N/A N/A N/A N/A "$7,244.71 " N/A N/A "$9,847.18 " "$26,403.08 " "$7,033.70 " "$9,495.50 " "$8,651.45 " N/A "$7,244.71 " N/A N/A N/A N/A N/A "$7,033.70 " "$23,187.11 " "$14,419.09 " "$7,033.70 " "$7,033.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,033.70 " "$7,033.70 " "$8,088.76 " "$7,033.70 " N/A "$6,682.02 " "$26,403.08 " 330104 636 2 Neonate birthwt >2499g w congenital/perinatal infection I N/A "$9,435.52 " N/A "$9,435.52 " N/A N/A N/A N/A "$8,963.75 " N/A "$9,058.10 " N/A N/A N/A N/A N/A "$12,077.47 " "$9,435.52 " N/A N/A N/A N/A "$9,718.59 " N/A N/A "$13,209.73 " "$35,831.60 " "$9,435.52 " "$12,737.96 " "$11,605.70 " N/A "$9,718.59 " N/A N/A N/A N/A N/A "$9,435.52 " "$31,467.22 " "$19,342.83 " "$9,435.52 " "$9,435.52 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,435.52 " "$9,435.52 " "$10,850.85 " "$9,435.52 " N/A "$8,963.75 " "$35,831.60 " 330104 636 3 Neonate birthwt >2499g w congenital/perinatal infection I N/A "$14,320.23 " N/A "$14,320.23 " N/A N/A N/A N/A "$13,604.22 " N/A "$13,747.42 " N/A N/A N/A N/A N/A "$18,329.90 " "$14,320.23 " N/A N/A N/A N/A "$14,749.84 " N/A N/A "$20,048.32 " "$55,006.85 " "$14,320.23 " "$19,332.31 " "$17,613.88 " N/A "$14,749.84 " N/A N/A N/A N/A N/A "$14,320.23 " "$48,306.88 " "$29,356.47 " "$14,320.23 " "$14,320.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,320.23 " "$14,320.23 " "$16,468.27 " "$14,320.23 " N/A "$13,604.22 " "$55,006.85 " 330104 636 4 Neonate birthwt >2499g w congenital/perinatal infection I N/A "$18,574.85 " N/A "$18,574.85 " N/A N/A N/A N/A "$17,646.11 " N/A "$17,831.86 " N/A N/A N/A N/A N/A "$23,775.81 " "$18,574.85 " N/A N/A N/A N/A "$19,132.10 " N/A N/A "$26,004.79 " "$71,708.66 " "$18,574.85 " "$25,076.05 " "$22,847.07 " N/A "$19,132.10 " N/A N/A N/A N/A N/A "$18,574.85 " "$62,974.36 " "$38,078.44 " "$18,574.85 " "$18,574.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,574.85 " "$18,574.85 " "$21,361.08 " "$18,574.85 " N/A "$17,646.11 " "$71,708.66 " 330104 639 1 Neonate birthwt >2499g w other significant condition I N/A "$3,820.60 " N/A "$3,820.60 " N/A N/A N/A N/A "$3,629.57 " N/A "$3,667.78 " N/A N/A N/A N/A N/A "$4,890.37 " "$3,820.60 " N/A N/A N/A N/A "$3,935.22 " N/A N/A "$5,348.84 " "$13,789.82 " "$3,820.60 " "$5,157.81 " "$4,699.34 " N/A "$3,935.22 " N/A N/A N/A N/A N/A "$3,820.60 " "$12,110.18 " "$7,832.23 " "$3,820.60 " "$3,820.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,820.60 " "$3,820.60 " "$4,393.69 " "$3,820.60 " N/A "$3,629.57 " "$13,789.82 " 330104 639 2 Neonate birthwt >2499g w other significant condition I N/A "$9,139.90 " N/A "$9,139.90 " N/A N/A N/A N/A "$8,682.90 " N/A "$8,774.30 " N/A N/A N/A N/A N/A "$11,699.07 " "$9,139.90 " N/A N/A N/A N/A "$9,414.09 " N/A N/A "$12,795.85 " "$34,671.08 " "$9,139.90 " "$12,338.86 " "$11,242.07 " N/A "$9,414.09 " N/A N/A N/A N/A N/A "$9,139.90 " "$30,448.06 " "$18,736.78 " "$9,139.90 " "$9,139.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,139.90 " "$9,139.90 " "$10,510.88 " "$9,139.90 " N/A "$8,682.90 " "$34,671.08 " 330104 639 3 Neonate birthwt >2499g w other significant condition I N/A "$13,002.84 " N/A "$13,002.84 " N/A N/A N/A N/A "$12,352.70 " N/A "$12,482.72 " N/A N/A N/A N/A N/A "$16,643.63 " "$13,002.84 " N/A N/A N/A N/A "$13,392.92 " N/A N/A "$18,203.97 " "$49,835.34 " "$13,002.84 " "$17,553.83 " "$15,993.49 " N/A "$13,392.92 " N/A N/A N/A N/A N/A "$13,002.84 " "$43,765.27 " "$26,655.82 " "$13,002.84 " "$13,002.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,002.84 " "$13,002.84 " "$14,953.26 " "$13,002.84 " N/A "$12,352.70 " "$49,835.34 " 330104 639 4 Neonate birthwt >2499g w other significant condition I N/A "$26,426.07 " N/A "$26,426.07 " N/A N/A N/A N/A "$25,104.77 " N/A "$25,369.03 " N/A N/A N/A N/A N/A "$33,825.37 " "$26,426.07 " N/A N/A N/A N/A "$27,218.86 " N/A N/A "$36,996.50 " "$102,529.18 " "$26,426.07 " "$35,675.20 " "$32,504.07 " N/A "$27,218.86 " N/A N/A N/A N/A N/A "$26,426.07 " "$90,040.87 " "$54,173.45 " "$26,426.07 " "$26,426.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,426.07 " "$26,426.07 " "$30,389.98 " "$26,426.07 " N/A "$25,104.77 " "$102,529.18 " 330104 640 1 Neonate birthwt >2499g normal newborn or neonate w other problem I N/A "$1,499.16 " N/A "$1,499.16 " N/A N/A N/A N/A "$1,424.20 " N/A "$1,439.19 " N/A N/A N/A N/A N/A "$1,918.92 " "$1,499.16 " N/A N/A N/A N/A "$1,544.13 " N/A N/A "$2,098.82 " "$4,676.83 " "$1,499.16 " "$2,023.86 " "$1,843.96 " N/A "$1,544.13 " N/A N/A N/A N/A N/A "$1,499.16 " "$4,107.18 " "$3,073.27 " "$1,499.16 " "$1,499.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,499.16 " "$1,499.16 " "$1,724.03 " "$1,499.16 " N/A "$1,424.20 " "$4,676.83 " 330104 640 2 Neonate birthwt >2499g normal newborn or neonate w other problem I N/A "$1,963.04 " N/A "$1,963.04 " N/A N/A N/A N/A "$1,864.88 " N/A "$1,884.51 " N/A N/A N/A N/A N/A "$2,512.69 " "$1,963.04 " N/A N/A N/A N/A "$2,021.93 " N/A N/A "$2,748.25 " "$6,497.82 " "$1,963.04 " "$2,650.10 " "$2,414.53 " N/A "$2,021.93 " N/A N/A N/A N/A N/A "$1,963.04 " "$5,706.37 " "$4,024.22 " "$1,963.04 " "$1,963.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$1,963.04 " "$1,963.04 " "$2,257.49 " "$1,963.04 " N/A "$1,864.88 " "$6,497.82 " 330104 640 3 Neonate birthwt >2499g normal newborn or neonate w other problem I N/A "$3,986.81 " N/A "$3,986.81 " N/A N/A N/A N/A "$3,787.47 " N/A "$3,827.33 " N/A N/A N/A N/A N/A "$5,103.11 " "$3,986.81 " N/A N/A N/A N/A "$4,106.41 " N/A N/A "$5,581.53 " "$14,442.27 " "$3,986.81 " "$5,382.19 " "$4,903.77 " N/A "$4,106.41 " N/A N/A N/A N/A N/A "$3,986.81 " "$12,683.17 " "$8,172.95 " "$3,986.81 " "$3,986.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,986.81 " "$3,986.81 " "$4,584.83 " "$3,986.81 " N/A "$3,787.47 " "$14,442.27 " 330104 640 4 Neonate birthwt >2499g normal newborn or neonate w other problem I N/A "$3,990.89 " N/A "$3,990.89 " N/A N/A N/A N/A "$3,791.35 " N/A "$3,831.26 " N/A N/A N/A N/A N/A "$5,108.34 " "$3,990.89 " N/A N/A N/A N/A "$4,110.62 " N/A N/A "$5,587.25 " "$14,458.32 " "$3,990.89 " "$5,387.71 " "$4,908.80 " N/A "$4,110.62 " N/A N/A N/A N/A N/A "$3,990.89 " "$12,697.26 " "$8,181.33 " "$3,990.89 " "$3,990.89 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,990.89 " "$3,990.89 " "$4,589.53 " "$3,990.89 " N/A "$3,791.35 " "$14,458.32 " 330104 650 1 Splenectomy I N/A "$9,158.29 " N/A "$9,158.29 " N/A N/A N/A N/A "$8,700.37 " N/A "$8,791.96 " N/A N/A N/A N/A N/A "$11,722.61 " "$9,158.29 " N/A N/A N/A N/A "$9,433.04 " N/A N/A "$12,821.60 " "$34,743.28 " "$9,158.29 " "$12,363.69 " "$11,264.69 " N/A "$9,433.04 " N/A N/A N/A N/A N/A "$9,158.29 " "$30,511.46 " "$18,774.49 " "$9,158.29 " "$9,158.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,158.29 " "$9,158.29 " "$10,532.03 " "$9,158.29 " N/A "$8,700.37 " "$34,743.28 " 330104 650 2 Splenectomy I N/A "$13,825.02 " N/A "$13,825.02 " N/A N/A N/A N/A "$13,133.77 " N/A "$13,272.02 " N/A N/A N/A N/A N/A "$17,696.02 " "$13,825.02 " N/A N/A N/A N/A "$14,239.77 " N/A N/A "$19,355.02 " "$53,062.86 " "$13,825.02 " "$18,663.77 " "$17,004.77 " N/A "$14,239.77 " N/A N/A N/A N/A N/A "$13,825.02 " "$46,599.67 " "$28,341.28 " "$13,825.02 " "$13,825.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,825.02 " "$13,825.02 " "$15,898.77 " "$13,825.02 " N/A "$13,133.77 " "$53,062.86 " 330104 650 3 Splenectomy I N/A "$16,596.72 " N/A "$16,596.72 " N/A N/A N/A N/A "$15,766.88 " N/A "$15,932.85 " N/A N/A N/A N/A N/A "$21,243.80 " "$16,596.72 " N/A N/A N/A N/A "$17,094.62 " N/A N/A "$23,235.40 " "$63,943.36 " "$16,596.72 " "$22,405.57 " "$20,413.96 " N/A "$17,094.62 " N/A N/A N/A N/A N/A "$16,596.72 " "$56,154.90 " "$34,023.27 " "$16,596.72 " "$16,596.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,596.72 " "$16,596.72 " "$19,086.23 " "$16,596.72 " N/A "$15,766.88 " "$63,943.36 " 330104 650 4 Splenectomy I N/A "$39,155.19 " N/A "$39,155.19 " N/A N/A N/A N/A "$37,197.43 " N/A "$37,588.98 " N/A N/A N/A N/A N/A "$50,118.64 " "$39,155.19 " N/A N/A N/A N/A "$40,329.85 " N/A N/A "$54,817.27 " "$152,498.22 " "$39,155.19 " "$52,859.51 " "$48,160.88 " N/A "$40,329.85 " N/A N/A N/A N/A N/A "$39,155.19 " "$133,923.55 " "$80,268.14 " "$39,155.19 " "$39,155.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$39,155.19 " "$39,155.19 " "$45,028.47 " "$39,155.19 " N/A "$37,197.43 " "$152,498.22 " 330104 651 1 Other procedures of blood & blood-forming organs I N/A "$7,400.86 " N/A "$7,400.86 " N/A N/A N/A N/A "$7,030.81 " N/A "$7,104.82 " N/A N/A N/A N/A N/A "$9,473.09 " "$7,400.86 " N/A N/A N/A N/A "$7,622.88 " N/A N/A "$10,361.20 " "$27,844.36 " "$7,400.86 " "$9,991.15 " "$9,103.05 " N/A "$7,622.88 " N/A N/A N/A N/A N/A "$7,400.86 " "$24,452.85 " "$15,171.75 " "$7,400.86 " "$7,400.86 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,400.86 " "$7,400.86 " "$8,510.98 " "$7,400.86 " N/A "$7,030.81 " "$27,844.36 " 330104 651 2 Other procedures of blood & blood-forming organs I N/A "$9,714.13 " N/A "$9,714.13 " N/A N/A N/A N/A "$9,228.42 " N/A "$9,325.56 " N/A N/A N/A N/A N/A "$12,434.08 " "$9,714.13 " N/A N/A N/A N/A "$10,005.55 " N/A N/A "$13,599.78 " "$36,925.27 " "$9,714.13 " "$13,114.07 " "$11,948.37 " N/A "$10,005.55 " N/A N/A N/A N/A N/A "$9,714.13 " "$32,427.67 " "$19,913.96 " "$9,714.13 " "$9,714.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,714.13 " "$9,714.13 " "$11,171.24 " "$9,714.13 " N/A "$9,228.42 " "$36,925.27 " 330104 651 3 Other procedures of blood & blood-forming organs I N/A "$18,066.69 " N/A "$18,066.69 " N/A N/A N/A N/A "$17,163.36 " N/A "$17,344.03 " N/A N/A N/A N/A N/A "$23,125.37 " "$18,066.69 " N/A N/A N/A N/A "$18,608.69 " N/A N/A "$25,293.37 " "$69,713.85 " "$18,066.69 " "$24,390.04 " "$22,222.03 " N/A "$18,608.69 " N/A N/A N/A N/A N/A "$18,066.69 " "$61,222.53 " "$37,036.72 " "$18,066.69 " "$18,066.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,066.69 " "$18,066.69 " "$20,776.70 " "$18,066.69 " N/A "$17,163.36 " "$69,713.85 " 330104 651 4 Other procedures of blood & blood-forming organs I N/A "$26,001.02 " N/A "$26,001.02 " N/A N/A N/A N/A "$24,700.97 " N/A "$24,960.98 " N/A N/A N/A N/A N/A "$33,281.31 " "$26,001.02 " N/A N/A N/A N/A "$26,781.05 " N/A N/A "$36,401.43 " "$100,860.61 " "$26,001.02 " "$35,101.38 " "$31,981.25 " N/A "$26,781.05 " N/A N/A N/A N/A N/A "$26,001.02 " "$88,575.53 " "$53,302.09 " "$26,001.02 " "$26,001.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,001.02 " "$26,001.02 " "$29,901.17 " "$26,001.02 " N/A "$24,700.97 " "$100,860.61 " 330104 660 1 Major hematologic/immunologic diag exc sickle cell crisis & coagul I N/A "$5,057.61 " N/A "$5,057.61 " N/A N/A N/A N/A "$4,804.73 " N/A "$4,855.31 " N/A N/A N/A N/A N/A "$6,473.74 " "$5,057.61 " N/A N/A N/A N/A "$5,209.34 " N/A N/A "$7,080.66 " "$18,645.80 " "$5,057.61 " "$6,827.78 " "$6,220.86 " N/A "$5,209.34 " N/A N/A N/A N/A N/A "$5,057.61 " "$16,374.70 " "$10,368.11 " "$5,057.61 " "$5,057.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,057.61 " "$5,057.61 " "$5,816.26 " "$5,057.61 " N/A "$4,804.73 " "$18,645.80 " 330104 660 2 Major hematologic/immunologic diag exc sickle cell crisis & coagul I N/A "$6,437.67 " N/A "$6,437.67 " N/A N/A N/A N/A "$6,115.79 " N/A "$6,180.17 " N/A N/A N/A N/A N/A "$8,240.22 " "$6,437.67 " N/A N/A N/A N/A "$6,630.80 " N/A N/A "$9,012.74 " "$24,063.33 " "$6,437.67 " "$8,690.86 " "$7,918.34 " N/A "$6,630.80 " N/A N/A N/A N/A N/A "$6,437.67 " "$21,132.35 " "$13,197.23 " "$6,437.67 " "$6,437.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,437.67 " "$6,437.67 " "$7,403.32 " "$6,437.67 " N/A "$6,115.79 " "$24,063.33 " 330104 660 3 Major hematologic/immunologic diag exc sickle cell crisis & coagul I N/A "$10,673.22 " N/A "$10,673.22 " N/A N/A N/A N/A "$10,139.56 " N/A "$10,246.29 " N/A N/A N/A N/A N/A "$13,661.72 " "$10,673.22 " N/A N/A N/A N/A "$10,993.42 " N/A N/A "$14,942.51 " "$40,690.26 " "$10,673.22 " "$14,408.85 " "$13,128.06 " N/A "$10,993.42 " N/A N/A N/A N/A N/A "$10,673.22 " "$35,734.08 " "$21,880.10 " "$10,673.22 " "$10,673.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,673.22 " "$10,673.22 " "$12,274.20 " "$10,673.22 " N/A "$10,139.56 " "$40,690.26 " 330104 660 4 Major hematologic/immunologic diag exc sickle cell crisis & coagul I N/A "$34,216.67 " N/A "$34,216.67 " N/A N/A N/A N/A "$32,505.84 " N/A "$32,848.00 " N/A N/A N/A N/A N/A "$43,797.34 " "$34,216.67 " N/A N/A N/A N/A "$35,243.17 " N/A N/A "$47,903.34 " "$133,111.72 " "$34,216.67 " "$46,192.51 " "$42,086.51 " N/A "$35,243.17 " N/A N/A N/A N/A N/A "$34,216.67 " "$116,898.37 " "$70,144.18 " "$34,216.67 " "$34,216.67 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,216.67 " "$34,216.67 " "$39,349.17 " "$34,216.67 " N/A "$32,505.84 " "$133,111.72 " 330104 661 1 Coagulation & platelet disorders I N/A "$7,184.92 " N/A "$7,184.92 " N/A N/A N/A N/A "$6,825.68 " N/A "$6,897.53 " N/A N/A N/A N/A N/A "$9,196.70 " "$7,184.92 " N/A N/A N/A N/A "$7,400.47 " N/A N/A "$10,058.89 " "$26,996.70 " "$7,184.92 " "$9,699.65 " "$8,837.46 " N/A "$7,400.47 " N/A N/A N/A N/A N/A "$7,184.92 " "$23,708.44 " "$14,729.09 " "$7,184.92 " "$7,184.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,184.92 " "$7,184.92 " "$8,262.66 " "$7,184.92 " N/A "$6,825.68 " "$26,996.70 " 330104 661 2 Coagulation & platelet disorders I N/A "$8,385.15 " N/A "$8,385.15 " N/A N/A N/A N/A "$7,965.90 " N/A "$8,049.75 " N/A N/A N/A N/A N/A "$10,733.00 " "$8,385.15 " N/A N/A N/A N/A "$8,636.71 " N/A N/A "$11,739.21 " "$31,708.29 " "$8,385.15 " "$11,319.96 " "$10,313.74 " N/A "$8,636.71 " N/A N/A N/A N/A N/A "$8,385.15 " "$27,846.14 " "$17,189.56 " "$8,385.15 " "$8,385.15 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,385.15 " "$8,385.15 " "$9,642.93 " "$8,385.15 " N/A "$7,965.90 " "$31,708.29 " 330104 661 3 Coagulation & platelet disorders I N/A "$13,630.20 " N/A "$13,630.20 " N/A N/A N/A N/A "$12,948.69 " N/A "$13,084.99 " N/A N/A N/A N/A N/A "$17,446.66 " "$13,630.20 " N/A N/A N/A N/A "$14,039.11 " N/A N/A "$19,082.28 " "$52,298.09 " "$13,630.20 " "$18,400.77 " "$16,765.15 " N/A "$14,039.11 " N/A N/A N/A N/A N/A "$13,630.20 " "$45,928.05 " "$27,941.91 " "$13,630.20 " "$13,630.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,630.20 " "$13,630.20 " "$15,674.73 " "$13,630.20 " N/A "$12,948.69 " "$52,298.09 " 330104 661 4 Coagulation & platelet disorders I N/A "$31,410.91 " N/A "$31,410.91 " N/A N/A N/A N/A "$29,840.37 " N/A "$30,154.48 " N/A N/A N/A N/A N/A "$40,205.97 " "$31,410.91 " N/A N/A N/A N/A "$32,353.24 " N/A N/A "$43,975.28 " "$122,097.51 " "$31,410.91 " "$42,404.73 " "$38,635.42 " N/A "$32,353.24 " N/A N/A N/A N/A N/A "$31,410.91 " "$107,225.73 " "$64,392.37 " "$31,410.91 " "$31,410.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$31,410.91 " "$31,410.91 " "$36,122.55 " "$31,410.91 " N/A "$29,840.37 " "$122,097.51 " 330104 662 1 Sickle cell anemia crisis I N/A "$4,863.48 " N/A "$4,863.48 " N/A N/A N/A N/A "$4,620.30 " N/A "$4,668.94 " N/A N/A N/A N/A N/A "$6,225.25 " "$4,863.48 " N/A N/A N/A N/A "$5,009.38 " N/A N/A "$6,808.87 " "$17,883.71 " "$4,863.48 " "$6,565.70 " "$5,982.08 " N/A "$5,009.38 " N/A N/A N/A N/A N/A "$4,863.48 " "$15,705.43 " "$9,970.13 " "$4,863.48 " "$4,863.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,863.48 " "$4,863.48 " "$5,593.00 " "$4,863.48 " N/A "$4,620.30 " "$17,883.71 " 330104 662 2 Sickle cell anemia crisis I N/A "$6,882.48 " N/A "$6,882.48 " N/A N/A N/A N/A "$6,538.36 " N/A "$6,607.18 " N/A N/A N/A N/A N/A "$8,809.58 " "$6,882.48 " N/A N/A N/A N/A "$7,088.96 " N/A N/A "$9,635.47 " "$25,809.45 " "$6,882.48 " "$9,291.35 " "$8,465.45 " N/A "$7,088.96 " N/A N/A N/A N/A N/A "$6,882.48 " "$22,665.79 " "$14,109.09 " "$6,882.48 " "$6,882.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,882.48 " "$6,882.48 " "$7,914.85 " "$6,882.48 " N/A "$6,538.36 " "$25,809.45 " 330104 662 3 Sickle cell anemia crisis I N/A "$10,802.64 " N/A "$10,802.64 " N/A N/A N/A N/A "$10,262.51 " N/A "$10,370.54 " N/A N/A N/A N/A N/A "$13,827.38 " "$10,802.64 " N/A N/A N/A N/A "$11,126.72 " N/A N/A "$15,123.70 " "$41,198.32 " "$10,802.64 " "$14,583.57 " "$13,287.25 " N/A "$11,126.72 " N/A N/A N/A N/A N/A "$10,802.64 " "$36,180.26 " "$22,145.42 " "$10,802.64 " "$10,802.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,802.64 " "$10,802.64 " "$12,423.04 " "$10,802.64 " N/A "$10,262.51 " "$41,198.32 " 330104 662 4 Sickle cell anemia crisis I N/A "$22,870.34 " N/A "$22,870.34 " N/A N/A N/A N/A "$21,726.82 " N/A "$21,955.53 " N/A N/A N/A N/A N/A "$29,274.03 " "$22,870.34 " N/A N/A N/A N/A "$23,556.45 " N/A N/A "$32,018.48 " "$88,570.90 " "$22,870.34 " "$30,874.96 " "$28,130.52 " N/A "$23,556.45 " N/A N/A N/A N/A N/A "$22,870.34 " "$77,782.74 " "$46,884.20 " "$22,870.34 " "$22,870.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,870.34 " "$22,870.34 " "$26,300.89 " "$22,870.34 " N/A "$21,726.82 " "$88,570.90 " 330104 663 1 Other anemia & disorders of blood & blood-forming organs I N/A "$3,804.25 " N/A "$3,804.25 " N/A N/A N/A N/A "$3,614.04 " N/A "$3,652.08 " N/A N/A N/A N/A N/A "$4,869.44 " "$3,804.25 " N/A N/A N/A N/A "$3,918.38 " N/A N/A "$5,325.95 " "$13,725.64 " "$3,804.25 " "$5,135.74 " "$4,679.23 " N/A "$3,918.38 " N/A N/A N/A N/A N/A "$3,804.25 " "$12,053.82 " "$7,798.72 " "$3,804.25 " "$3,804.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,804.25 " "$3,804.25 " "$4,374.89 " "$3,804.25 " N/A "$3,614.04 " "$13,725.64 " 330104 663 2 Other anemia & disorders of blood & blood-forming organs I N/A "$5,107.34 " N/A "$5,107.34 " N/A N/A N/A N/A "$4,851.97 " N/A "$4,903.05 " N/A N/A N/A N/A N/A "$6,537.39 " "$5,107.34 " N/A N/A N/A N/A "$5,260.56 " N/A N/A "$7,150.27 " "$18,841.00 " "$5,107.34 " "$6,894.91 " "$6,282.03 " N/A "$5,260.56 " N/A N/A N/A N/A N/A "$5,107.34 " "$16,546.12 " "$10,470.05 " "$5,107.34 " "$5,107.34 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,107.34 " "$5,107.34 " "$5,873.44 " "$5,107.34 " N/A "$4,851.97 " "$18,841.00 " 330104 663 3 Other anemia & disorders of blood & blood-forming organs I N/A "$7,871.55 " N/A "$7,871.55 " N/A N/A N/A N/A "$7,477.97 " N/A "$7,556.69 " N/A N/A N/A N/A N/A "$10,075.58 " "$7,871.55 " N/A N/A N/A N/A "$8,107.69 " N/A N/A "$11,020.17 " "$29,692.10 " "$7,871.55 " "$10,626.59 " "$9,682.00 " N/A "$8,107.69 " N/A N/A N/A N/A N/A "$7,871.55 " "$26,075.52 " "$16,136.67 " "$7,871.55 " "$7,871.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,871.55 " "$7,871.55 " "$9,052.28 " "$7,871.55 " N/A "$7,477.97 " "$29,692.10 " 330104 663 4 Other anemia & disorders of blood & blood-forming organs I N/A "$16,352.18 " N/A "$16,352.18 " N/A N/A N/A N/A "$15,534.57 " N/A "$15,698.09 " N/A N/A N/A N/A N/A "$20,930.79 " "$16,352.18 " N/A N/A N/A N/A "$16,842.74 " N/A N/A "$22,893.05 " "$62,983.40 " "$16,352.18 " "$22,075.44 " "$20,113.18 " N/A "$16,842.74 " N/A N/A N/A N/A N/A "$16,352.18 " "$55,311.86 " "$33,521.96 " "$16,352.18 " "$16,352.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,352.18 " "$16,352.18 " "$18,805.00 " "$16,352.18 " N/A "$15,534.57 " "$62,983.40 " 330104 680 1 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms I N/A "$9,735.24 " N/A "$9,735.24 " N/A N/A N/A N/A "$9,248.48 " N/A "$9,345.83 " N/A N/A N/A N/A N/A "$12,461.11 " "$9,735.24 " N/A N/A N/A N/A "$10,027.30 " N/A N/A "$13,629.34 " "$37,008.16 " "$9,735.24 " "$13,142.58 " "$11,974.35 " N/A "$10,027.30 " N/A N/A N/A N/A N/A "$9,735.24 " "$32,500.47 " "$19,957.25 " "$9,735.24 " "$9,735.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,735.24 " "$9,735.24 " "$11,195.53 " "$9,735.24 " N/A "$9,248.48 " "$37,008.16 " 330104 680 2 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms I N/A "$15,168.97 " N/A "$15,168.97 " N/A N/A N/A N/A "$14,410.53 " N/A "$14,562.22 " N/A N/A N/A N/A N/A "$19,416.29 " "$15,168.97 " N/A N/A N/A N/A "$15,624.04 " N/A N/A "$21,236.56 " "$58,338.66 " "$15,168.97 " "$20,478.12 " "$18,657.84 " N/A "$15,624.04 " N/A N/A N/A N/A N/A "$15,168.97 " "$51,232.86 " "$31,096.40 " "$15,168.97 " "$15,168.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,168.97 " "$15,168.97 " "$17,444.32 " "$15,168.97 " N/A "$14,410.53 " "$58,338.66 " 330104 680 3 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms I N/A "$26,660.40 " N/A "$26,660.40 " N/A N/A N/A N/A "$25,327.38 " N/A "$25,593.98 " N/A N/A N/A N/A N/A "$34,125.31 " "$26,660.40 " N/A N/A N/A N/A "$27,460.21 " N/A N/A "$37,324.56 " "$103,449.04 " "$26,660.40 " "$35,991.54 " "$32,792.29 " N/A "$27,460.21 " N/A N/A N/A N/A N/A "$26,660.40 " "$90,848.68 " "$54,653.81 " "$26,660.40 " "$26,660.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,660.40 " "$26,660.40 " "$30,659.46 " "$26,660.40 " N/A "$25,327.38 " "$103,449.04 " 330104 680 4 Major O.R. procedures for lymphatic/hematopoietic/other neoplasms I N/A "$61,247.74 " N/A "$61,247.74 " N/A N/A N/A N/A "$58,185.35 " N/A "$58,797.83 " N/A N/A N/A N/A N/A "$78,397.11 " "$61,247.74 " N/A N/A N/A N/A "$63,085.17 " N/A N/A "$85,746.83 " "$239,224.06 " "$61,247.74 " "$82,684.45 " "$75,334.72 " N/A "$63,085.17 " N/A N/A N/A N/A N/A "$61,247.74 " "$210,085.96 " "$125,557.87 " "$61,247.74 " "$61,247.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$61,247.74 " "$61,247.74 " "$70,434.90 " "$61,247.74 " N/A "$58,185.35 " "$239,224.06 " 330104 681 1 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms I N/A "$6,766.68 " N/A "$6,766.68 " N/A N/A N/A N/A "$6,428.35 " N/A "$6,496.01 " N/A N/A N/A N/A N/A "$8,661.35 " "$6,766.68 " N/A N/A N/A N/A "$6,969.68 " N/A N/A "$9,473.35 " "$25,354.87 " "$6,766.68 " "$9,135.02 " "$8,323.02 " N/A "$6,969.68 " N/A N/A N/A N/A N/A "$6,766.68 " "$22,266.58 " "$13,871.70 " "$6,766.68 " "$6,766.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,766.68 " "$6,766.68 " "$7,781.68 " "$6,766.68 " N/A "$6,428.35 " "$25,354.87 " 330104 681 2 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms I N/A "$11,107.81 " N/A "$11,107.81 " N/A N/A N/A N/A "$10,552.42 " N/A "$10,663.50 " N/A N/A N/A N/A N/A "$14,218.00 " "$11,107.81 " N/A N/A N/A N/A "$11,441.04 " N/A N/A "$15,550.93 " "$42,396.27 " "$11,107.81 " "$14,995.54 " "$13,662.61 " N/A "$11,441.04 " N/A N/A N/A N/A N/A "$11,107.81 " "$37,232.30 " "$22,771.01 " "$11,107.81 " "$11,107.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,107.81 " "$11,107.81 " "$12,773.98 " "$11,107.81 " N/A "$10,552.42 " "$42,396.27 " 330104 681 3 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms I N/A "$26,323.90 " N/A "$26,323.90 " N/A N/A N/A N/A "$25,007.70 " N/A "$25,270.94 " N/A N/A N/A N/A N/A "$33,694.59 " "$26,323.90 " N/A N/A N/A N/A "$27,113.61 " N/A N/A "$36,853.46 " "$102,128.08 " "$26,323.90 " "$35,537.26 " "$32,378.39 " N/A "$27,113.61 " N/A N/A N/A N/A N/A "$26,323.90 " "$89,688.62 " "$53,963.99 " "$26,323.90 " "$26,323.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,323.90 " "$26,323.90 " "$30,272.48 " "$26,323.90 " N/A "$25,007.70 " "$102,128.08 " 330104 681 4 Other O.R. procedures for lymphatic/hematopoietic/other neoplasms I N/A "$61,417.35 " N/A "$61,417.35 " N/A N/A N/A N/A "$58,346.48 " N/A "$58,960.66 " N/A N/A N/A N/A N/A "$78,614.21 " "$61,417.35 " N/A N/A N/A N/A "$63,259.87 " N/A N/A "$85,984.29 " "$239,889.89 " "$61,417.35 " "$82,913.42 " "$75,543.34 " N/A "$63,259.87 " N/A N/A N/A N/A N/A "$61,417.35 " "$210,670.69 " "$125,905.57 " "$61,417.35 " "$61,417.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$61,417.35 " "$61,417.35 " "$70,629.95 " "$61,417.35 " N/A "$58,346.48 " "$239,889.89 " 330104 690 1 Acute leukemia I N/A "$9,413.05 " N/A "$9,413.05 " N/A N/A N/A N/A "$8,942.39 " N/A "$9,036.52 " N/A N/A N/A N/A N/A "$12,048.70 " "$9,413.05 " N/A N/A N/A N/A "$9,695.44 " N/A N/A "$13,178.26 " "$35,743.36 " "$9,413.05 " "$12,707.61 " "$11,578.05 " N/A "$9,695.44 " N/A N/A N/A N/A N/A "$9,413.05 " "$31,389.73 " "$19,296.74 " "$9,413.05 " "$9,413.05 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,413.05 " "$9,413.05 " "$10,825.00 " "$9,413.05 " N/A "$8,942.39 " "$35,743.36 " 330104 690 2 Acute leukemia I N/A "$18,826.88 " N/A "$18,826.88 " N/A N/A N/A N/A "$17,885.54 " N/A "$18,073.81 " N/A N/A N/A N/A N/A "$24,098.41 " "$18,826.88 " N/A N/A N/A N/A "$19,391.69 " N/A N/A "$26,357.64 " "$72,698.04 " "$18,826.88 " "$25,416.29 " "$23,157.07 " N/A "$19,391.69 " N/A N/A N/A N/A N/A "$18,826.88 " "$63,843.23 " "$38,595.11 " "$18,826.88 " "$18,826.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,826.88 " "$18,826.88 " "$21,650.92 " "$18,826.88 " N/A "$17,885.54 " "$72,698.04 " 330104 690 3 Acute leukemia I N/A "$41,606.74 " N/A "$41,606.74 " N/A N/A N/A N/A "$39,526.40 " N/A "$39,942.47 " N/A N/A N/A N/A N/A "$53,256.63 " "$41,606.74 " N/A N/A N/A N/A "$42,854.94 " N/A N/A "$58,249.43 " "$162,121.95 " "$41,606.74 " "$56,169.10 " "$51,176.29 " N/A "$42,854.94 " N/A N/A N/A N/A N/A "$41,606.74 " "$142,375.08 " "$85,293.82 " "$41,606.74 " "$41,606.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,606.74 " "$41,606.74 " "$47,847.75 " "$41,606.74 " N/A "$39,526.40 " "$162,121.95 " 330104 690 4 Acute leukemia I N/A "$59,931.71 " N/A "$59,931.71 " N/A N/A N/A N/A "$56,935.12 " N/A "$57,534.44 " N/A N/A N/A N/A N/A "$76,712.59 " "$59,931.71 " N/A N/A N/A N/A "$61,729.66 " N/A N/A "$83,904.39 " "$234,057.89 " "$59,931.71 " "$80,907.81 " "$73,716.00 " N/A "$61,729.66 " N/A N/A N/A N/A N/A "$59,931.71 " "$205,549.05 " "$122,860.00 " "$59,931.71 " "$59,931.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$59,931.71 " "$59,931.71 " "$68,921.47 " "$59,931.71 " N/A "$56,935.12 " "$234,057.89 " 330104 691 1 Lymphoma myeloma & non-acute leukemia I N/A "$7,274.16 " N/A "$7,274.16 " N/A N/A N/A N/A "$6,910.45 " N/A "$6,983.19 " N/A N/A N/A N/A N/A "$9,310.92 " "$7,274.16 " N/A N/A N/A N/A "$7,492.38 " N/A N/A "$10,183.82 " "$27,347.00 " "$7,274.16 " "$9,820.11 " "$8,947.21 " N/A "$7,492.38 " N/A N/A N/A N/A N/A "$7,274.16 " "$24,016.06 " "$14,912.02 " "$7,274.16 " "$7,274.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,274.16 " "$7,274.16 " "$8,365.28 " "$7,274.16 " N/A "$6,910.45 " "$27,347.00 " 330104 691 2 Lymphoma myeloma & non-acute leukemia I N/A "$10,416.42 " N/A "$10,416.42 " N/A N/A N/A N/A "$9,895.60 " N/A "$9,999.76 " N/A N/A N/A N/A N/A "$13,333.01 " "$10,416.42 " N/A N/A N/A N/A "$10,728.91 " N/A N/A "$14,582.98 " "$39,682.16 " "$10,416.42 " "$14,062.16 " "$12,812.19 " N/A "$10,728.91 " N/A N/A N/A N/A N/A "$10,416.42 " "$34,848.77 " "$21,353.65 " "$10,416.42 " "$10,416.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,416.42 " "$10,416.42 " "$11,978.88 " "$10,416.42 " N/A "$9,895.60 " "$39,682.16 " 330104 691 3 Lymphoma myeloma & non-acute leukemia I N/A "$17,423.66 " N/A "$17,423.66 " N/A N/A N/A N/A "$16,552.48 " N/A "$16,726.72 " N/A N/A N/A N/A N/A "$22,302.29 " "$17,423.66 " N/A N/A N/A N/A "$17,946.37 " N/A N/A "$24,393.13 " "$67,189.60 " "$17,423.66 " "$23,521.95 " "$21,431.11 " N/A "$17,946.37 " N/A N/A N/A N/A N/A "$17,423.66 " "$59,005.73 " "$35,718.51 " "$17,423.66 " "$17,423.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,423.66 " "$17,423.66 " "$20,037.21 " "$17,423.66 " N/A "$16,552.48 " "$67,189.60 " 330104 691 4 Lymphoma myeloma & non-acute leukemia I N/A "$43,445.23 " N/A "$43,445.23 " N/A N/A N/A N/A "$41,272.97 " N/A "$41,707.42 " N/A N/A N/A N/A N/A "$55,609.89 " "$43,445.23 " N/A N/A N/A N/A "$44,748.59 " N/A N/A "$60,823.32 " "$169,339.07 " "$43,445.23 " "$58,651.06 " "$53,437.63 " N/A "$44,748.59 " N/A N/A N/A N/A N/A "$43,445.23 " "$148,713.14 " "$89,062.72 " "$43,445.23 " "$43,445.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,445.23 " "$43,445.23 " "$49,962.01 " "$43,445.23 " N/A "$41,272.97 " "$169,339.07 " 330104 692 1 Radiotherapy I N/A "$4,366.90 " N/A "$4,366.90 " N/A N/A N/A N/A "$4,148.56 " N/A "$4,192.23 " N/A N/A N/A N/A N/A "$5,589.63 " "$4,366.90 " N/A N/A N/A N/A "$4,497.91 " N/A N/A "$6,113.66 " "$15,934.37 " "$4,366.90 " "$5,895.32 " "$5,371.29 " N/A "$4,497.91 " N/A N/A N/A N/A N/A "$4,366.90 " "$13,993.52 " "$8,952.15 " "$4,366.90 " "$4,366.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,366.90 " "$4,366.90 " "$5,021.94 " "$4,366.90 " N/A "$4,148.56 " "$15,934.37 " 330104 692 2 Radiotherapy I N/A "$9,169.19 " N/A "$9,169.19 " N/A N/A N/A N/A "$8,710.73 " N/A "$8,802.42 " N/A N/A N/A N/A N/A "$11,736.56 " "$9,169.19 " N/A N/A N/A N/A "$9,444.26 " N/A N/A "$12,836.86 " "$34,786.07 " "$9,169.19 " "$12,378.40 " "$11,278.10 " N/A "$9,444.26 " N/A N/A N/A N/A N/A "$9,169.19 " "$30,549.03 " "$18,796.83 " "$9,169.19 " "$9,169.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,169.19 " "$9,169.19 " "$10,544.56 " "$9,169.19 " N/A "$8,710.73 " "$34,786.07 " 330104 692 3 Radiotherapy I N/A "$19,270.33 " N/A "$19,270.33 " N/A N/A N/A N/A "$18,306.81 " N/A "$18,499.52 " N/A N/A N/A N/A N/A "$24,666.02 " "$19,270.33 " N/A N/A N/A N/A "$19,848.44 " N/A N/A "$26,978.46 " "$74,438.81 " "$19,270.33 " "$26,014.95 " "$23,702.51 " N/A "$19,848.44 " N/A N/A N/A N/A N/A "$19,270.33 " "$65,371.98 " "$39,504.18 " "$19,270.33 " "$19,270.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,270.33 " "$19,270.33 " "$22,160.88 " "$19,270.33 " N/A "$18,306.81 " "$74,438.81 " 330104 692 4 Radiotherapy I N/A "$21,585.64 " N/A "$21,585.64 " N/A N/A N/A N/A "$20,506.36 " N/A "$20,722.22 " N/A N/A N/A N/A N/A "$27,629.62 " "$21,585.64 " N/A N/A N/A N/A "$22,233.21 " N/A N/A "$30,219.90 " "$83,527.74 " "$21,585.64 " "$29,140.62 " "$26,550.34 " N/A "$22,233.21 " N/A N/A N/A N/A N/A "$21,585.64 " "$73,353.85 " "$44,250.57 " "$21,585.64 " "$21,585.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$21,585.64 " "$21,585.64 " "$24,823.49 " "$21,585.64 " N/A "$20,506.36 " "$83,527.74 " 330104 694 1 Lymphatic & other malignancies & neoplasms of uncertain behavior I N/A "$4,549.46 " N/A "$4,549.46 " N/A N/A N/A N/A "$4,321.98 " N/A "$4,367.48 " N/A N/A N/A N/A N/A "$5,823.30 " "$4,549.46 " N/A N/A N/A N/A "$4,685.94 " N/A N/A "$6,369.24 " "$16,651.00 " "$4,549.46 " "$6,141.77 " "$5,595.83 " N/A "$4,685.94 " N/A N/A N/A N/A N/A "$4,549.46 " "$14,622.86 " "$9,326.39 " "$4,549.46 " "$4,549.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,549.46 " "$4,549.46 " "$5,231.88 " "$4,549.46 " N/A "$4,321.98 " "$16,651.00 " 330104 694 2 Lymphatic & other malignancies & neoplasms of uncertain behavior I N/A "$6,993.51 " N/A "$6,993.51 " N/A N/A N/A N/A "$6,643.84 " N/A "$6,713.77 " N/A N/A N/A N/A N/A "$8,951.70 " "$6,993.51 " N/A N/A N/A N/A "$7,203.32 " N/A N/A "$9,790.92 " "$26,245.31 " "$6,993.51 " "$9,441.24 " "$8,602.02 " N/A "$7,203.32 " N/A N/A N/A N/A N/A "$6,993.51 " "$23,048.56 " "$14,336.70 " "$6,993.51 " "$6,993.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,993.51 " "$6,993.51 " "$8,042.54 " "$6,993.51 " N/A "$6,643.84 " "$26,245.31 " 330104 694 3 Lymphatic & other malignancies & neoplasms of uncertain behavior I N/A "$11,348.95 " N/A "$11,348.95 " N/A N/A N/A N/A "$10,781.50 " N/A "$10,894.99 " N/A N/A N/A N/A N/A "$14,526.65 " "$11,348.95 " N/A N/A N/A N/A "$11,689.41 " N/A N/A "$15,888.52 " "$43,342.87 " "$11,348.95 " "$15,321.08 " "$13,959.20 " N/A "$11,689.41 " N/A N/A N/A N/A N/A "$11,348.95 " "$38,063.59 " "$23,265.34 " "$11,348.95 " "$11,348.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,348.95 " "$11,348.95 " "$13,051.29 " "$11,348.95 " N/A "$10,781.50 " "$43,342.87 " 330104 694 4 Lymphatic & other malignancies & neoplasms of uncertain behavior I N/A "$23,341.03 " N/A "$23,341.03 " N/A N/A N/A N/A "$22,173.98 " N/A "$22,407.39 " N/A N/A N/A N/A N/A "$29,876.52 " "$23,341.03 " N/A N/A N/A N/A "$24,041.26 " N/A N/A "$32,677.44 " "$90,418.64 " "$23,341.03 " "$31,510.39 " "$28,709.47 " N/A "$24,041.26 " N/A N/A N/A N/A N/A "$23,341.03 " "$79,405.42 " "$47,849.11 " "$23,341.03 " "$23,341.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$23,341.03 " "$23,341.03 " "$26,842.19 " "$23,341.03 " N/A "$22,173.98 " "$90,418.64 " 330104 695 1 Chemotherapy for acute leukemia # I N/A "$6,471.73 " N/A "$6,471.73 " N/A N/A N/A N/A "$6,148.15 " N/A "$6,212.86 " N/A N/A N/A N/A N/A "$8,283.82 " "$6,471.73 " N/A N/A N/A N/A "$6,665.88 " N/A N/A "$9,060.43 " "$24,197.03 " "$6,471.73 " "$8,736.84 " "$7,960.23 " N/A "$6,665.88 " N/A N/A N/A N/A N/A "$6,471.73 " "$21,249.77 " "$13,267.05 " "$6,471.73 " "$6,471.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,471.73 " "$6,471.73 " "$7,442.49 " "$6,471.73 " N/A "$6,148.15 " "$24,197.03 " 330104 695 2 Chemotherapy for acute leukemia # I N/A "$6,480.59 " N/A "$6,480.59 " N/A N/A N/A N/A "$6,156.56 " N/A "$6,221.36 " N/A N/A N/A N/A N/A "$8,295.15 " "$6,480.59 " N/A N/A N/A N/A "$6,675.01 " N/A N/A "$9,072.82 " "$24,231.79 " "$6,480.59 " "$8,748.79 " "$7,971.12 " N/A "$6,675.01 " N/A N/A N/A N/A N/A "$6,480.59 " "$21,280.29 " "$13,285.21 " "$6,480.59 " "$6,480.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,480.59 " "$6,480.59 " "$7,452.68 " "$6,480.59 " N/A "$6,156.56 " "$24,231.79 " 330104 695 3 Chemotherapy for acute leukemia # I N/A "$16,914.83 " N/A "$16,914.83 " N/A N/A N/A N/A "$16,069.09 " N/A "$16,238.23 " N/A N/A N/A N/A N/A "$21,650.98 " "$16,914.83 " N/A N/A N/A N/A "$17,422.27 " N/A N/A "$23,680.76 " "$65,192.12 " "$16,914.83 " "$22,835.02 " "$20,805.24 " N/A "$17,422.27 " N/A N/A N/A N/A N/A "$16,914.83 " "$57,251.55 " "$34,675.39 " "$16,914.83 " "$16,914.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,914.83 " "$16,914.83 " "$19,452.05 " "$16,914.83 " N/A "$16,069.09 " "$65,192.12 " 330104 695 4 Chemotherapy for acute leukemia # I N/A "$50,624.81 " N/A "$50,624.81 " N/A N/A N/A N/A "$48,093.57 " N/A "$48,599.82 " N/A N/A N/A N/A N/A "$64,799.76 " "$50,624.81 " N/A N/A N/A N/A "$52,143.56 " N/A N/A "$70,874.74 " "$197,523.03 " "$50,624.81 " "$68,343.50 " "$62,268.52 " N/A "$52,143.56 " N/A N/A N/A N/A N/A "$50,624.81 " "$173,464.22 " "$103,780.87 " "$50,624.81 " "$50,624.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$50,624.81 " "$50,624.81 " "$58,218.54 " "$50,624.81 " N/A "$48,093.57 " "$197,523.03 " 330104 696 1 Other Chemotherapy # I N/A "$5,395.48 " N/A "$5,395.48 " N/A N/A N/A N/A "$5,125.70 " N/A "$5,179.66 " N/A N/A N/A N/A N/A "$6,906.21 " "$5,395.48 " N/A N/A N/A N/A "$5,557.34 " N/A N/A "$7,553.67 " "$19,972.11 " "$5,395.48 " "$7,283.89 " "$6,636.44 " N/A "$5,557.34 " N/A N/A N/A N/A N/A "$5,395.48 " "$17,539.45 " "$11,060.73 " "$5,395.48 " "$5,395.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,395.48 " "$5,395.48 " "$6,204.80 " "$5,395.48 " N/A "$5,125.70 " "$19,972.11 " 330104 696 2 Other Chemotherapy # I N/A "$7,149.50 " N/A "$7,149.50 " N/A N/A N/A N/A "$6,792.03 " N/A "$6,863.52 " N/A N/A N/A N/A N/A "$9,151.36 " "$7,149.50 " N/A N/A N/A N/A "$7,363.99 " N/A N/A "$10,009.30 " "$26,857.66 " "$7,149.50 " "$9,651.83 " "$8,793.89 " N/A "$7,363.99 " N/A N/A N/A N/A N/A "$7,149.50 " "$23,586.33 " "$14,656.48 " "$7,149.50 " "$7,149.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,149.50 " "$7,149.50 " "$8,221.93 " "$7,149.50 " N/A "$6,792.03 " "$26,857.66 " 330104 696 3 Other Chemotherapy # I N/A "$10,627.58 " N/A "$10,627.58 " N/A N/A N/A N/A "$10,096.20 " N/A "$10,202.48 " N/A N/A N/A N/A N/A "$13,603.30 " "$10,627.58 " N/A N/A N/A N/A "$10,946.41 " N/A N/A "$14,878.61 " "$40,511.10 " "$10,627.58 " "$14,347.23 " "$13,071.92 " N/A "$10,946.41 " N/A N/A N/A N/A N/A "$10,627.58 " "$35,576.74 " "$21,786.54 " "$10,627.58 " "$10,627.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,627.58 " "$10,627.58 " "$12,221.72 " "$10,627.58 " N/A "$10,096.20 " "$40,511.10 " 330104 696 4 Other Chemotherapy # I N/A "$30,241.33 " N/A "$30,241.33 " N/A N/A N/A N/A "$28,729.27 " N/A "$29,031.68 " N/A N/A N/A N/A N/A "$38,708.91 " "$30,241.33 " N/A N/A N/A N/A "$31,148.57 " N/A N/A "$42,337.87 " "$117,506.26 " "$30,241.33 " "$40,825.80 " "$37,196.84 " N/A "$31,148.57 " N/A N/A N/A N/A N/A "$30,241.33 " "$103,193.70 " "$61,994.74 " "$30,241.33 " "$30,241.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$30,241.33 " "$30,241.33 " "$34,777.53 " "$30,241.33 " N/A "$28,729.27 " "$117,506.26 " 330104 710 1 Infectious & parasitic diseases including HIV w O.R. procedure I N/A "$7,691.04 " N/A "$7,691.04 " N/A N/A N/A N/A "$7,306.48 " N/A "$7,383.39 " N/A N/A N/A N/A N/A "$9,844.53 " "$7,691.04 " N/A N/A N/A N/A "$7,921.77 " N/A N/A "$10,767.45 " "$28,983.49 " "$7,691.04 " "$10,382.90 " "$9,459.97 " N/A "$7,921.77 " N/A N/A N/A N/A N/A "$7,691.04 " "$25,453.22 " "$15,766.62 " "$7,691.04 " "$7,691.04 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,691.04 " "$7,691.04 " "$8,844.69 " "$7,691.04 " N/A "$7,306.48 " "$28,983.49 " 330104 710 2 Infectious & parasitic diseases including HIV w O.R. procedure I N/A "$11,656.84 " N/A "$11,656.84 " N/A N/A N/A N/A "$11,073.99 " N/A "$11,190.56 " N/A N/A N/A N/A N/A "$14,920.75 " "$11,656.84 " N/A N/A N/A N/A "$12,006.54 " N/A N/A "$16,319.57 " "$44,551.51 " "$11,656.84 " "$15,736.73 " "$14,337.91 " N/A "$12,006.54 " N/A N/A N/A N/A N/A "$11,656.84 " "$39,125.03 " "$23,896.52 " "$11,656.84 " "$11,656.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,656.84 " "$11,656.84 " "$13,405.36 " "$11,656.84 " N/A "$11,073.99 " "$44,551.51 " 330104 710 3 Infectious & parasitic diseases including HIV w O.R. procedure I N/A "$20,576.82 " N/A "$20,576.82 " N/A N/A N/A N/A "$19,547.98 " N/A "$19,753.75 " N/A N/A N/A N/A N/A "$26,338.33 " "$20,576.82 " N/A N/A N/A N/A "$21,194.13 " N/A N/A "$28,807.55 " "$79,567.54 " "$20,576.82 " "$27,778.71 " "$25,309.49 " N/A "$21,194.13 " N/A N/A N/A N/A N/A "$20,576.82 " "$69,876.01 " "$42,182.49 " "$20,576.82 " "$20,576.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,576.82 " "$20,576.82 " "$23,663.35 " "$20,576.82 " N/A "$19,547.98 " "$79,567.54 " 330104 710 4 Infectious & parasitic diseases including HIV w O.R. procedure I N/A "$43,360.76 " N/A "$43,360.76 " N/A N/A N/A N/A "$41,192.73 " N/A "$41,626.33 " N/A N/A N/A N/A N/A "$55,501.78 " "$43,360.76 " N/A N/A N/A N/A "$44,661.59 " N/A N/A "$60,705.07 " "$169,007.50 " "$43,360.76 " "$58,537.03 " "$53,333.74 " N/A "$44,661.59 " N/A N/A N/A N/A N/A "$43,360.76 " "$148,421.95 " "$88,889.57 " "$43,360.76 " "$43,360.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,360.76 " "$43,360.76 " "$49,864.88 " "$43,360.76 " N/A "$41,192.73 " "$169,007.50 " 330104 711 1 Post-op post-trauma other device infections w O.R. procedure I N/A "$8,197.83 " N/A "$8,197.83 " N/A N/A N/A N/A "$7,787.94 " N/A "$7,869.92 " N/A N/A N/A N/A N/A "$10,493.22 " "$8,197.83 " N/A N/A N/A N/A "$8,443.76 " N/A N/A "$11,476.96 " "$30,972.94 " "$8,197.83 " "$11,067.07 " "$10,083.33 " N/A "$8,443.76 " N/A N/A N/A N/A N/A "$8,197.83 " "$27,200.36 " "$16,805.55 " "$8,197.83 " "$8,197.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,197.83 " "$8,197.83 " "$9,427.50 " "$8,197.83 " N/A "$7,787.94 " "$30,972.94 " 330104 711 2 Post-op post-trauma other device infections w O.R. procedure I N/A "$11,101.00 " N/A "$11,101.00 " N/A N/A N/A N/A "$10,545.95 " N/A "$10,656.96 " N/A N/A N/A N/A N/A "$14,209.28 " "$11,101.00 " N/A N/A N/A N/A "$11,434.03 " N/A N/A "$15,541.40 " "$42,369.53 " "$11,101.00 " "$14,986.35 " "$13,654.23 " N/A "$11,434.03 " N/A N/A N/A N/A N/A "$11,101.00 " "$37,208.81 " "$22,757.05 " "$11,101.00 " "$11,101.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,101.00 " "$11,101.00 " "$12,766.15 " "$11,101.00 " N/A "$10,545.95 " "$42,369.53 " 330104 711 3 Post-op post-trauma other device infections w O.R. procedure I N/A "$19,890.88 " N/A "$19,890.88 " N/A N/A N/A N/A "$18,896.34 " N/A "$19,095.24 " N/A N/A N/A N/A N/A "$25,460.33 " "$19,890.88 " N/A N/A N/A N/A "$20,487.61 " N/A N/A "$27,847.23 " "$76,874.83 " "$19,890.88 " "$26,852.69 " "$24,465.78 " N/A "$20,487.61 " N/A N/A N/A N/A N/A "$19,890.88 " "$67,511.28 " "$40,776.30 " "$19,890.88 " "$19,890.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,890.88 " "$19,890.88 " "$22,874.51 " "$19,890.88 " N/A "$18,896.34 " "$76,874.83 " 330104 711 4 Post-op post-trauma other device infections w O.R. procedure I N/A "$41,422.82 " N/A "$41,422.82 " N/A N/A N/A N/A "$39,351.68 " N/A "$39,765.91 " N/A N/A N/A N/A N/A "$53,021.21 " "$41,422.82 " N/A N/A N/A N/A "$42,665.51 " N/A N/A "$57,991.95 " "$161,399.97 " "$41,422.82 " "$55,920.81 " "$50,950.07 " N/A "$42,665.51 " N/A N/A N/A N/A N/A "$41,422.82 " "$141,741.04 " "$84,916.78 " "$41,422.82 " "$41,422.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$41,422.82 " "$41,422.82 " "$47,636.25 " "$41,422.82 " N/A "$39,351.68 " "$161,399.97 " 330104 720 1 Septicemia & disseminated infections I N/A "$4,424.80 " N/A "$4,424.80 " N/A N/A N/A N/A "$4,203.56 " N/A "$4,247.81 " N/A N/A N/A N/A N/A "$5,663.75 " "$4,424.80 " N/A N/A N/A N/A "$4,557.55 " N/A N/A "$6,194.72 " "$16,161.66 " "$4,424.80 " "$5,973.48 " "$5,442.51 " N/A "$4,557.55 " N/A N/A N/A N/A N/A "$4,424.80 " "$14,193.13 " "$9,070.84 " "$4,424.80 " "$4,424.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,424.80 " "$4,424.80 " "$5,088.52 " "$4,424.80 " N/A "$4,203.56 " "$16,161.66 " 330104 720 2 Septicemia & disseminated infections I N/A "$5,986.74 " N/A "$5,986.74 " N/A N/A N/A N/A "$5,687.40 " N/A "$5,747.27 " N/A N/A N/A N/A N/A "$7,663.02 " "$5,986.74 " N/A N/A N/A N/A "$6,166.34 " N/A N/A "$8,381.43 " "$22,293.14 " "$5,986.74 " "$8,082.09 " "$7,363.69 " N/A "$6,166.34 " N/A N/A N/A N/A N/A "$5,986.74 " "$19,577.78 " "$12,272.81 " "$5,986.74 " "$5,986.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,986.74 " "$5,986.74 " "$6,884.75 " "$5,986.74 " N/A "$5,687.40 " "$22,293.14 " 330104 720 3 Septicemia & disseminated infections I N/A "$10,443.66 " N/A "$10,443.66 " N/A N/A N/A N/A "$9,921.48 " N/A "$10,025.92 " N/A N/A N/A N/A N/A "$13,367.89 " "$10,443.66 " N/A N/A N/A N/A "$10,756.97 " N/A N/A "$14,621.13 " "$39,789.12 " "$10,443.66 " "$14,098.95 " "$12,845.71 " N/A "$10,756.97 " N/A N/A N/A N/A N/A "$10,443.66 " "$34,942.70 " "$21,409.51 " "$10,443.66 " "$10,443.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,443.66 " "$10,443.66 " "$12,010.21 " "$10,443.66 " N/A "$9,921.48 " "$39,789.12 " 330104 720 4 Septicemia & disseminated infections I N/A "$22,107.42 " N/A "$22,107.42 " N/A N/A N/A N/A "$21,002.05 " N/A "$21,223.13 " N/A N/A N/A N/A N/A "$28,297.50 " "$22,107.42 " N/A N/A N/A N/A "$22,770.65 " N/A N/A "$30,950.39 " "$85,576.02 " "$22,107.42 " "$29,845.02 " "$27,192.13 " N/A "$22,770.65 " N/A N/A N/A N/A N/A "$22,107.42 " "$75,152.64 " "$45,320.22 " "$22,107.42 " "$22,107.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,107.42 " "$22,107.42 " "$25,423.54 " "$22,107.42 " N/A "$21,002.05 " "$85,576.02 " 330104 721 1 Post-operative post-traumatic other device infections I N/A "$4,693.18 " N/A "$4,693.18 " N/A N/A N/A N/A "$4,458.53 " N/A "$4,505.46 " N/A N/A N/A N/A N/A "$6,007.28 " "$4,693.18 " N/A N/A N/A N/A "$4,833.98 " N/A N/A "$6,570.46 " "$17,215.21 " "$4,693.18 " "$6,335.80 " "$5,772.62 " N/A "$4,833.98 " N/A N/A N/A N/A N/A "$4,693.18 " "$15,118.36 " "$9,621.03 " "$4,693.18 " "$4,693.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,693.18 " "$4,693.18 " "$5,397.16 " "$4,693.18 " N/A "$4,458.53 " "$17,215.21 " 330104 721 2 Post-operative post-traumatic other device infections I N/A "$6,073.93 " N/A "$6,073.93 " N/A N/A N/A N/A "$5,770.23 " N/A "$5,830.97 " N/A N/A N/A N/A N/A "$7,774.63 " "$6,073.93 " N/A N/A N/A N/A "$6,256.14 " N/A N/A "$8,503.50 " "$22,635.41 " "$6,073.93 " "$8,199.80 " "$7,470.93 " N/A "$6,256.14 " N/A N/A N/A N/A N/A "$6,073.93 " "$19,878.36 " "$12,451.55 " "$6,073.93 " "$6,073.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,073.93 " "$6,073.93 " "$6,985.02 " "$6,073.93 " N/A "$5,770.23 " "$22,635.41 " 330104 721 3 Post-operative post-traumatic other device infections I N/A "$10,059.48 " N/A "$10,059.48 " N/A N/A N/A N/A "$9,556.51 " N/A "$9,657.10 " N/A N/A N/A N/A N/A "$12,876.14 " "$10,059.48 " N/A N/A N/A N/A "$10,361.27 " N/A N/A "$14,083.27 " "$38,280.98 " "$10,059.48 " "$13,580.30 " "$12,373.16 " N/A "$10,361.27 " N/A N/A N/A N/A N/A "$10,059.48 " "$33,618.26 " "$20,621.94 " "$10,059.48 " "$10,059.48 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,059.48 " "$10,059.48 " "$11,568.40 " "$10,059.48 " N/A "$9,556.51 " "$38,280.98 " 330104 721 4 Post-operative post-traumatic other device infections I N/A "$19,591.84 " N/A "$19,591.84 " N/A N/A N/A N/A "$18,612.25 " N/A "$18,808.17 " N/A N/A N/A N/A N/A "$25,077.56 " "$19,591.84 " N/A N/A N/A N/A "$20,179.60 " N/A N/A "$27,428.58 " "$75,700.94 " "$19,591.84 " "$26,448.99 " "$24,097.97 " N/A "$20,179.60 " N/A N/A N/A N/A N/A "$19,591.84 " "$66,480.37 " "$40,163.28 " "$19,591.84 " "$19,591.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,591.84 " "$19,591.84 " "$22,530.62 " "$19,591.84 " N/A "$18,612.25 " "$75,700.94 " 330104 722 1 Fever I N/A "$3,804.93 " N/A "$3,804.93 " N/A N/A N/A N/A "$3,614.69 " N/A "$3,652.74 " N/A N/A N/A N/A N/A "$4,870.31 " "$3,804.93 " N/A N/A N/A N/A "$3,919.08 " N/A N/A "$5,326.91 " "$13,728.32 " "$3,804.93 " "$5,136.66 " "$4,680.07 " N/A "$3,919.08 " N/A N/A N/A N/A N/A "$3,804.93 " "$12,056.17 " "$7,800.11 " "$3,804.93 " "$3,804.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,804.93 " "$3,804.93 " "$4,375.67 " "$3,804.93 " N/A "$3,614.69 " "$13,728.32 " 330104 722 2 Fever I N/A "$4,291.97 " N/A "$4,291.97 " N/A N/A N/A N/A "$4,077.37 " N/A "$4,120.29 " N/A N/A N/A N/A N/A "$5,493.72 " "$4,291.97 " N/A N/A N/A N/A "$4,420.73 " N/A N/A "$6,008.76 " "$15,640.23 " "$4,291.97 " "$5,794.16 " "$5,279.13 " N/A "$4,420.73 " N/A N/A N/A N/A N/A "$4,291.97 " "$13,735.21 " "$8,798.54 " "$4,291.97 " "$4,291.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,291.97 " "$4,291.97 " "$4,935.77 " "$4,291.97 " N/A "$4,077.37 " "$15,640.23 " 330104 722 3 Fever I N/A "$6,090.96 " N/A "$6,090.96 " N/A N/A N/A N/A "$5,786.41 " N/A "$5,847.32 " N/A N/A N/A N/A N/A "$7,796.42 " "$6,090.96 " N/A N/A N/A N/A "$6,273.68 " N/A N/A "$8,527.34 " "$22,702.26 " "$6,090.96 " "$8,222.79 " "$7,491.88 " N/A "$6,273.68 " N/A N/A N/A N/A N/A "$6,090.96 " "$19,937.07 " "$12,486.46 " "$6,090.96 " "$6,090.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,090.96 " "$6,090.96 " "$7,004.60 " "$6,090.96 " N/A "$5,786.41 " "$22,702.26 " 330104 722 4 Fever I N/A "$12,514.44 " N/A "$12,514.44 " N/A N/A N/A N/A "$11,888.71 " N/A "$12,013.86 " N/A N/A N/A N/A N/A "$16,018.48 " "$12,514.44 " N/A N/A N/A N/A "$12,889.87 " N/A N/A "$17,520.21 " "$47,918.08 " "$12,514.44 " "$16,894.49 " "$15,392.76 " N/A "$12,889.87 " N/A N/A N/A N/A N/A "$12,514.44 " "$42,081.54 " "$25,654.59 " "$12,514.44 " "$12,514.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,514.44 " "$12,514.44 " "$14,391.60 " "$12,514.44 " N/A "$11,888.71 " "$47,918.08 " 330104 723 1 Viral illness I N/A "$3,439.82 " N/A "$3,439.82 " N/A N/A N/A N/A "$3,267.83 " N/A "$3,302.23 " N/A N/A N/A N/A N/A "$4,402.97 " "$3,439.82 " N/A N/A N/A N/A "$3,543.02 " N/A N/A "$4,815.75 " "$12,295.05 " "$3,439.82 " "$4,643.76 " "$4,230.98 " N/A "$3,543.02 " N/A N/A N/A N/A N/A "$3,439.82 " "$10,797.48 " "$7,051.64 " "$3,439.82 " "$3,439.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,439.82 " "$3,439.82 " "$3,955.80 " "$3,439.82 " N/A "$3,267.83 " "$12,295.05 " 330104 723 2 Viral illness I N/A "$4,091.03 " N/A "$4,091.03 " N/A N/A N/A N/A "$3,886.47 " N/A "$3,927.38 " N/A N/A N/A N/A N/A "$5,236.51 " "$4,091.03 " N/A N/A N/A N/A "$4,213.76 " N/A N/A "$5,727.44 " "$14,851.40 " "$4,091.03 " "$5,522.89 " "$5,031.96 " N/A "$4,213.76 " N/A N/A N/A N/A N/A "$4,091.03 " "$13,042.46 " "$8,386.60 " "$4,091.03 " "$4,091.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,091.03 " "$4,091.03 " "$4,704.68 " "$4,091.03 " N/A "$3,886.47 " "$14,851.40 " 330104 723 3 Viral illness I N/A "$6,127.74 " N/A "$6,127.74 " N/A N/A N/A N/A "$5,821.35 " N/A "$5,882.63 " N/A N/A N/A N/A N/A "$7,843.51 " "$6,127.74 " N/A N/A N/A N/A "$6,311.57 " N/A N/A "$8,578.83 " "$22,846.66 " "$6,127.74 " "$8,272.45 " "$7,537.12 " N/A "$6,311.57 " N/A N/A N/A N/A N/A "$6,127.74 " "$20,063.88 " "$12,561.87 " "$6,127.74 " "$6,127.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,127.74 " "$6,127.74 " "$7,046.90 " "$6,127.74 " N/A "$5,821.35 " "$22,846.66 " 330104 723 4 Viral illness I N/A "$18,615.72 " N/A "$18,615.72 " N/A N/A N/A N/A "$17,684.93 " N/A "$17,871.09 " N/A N/A N/A N/A N/A "$23,828.12 " "$18,615.72 " N/A N/A N/A N/A "$19,174.19 " N/A N/A "$26,062.01 " "$71,869.10 " "$18,615.72 " "$25,131.22 " "$22,897.34 " N/A "$19,174.19 " N/A N/A N/A N/A N/A "$18,615.72 " "$63,115.26 " "$38,162.23 " "$18,615.72 " "$18,615.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,615.72 " "$18,615.72 " "$21,408.08 " "$18,615.72 " N/A "$17,684.93 " "$71,869.10 " 330104 724 1 Other infectious & parasitic diseases I N/A "$4,708.85 " N/A "$4,708.85 " N/A N/A N/A N/A "$4,473.41 " N/A "$4,520.50 " N/A N/A N/A N/A N/A "$6,027.33 " "$4,708.85 " N/A N/A N/A N/A "$4,850.12 " N/A N/A "$6,592.39 " "$17,276.71 " "$4,708.85 " "$6,356.95 " "$5,791.89 " N/A "$4,850.12 " N/A N/A N/A N/A N/A "$4,708.85 " "$15,172.37 " "$9,653.15 " "$4,708.85 " "$4,708.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,708.85 " "$4,708.85 " "$5,415.18 " "$4,708.85 " N/A "$4,473.41 " "$17,276.71 " 330104 724 2 Other infectious & parasitic diseases I N/A "$5,533.75 " N/A "$5,533.75 " N/A N/A N/A N/A "$5,257.07 " N/A "$5,312.40 " N/A N/A N/A N/A N/A "$7,083.21 " "$5,533.75 " N/A N/A N/A N/A "$5,699.77 " N/A N/A "$7,747.26 " "$20,514.93 " "$5,533.75 " "$7,470.57 " "$6,806.52 " N/A "$5,699.77 " N/A N/A N/A N/A N/A "$5,533.75 " "$18,016.16 " "$11,344.20 " "$5,533.75 " "$5,533.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,533.75 " "$5,533.75 " "$6,363.82 " "$5,533.75 " N/A "$5,257.07 " "$20,514.93 " 330104 724 3 Other infectious & parasitic diseases I N/A "$9,591.51 " N/A "$9,591.51 " N/A N/A N/A N/A "$9,111.94 " N/A "$9,207.85 " N/A N/A N/A N/A N/A "$12,277.14 " "$9,591.51 " N/A N/A N/A N/A "$9,879.26 " N/A N/A "$13,428.12 " "$36,443.95 " "$9,591.51 " "$12,948.54 " "$11,797.56 " N/A "$9,879.26 " N/A N/A N/A N/A N/A "$9,591.51 " "$32,004.98 " "$19,662.60 " "$9,591.51 " "$9,591.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,591.51 " "$9,591.51 " "$11,030.24 " "$9,591.51 " N/A "$9,111.94 " "$36,443.95 " 330104 724 4 Other infectious & parasitic diseases I N/A "$24,970.40 " N/A "$24,970.40 " N/A N/A N/A N/A "$23,721.88 " N/A "$23,971.59 " N/A N/A N/A N/A N/A "$31,962.11 " "$24,970.40 " N/A N/A N/A N/A "$25,719.51 " N/A N/A "$34,958.56 " "$96,814.84 " "$24,970.40 " "$33,710.04 " "$30,713.59 " N/A "$25,719.51 " N/A N/A N/A N/A N/A "$24,970.40 " "$85,022.55 " "$51,189.32 " "$24,970.40 " "$24,970.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$24,970.40 " "$24,970.40 " "$28,715.96 " "$24,970.40 " N/A "$23,721.88 " "$96,814.84 " 330104 740 1 Mental illness diagnosis w O.R. procedure I N/A "$20,920.14 " N/A "$20,920.14 " N/A N/A N/A N/A "$19,874.13 " N/A "$20,083.33 " N/A N/A N/A N/A N/A "$26,777.77 " "$20,920.14 " N/A N/A N/A N/A "$21,547.74 " N/A N/A "$29,288.19 " "$80,915.24 " "$20,920.14 " "$28,242.18 " "$25,731.77 " N/A "$21,547.74 " N/A N/A N/A N/A N/A "$20,920.14 " "$71,059.56 " "$42,886.28 " "$20,920.14 " "$20,920.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,920.14 " "$20,920.14 " "$24,058.16 " "$20,920.14 " N/A "$19,874.13 " "$80,915.24 " 330104 740 2 Mental illness diagnosis w O.R. procedure I N/A "$20,920.14 " N/A "$20,920.14 " N/A N/A N/A N/A "$19,874.13 " N/A "$20,083.33 " N/A N/A N/A N/A N/A "$26,777.77 " "$20,920.14 " N/A N/A N/A N/A "$21,547.74 " N/A N/A "$29,288.19 " "$80,915.24 " "$20,920.14 " "$28,242.18 " "$25,731.77 " N/A "$21,547.74 " N/A N/A N/A N/A N/A "$20,920.14 " "$71,059.56 " "$42,886.28 " "$20,920.14 " "$20,920.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,920.14 " "$20,920.14 " "$24,058.16 " "$20,920.14 " N/A "$19,874.13 " "$80,915.24 " 330104 740 3 Mental illness diagnosis w O.R. procedure I N/A "$20,920.14 " N/A "$20,920.14 " N/A N/A N/A N/A "$19,874.13 " N/A "$20,083.33 " N/A N/A N/A N/A N/A "$26,777.77 " "$20,920.14 " N/A N/A N/A N/A "$21,547.74 " N/A N/A "$29,288.19 " "$80,915.24 " "$20,920.14 " "$28,242.18 " "$25,731.77 " N/A "$21,547.74 " N/A N/A N/A N/A N/A "$20,920.14 " "$71,059.56 " "$42,886.28 " "$20,920.14 " "$20,920.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,920.14 " "$20,920.14 " "$24,058.16 " "$20,920.14 " N/A "$19,874.13 " "$80,915.24 " 330104 740 4 Mental illness diagnosis w O.R. procedure I N/A "$20,920.14 " N/A "$20,920.14 " N/A N/A N/A N/A "$19,874.13 " N/A "$20,083.33 " N/A N/A N/A N/A N/A "$26,777.77 " "$20,920.14 " N/A N/A N/A N/A "$21,547.74 " N/A N/A "$29,288.19 " "$80,915.24 " "$20,920.14 " "$28,242.18 " "$25,731.77 " N/A "$21,547.74 " N/A N/A N/A N/A N/A "$20,920.14 " "$71,059.56 " "$42,886.28 " "$20,920.14 " "$20,920.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$20,920.14 " "$20,920.14 " "$24,058.16 " "$20,920.14 " N/A "$19,874.13 " "$80,915.24 " 330104 750 1 Schizophrenia I N/A "$10,434.13 " N/A "$10,434.13 " N/A N/A N/A N/A "$9,912.42 " N/A "$10,016.76 " N/A N/A N/A N/A N/A "$13,355.68 " "$10,434.13 " N/A N/A N/A N/A "$10,747.15 " N/A N/A "$14,607.78 " "$39,751.68 " "$10,434.13 " "$14,086.07 " "$12,833.98 " N/A "$10,747.15 " N/A N/A N/A N/A N/A "$10,434.13 " "$34,909.83 " "$21,389.96 " "$10,434.13 " "$10,434.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$10,434.13 " "$11,999.25 " "$10,434.13 " N/A $739.00 "$39,751.68 " 330104 750 2 Schizophrenia I N/A "$12,110.50 " N/A "$12,110.50 " N/A N/A N/A N/A "$11,504.97 " N/A "$11,626.08 " N/A N/A N/A N/A N/A "$15,501.44 " "$12,110.50 " N/A N/A N/A N/A "$12,473.81 " N/A N/A "$16,954.70 " "$46,332.40 " "$12,110.50 " "$16,349.17 " "$14,895.91 " N/A "$12,473.81 " N/A N/A N/A N/A N/A "$12,110.50 " "$40,688.99 " "$24,826.52 " "$12,110.50 " "$12,110.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$12,110.50 " "$13,927.07 " "$12,110.50 " N/A $739.00 "$46,332.40 " 330104 750 3 Schizophrenia I N/A "$15,092.68 " N/A "$15,092.68 " N/A N/A N/A N/A "$14,338.05 " N/A "$14,488.98 " N/A N/A N/A N/A N/A "$19,318.63 " "$15,092.68 " N/A N/A N/A N/A "$15,545.46 " N/A N/A "$21,129.76 " "$58,039.17 " "$15,092.68 " "$20,375.12 " "$18,564.00 " N/A "$15,545.46 " N/A N/A N/A N/A N/A "$15,092.68 " "$50,969.85 " "$30,940.00 " "$15,092.68 " "$15,092.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$15,092.68 " "$17,356.59 " "$15,092.68 " N/A $739.00 "$58,039.17 " 330104 750 4 Schizophrenia I N/A "$20,095.23 " N/A "$20,095.23 " N/A N/A N/A N/A "$19,090.47 " N/A "$19,291.42 " N/A N/A N/A N/A N/A "$25,721.90 " "$20,095.23 " N/A N/A N/A N/A "$20,698.09 " N/A N/A "$28,133.33 " "$77,677.03 " "$20,095.23 " "$27,128.56 " "$24,717.14 " N/A "$20,698.09 " N/A N/A N/A N/A N/A "$20,095.23 " "$68,215.77 " "$41,195.23 " "$20,095.23 " "$20,095.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$20,095.23 " "$23,109.52 " "$20,095.23 " N/A $739.00 "$77,677.03 " 330104 751 1 Major depressive disorders & other/unspecified psychoses I N/A "$6,152.94 " N/A "$6,152.94 " N/A N/A N/A N/A "$5,845.30 " N/A "$5,906.82 " N/A N/A N/A N/A N/A "$7,875.77 " "$6,152.94 " N/A N/A N/A N/A "$6,337.53 " N/A N/A "$8,614.12 " "$22,945.59 " "$6,152.94 " "$8,306.47 " "$7,568.12 " N/A "$6,337.53 " N/A N/A N/A N/A N/A "$6,152.94 " "$20,150.76 " "$12,613.53 " "$6,152.94 " "$6,152.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,152.94 " "$7,075.88 " "$6,152.94 " N/A $739.00 "$22,945.59 " 330104 751 2 Major depressive disorders & other/unspecified psychoses I N/A "$7,502.35 " N/A "$7,502.35 " N/A N/A N/A N/A "$7,127.23 " N/A "$7,202.26 " N/A N/A N/A N/A N/A "$9,603.01 " "$7,502.35 " N/A N/A N/A N/A "$7,727.42 " N/A N/A "$10,503.29 " "$28,242.79 " "$7,502.35 " "$10,128.17 " "$9,227.89 " N/A "$7,727.42 " N/A N/A N/A N/A N/A "$7,502.35 " "$24,802.74 " "$15,379.82 " "$7,502.35 " "$7,502.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$7,502.35 " "$8,627.70 " "$7,502.35 " N/A $739.00 "$28,242.79 " 330104 751 3 Major depressive disorders & other/unspecified psychoses I N/A "$12,536.23 " N/A "$12,536.23 " N/A N/A N/A N/A "$11,909.42 " N/A "$12,034.78 " N/A N/A N/A N/A N/A "$16,046.38 " "$12,536.23 " N/A N/A N/A N/A "$12,912.32 " N/A N/A "$17,550.73 " "$48,003.65 " "$12,536.23 " "$16,923.92 " "$15,419.57 " N/A "$12,912.32 " N/A N/A N/A N/A N/A "$12,536.23 " "$42,156.68 " "$25,699.28 " "$12,536.23 " "$12,536.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$12,536.23 " "$14,416.67 " "$12,536.23 " N/A $739.00 "$48,003.65 " 330104 751 4 Major depressive disorders & other/unspecified psychoses I N/A "$16,029.30 " N/A "$16,029.30 " N/A N/A N/A N/A "$15,227.83 " N/A "$15,388.13 " N/A N/A N/A N/A N/A "$20,517.50 " "$16,029.30 " N/A N/A N/A N/A "$16,510.18 " N/A N/A "$22,441.02 " "$61,715.92 " "$16,029.30 " "$21,639.55 " "$19,716.04 " N/A "$16,510.18 " N/A N/A N/A N/A N/A "$16,029.30 " "$54,198.76 " "$32,860.06 " "$16,029.30 " "$16,029.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$16,029.30 " "$18,433.69 " "$16,029.30 " N/A $739.00 "$61,715.92 " 330104 752 1 Disorders of personality & impulse control I N/A "$6,766.68 " N/A "$6,766.68 " N/A N/A N/A N/A "$6,428.35 " N/A "$6,496.01 " N/A N/A N/A N/A N/A "$8,661.35 " "$6,766.68 " N/A N/A N/A N/A "$6,969.68 " N/A N/A "$9,473.35 " "$25,354.87 " "$6,766.68 " "$9,135.02 " "$8,323.02 " N/A "$6,969.68 " N/A N/A N/A N/A N/A "$6,766.68 " "$22,266.58 " "$13,871.70 " "$6,766.68 " "$6,766.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,766.68 " "$7,781.68 " "$6,766.68 " N/A $739.00 "$25,354.87 " 330104 752 2 Disorders of personality & impulse control I N/A "$6,766.68 " N/A "$6,766.68 " N/A N/A N/A N/A "$6,428.35 " N/A "$6,496.01 " N/A N/A N/A N/A N/A "$8,661.35 " "$6,766.68 " N/A N/A N/A N/A "$6,969.68 " N/A N/A "$9,473.35 " "$25,354.87 " "$6,766.68 " "$9,135.02 " "$8,323.02 " N/A "$6,969.68 " N/A N/A N/A N/A N/A "$6,766.68 " "$22,266.58 " "$13,871.70 " "$6,766.68 " "$6,766.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,766.68 " "$7,781.68 " "$6,766.68 " N/A $739.00 "$25,354.87 " 330104 752 3 Disorders of personality & impulse control I N/A "$6,766.68 " N/A "$6,766.68 " N/A N/A N/A N/A "$6,428.35 " N/A "$6,496.01 " N/A N/A N/A N/A N/A "$8,661.35 " "$6,766.68 " N/A N/A N/A N/A "$6,969.68 " N/A N/A "$9,473.35 " "$25,354.87 " "$6,766.68 " "$9,135.02 " "$8,323.02 " N/A "$6,969.68 " N/A N/A N/A N/A N/A "$6,766.68 " "$22,266.58 " "$13,871.70 " "$6,766.68 " "$6,766.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,766.68 " "$7,781.68 " "$6,766.68 " N/A $739.00 "$25,354.87 " 330104 752 4 Disorders of personality & impulse control I N/A "$6,766.68 " N/A "$6,766.68 " N/A N/A N/A N/A "$6,428.35 " N/A "$6,496.01 " N/A N/A N/A N/A N/A "$8,661.35 " "$6,766.68 " N/A N/A N/A N/A "$6,969.68 " N/A N/A "$9,473.35 " "$25,354.87 " "$6,766.68 " "$9,135.02 " "$8,323.02 " N/A "$6,969.68 " N/A N/A N/A N/A N/A "$6,766.68 " "$22,266.58 " "$13,871.70 " "$6,766.68 " "$6,766.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,766.68 " "$7,781.68 " "$6,766.68 " N/A $739.00 "$25,354.87 " 330104 753 1 Bipolar disorders I N/A "$5,950.63 " N/A "$5,950.63 " N/A N/A N/A N/A "$5,653.10 " N/A "$5,712.61 " N/A N/A N/A N/A N/A "$7,616.81 " "$5,950.63 " N/A N/A N/A N/A "$6,129.15 " N/A N/A "$8,330.89 " "$22,151.42 " "$5,950.63 " "$8,033.36 " "$7,319.28 " N/A "$6,129.15 " N/A N/A N/A N/A N/A "$5,950.63 " "$19,453.32 " "$12,198.80 " "$5,950.63 " "$5,950.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,950.63 " "$6,843.23 " "$5,950.63 " N/A $739.00 "$22,151.42 " 330104 753 2 Bipolar disorders I N/A "$7,299.36 " N/A "$7,299.36 " N/A N/A N/A N/A "$6,934.39 " N/A "$7,007.39 " N/A N/A N/A N/A N/A "$9,343.18 " "$7,299.36 " N/A N/A N/A N/A "$7,518.34 " N/A N/A "$10,219.10 " "$27,445.94 " "$7,299.36 " "$9,854.14 " "$8,978.21 " N/A "$7,518.34 " N/A N/A N/A N/A N/A "$7,299.36 " "$24,102.95 " "$14,963.69 " "$7,299.36 " "$7,299.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$7,299.36 " "$8,394.26 " "$7,299.36 " N/A $739.00 "$27,445.94 " 330104 753 3 Bipolar disorders I N/A "$11,540.36 " N/A "$11,540.36 " N/A N/A N/A N/A "$10,963.34 " N/A "$11,078.74 " N/A N/A N/A N/A N/A "$14,771.66 " "$11,540.36 " N/A N/A N/A N/A "$11,886.57 " N/A N/A "$16,156.50 " "$44,094.26 " "$11,540.36 " "$15,579.48 " "$14,194.64 " N/A "$11,886.57 " N/A N/A N/A N/A N/A "$11,540.36 " "$38,723.47 " "$23,657.73 " "$11,540.36 " "$11,540.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$11,540.36 " "$13,271.41 " "$11,540.36 " N/A $739.00 "$44,094.26 " 330104 753 4 Bipolar disorders I N/A "$12,395.91 " N/A "$12,395.91 " N/A N/A N/A N/A "$11,776.12 " N/A "$11,900.08 " N/A N/A N/A N/A N/A "$15,866.77 " "$12,395.91 " N/A N/A N/A N/A "$12,767.79 " N/A N/A "$17,354.28 " "$47,452.80 " "$12,395.91 " "$16,734.48 " "$15,246.97 " N/A "$12,767.79 " N/A N/A N/A N/A N/A "$12,395.91 " "$41,672.93 " "$25,411.62 " "$12,395.91 " "$12,395.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$12,395.91 " "$14,255.30 " "$12,395.91 " N/A $739.00 "$47,452.80 " 330104 754 1 Depression except major depressive disorder I N/A "$5,027.64 " N/A "$5,027.64 " N/A N/A N/A N/A "$4,776.26 " N/A "$4,826.54 " N/A N/A N/A N/A N/A "$6,435.38 " "$5,027.64 " N/A N/A N/A N/A "$5,178.47 " N/A N/A "$7,038.70 " "$18,528.15 " "$5,027.64 " "$6,787.32 " "$6,184.00 " N/A "$5,178.47 " N/A N/A N/A N/A N/A "$5,027.64 " "$16,271.37 " "$10,306.67 " "$5,027.64 " "$5,027.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,027.64 " "$5,781.79 " "$5,027.64 " N/A $739.00 "$18,528.15 " 330104 754 2 Depression except major depressive disorder I N/A "$5,027.64 " N/A "$5,027.64 " N/A N/A N/A N/A "$4,776.26 " N/A "$4,826.54 " N/A N/A N/A N/A N/A "$6,435.38 " "$5,027.64 " N/A N/A N/A N/A "$5,178.47 " N/A N/A "$7,038.70 " "$18,528.15 " "$5,027.64 " "$6,787.32 " "$6,184.00 " N/A "$5,178.47 " N/A N/A N/A N/A N/A "$5,027.64 " "$16,271.37 " "$10,306.67 " "$5,027.64 " "$5,027.64 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,027.64 " "$5,781.79 " "$5,027.64 " N/A $739.00 "$18,528.15 " 330104 754 3 Depression except major depressive disorder I N/A "$6,112.75 " N/A "$6,112.75 " N/A N/A N/A N/A "$5,807.12 " N/A "$5,868.24 " N/A N/A N/A N/A N/A "$7,824.32 " "$6,112.75 " N/A N/A N/A N/A "$6,296.14 " N/A N/A "$8,557.85 " "$22,787.83 " "$6,112.75 " "$8,252.22 " "$7,518.69 " N/A "$6,296.14 " N/A N/A N/A N/A N/A "$6,112.75 " "$20,012.21 " "$12,531.14 " "$6,112.75 " "$6,112.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,112.75 " "$7,029.67 " "$6,112.75 " N/A $739.00 "$22,787.83 " 330104 754 4 Depression except major depressive disorder I N/A "$6,112.75 " N/A "$6,112.75 " N/A N/A N/A N/A "$5,807.12 " N/A "$5,868.24 " N/A N/A N/A N/A N/A "$7,824.32 " "$6,112.75 " N/A N/A N/A N/A "$6,296.14 " N/A N/A "$8,557.85 " "$22,787.83 " "$6,112.75 " "$8,252.22 " "$7,518.69 " N/A "$6,296.14 " N/A N/A N/A N/A N/A "$6,112.75 " "$20,012.21 " "$12,531.14 " "$6,112.75 " "$6,112.75 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,112.75 " "$7,029.67 " "$6,112.75 " N/A $739.00 "$22,787.83 " 330104 755 1 Adjustment disorders & neuroses except depressive diagnoses I N/A "$3,783.82 " N/A "$3,783.82 " N/A N/A N/A N/A "$3,594.63 " N/A "$3,632.46 " N/A N/A N/A N/A N/A "$4,843.28 " "$3,783.82 " N/A N/A N/A N/A "$3,897.33 " N/A N/A "$5,297.34 " "$13,645.42 " "$3,783.82 " "$5,108.15 " "$4,654.09 " N/A "$3,897.33 " N/A N/A N/A N/A N/A "$3,783.82 " "$11,983.37 " "$7,756.82 " "$3,783.82 " "$3,783.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$3,783.82 " "$4,351.39 " "$3,783.82 " N/A $739.00 "$13,645.42 " 330104 755 2 Adjustment disorders & neuroses except depressive diagnoses I N/A "$5,802.82 " N/A "$5,802.82 " N/A N/A N/A N/A "$5,512.68 " N/A "$5,570.71 " N/A N/A N/A N/A N/A "$7,427.61 " "$5,802.82 " N/A N/A N/A N/A "$5,976.90 " N/A N/A "$8,123.95 " "$21,571.16 " "$5,802.82 " "$7,833.81 " "$7,137.47 " N/A "$5,976.90 " N/A N/A N/A N/A N/A "$5,802.82 " "$18,943.74 " "$11,895.78 " "$5,802.82 " "$5,802.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,802.82 " "$6,673.24 " "$5,802.82 " N/A $739.00 "$21,571.16 " 330104 755 3 Adjustment disorders & neuroses except depressive diagnoses I N/A "$5,802.82 " N/A "$5,802.82 " N/A N/A N/A N/A "$5,512.68 " N/A "$5,570.71 " N/A N/A N/A N/A N/A "$7,427.61 " "$5,802.82 " N/A N/A N/A N/A "$5,976.90 " N/A N/A "$8,123.95 " "$21,571.16 " "$5,802.82 " "$7,833.81 " "$7,137.47 " N/A "$5,976.90 " N/A N/A N/A N/A N/A "$5,802.82 " "$18,943.74 " "$11,895.78 " "$5,802.82 " "$5,802.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,802.82 " "$6,673.24 " "$5,802.82 " N/A $739.00 "$21,571.16 " 330104 755 4 Adjustment disorders & neuroses except depressive diagnoses I N/A "$5,802.82 " N/A "$5,802.82 " N/A N/A N/A N/A "$5,512.68 " N/A "$5,570.71 " N/A N/A N/A N/A N/A "$7,427.61 " "$5,802.82 " N/A N/A N/A N/A "$5,976.90 " N/A N/A "$8,123.95 " "$21,571.16 " "$5,802.82 " "$7,833.81 " "$7,137.47 " N/A "$5,976.90 " N/A N/A N/A N/A N/A "$5,802.82 " "$18,943.74 " "$11,895.78 " "$5,802.82 " "$5,802.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,802.82 " "$6,673.24 " "$5,802.82 " N/A $739.00 "$21,571.16 " 330104 756 1 Acute anxiety & delirium states I N/A "$3,414.62 " N/A "$3,414.62 " N/A N/A N/A N/A "$3,243.89 " N/A "$3,278.03 " N/A N/A N/A N/A N/A "$4,370.71 " "$3,414.62 " N/A N/A N/A N/A "$3,517.06 " N/A N/A "$4,780.47 " "$12,196.11 " "$3,414.62 " "$4,609.74 " "$4,199.98 " N/A "$3,517.06 " N/A N/A N/A N/A N/A "$3,414.62 " "$10,710.60 " "$6,999.97 " "$3,414.62 " "$3,414.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$3,414.62 " "$3,926.81 " "$3,414.62 " N/A $739.00 "$12,196.11 " 330104 756 2 Acute anxiety & delirium states I N/A "$4,326.03 " N/A "$4,326.03 " N/A N/A N/A N/A "$4,109.73 " N/A "$4,152.99 " N/A N/A N/A N/A N/A "$5,537.32 " "$4,326.03 " N/A N/A N/A N/A "$4,455.81 " N/A N/A "$6,056.44 " "$15,773.93 " "$4,326.03 " "$5,840.14 " "$5,321.02 " N/A "$4,455.81 " N/A N/A N/A N/A N/A "$4,326.03 " "$13,852.62 " "$8,868.36 " "$4,326.03 " "$4,326.03 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$4,326.03 " "$4,974.94 " "$4,326.03 " N/A $739.00 "$15,773.93 " 330104 756 3 Acute anxiety & delirium states I N/A "$6,405.66 " N/A "$6,405.66 " N/A N/A N/A N/A "$6,085.38 " N/A "$6,149.43 " N/A N/A N/A N/A N/A "$8,199.24 " "$6,405.66 " N/A N/A N/A N/A "$6,597.83 " N/A N/A "$8,967.92 " "$23,937.65 " "$6,405.66 " "$8,647.64 " "$7,878.96 " N/A "$6,597.83 " N/A N/A N/A N/A N/A "$6,405.66 " "$21,021.98 " "$13,131.60 " "$6,405.66 " "$6,405.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,405.66 " "$7,366.51 " "$6,405.66 " N/A $739.00 "$23,937.65 " 330104 756 4 Acute anxiety & delirium states I N/A "$6,424.73 " N/A "$6,424.73 " N/A N/A N/A N/A "$6,103.49 " N/A "$6,167.74 " N/A N/A N/A N/A N/A "$8,223.66 " "$6,424.73 " N/A N/A N/A N/A "$6,617.47 " N/A N/A "$8,994.62 " "$24,012.52 " "$6,424.73 " "$8,673.39 " "$7,902.42 " N/A "$6,617.47 " N/A N/A N/A N/A N/A "$6,424.73 " "$21,087.73 " "$13,170.70 " "$6,424.73 " "$6,424.73 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,424.73 " "$7,388.44 " "$6,424.73 " N/A $739.00 "$24,012.52 " 330104 757 1 Organic mental health disturbances I N/A "$5,804.18 " N/A "$5,804.18 " N/A N/A N/A N/A "$5,513.97 " N/A "$5,572.01 " N/A N/A N/A N/A N/A "$7,429.35 " "$5,804.18 " N/A N/A N/A N/A "$5,978.31 " N/A N/A "$8,125.85 " "$21,576.51 " "$5,804.18 " "$7,835.64 " "$7,139.14 " N/A "$5,978.31 " N/A N/A N/A N/A N/A "$5,804.18 " "$18,948.43 " "$11,898.57 " "$5,804.18 " "$5,804.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,804.18 " "$6,674.81 " "$5,804.18 " N/A $739.00 "$21,576.51 " 330104 757 2 Organic mental health disturbances I N/A "$5,804.18 " N/A "$5,804.18 " N/A N/A N/A N/A "$5,513.97 " N/A "$5,572.01 " N/A N/A N/A N/A N/A "$7,429.35 " "$5,804.18 " N/A N/A N/A N/A "$5,978.31 " N/A N/A "$8,125.85 " "$21,576.51 " "$5,804.18 " "$7,835.64 " "$7,139.14 " N/A "$5,978.31 " N/A N/A N/A N/A N/A "$5,804.18 " "$18,948.43 " "$11,898.57 " "$5,804.18 " "$5,804.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,804.18 " "$6,674.81 " "$5,804.18 " N/A $739.00 "$21,576.51 " 330104 757 3 Organic mental health disturbances I N/A "$6,872.26 " N/A "$6,872.26 " N/A N/A N/A N/A "$6,528.65 " N/A "$6,597.37 " N/A N/A N/A N/A N/A "$8,796.50 " "$6,872.26 " N/A N/A N/A N/A "$7,078.43 " N/A N/A "$9,621.17 " "$25,769.34 " "$6,872.26 " "$9,277.56 " "$8,452.88 " N/A "$7,078.43 " N/A N/A N/A N/A N/A "$6,872.26 " "$22,630.57 " "$14,088.14 " "$6,872.26 " "$6,872.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,872.26 " "$7,903.10 " "$6,872.26 " N/A $739.00 "$25,769.34 " 330104 757 4 Organic mental health disturbances I N/A "$6,872.26 " N/A "$6,872.26 " N/A N/A N/A N/A "$6,528.65 " N/A "$6,597.37 " N/A N/A N/A N/A N/A "$8,796.50 " "$6,872.26 " N/A N/A N/A N/A "$7,078.43 " N/A N/A "$9,621.17 " "$25,769.34 " "$6,872.26 " "$9,277.56 " "$8,452.88 " N/A "$7,078.43 " N/A N/A N/A N/A N/A "$6,872.26 " "$22,630.57 " "$14,088.14 " "$6,872.26 " "$6,872.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,872.26 " "$7,903.10 " "$6,872.26 " N/A $739.00 "$25,769.34 " 330104 758 1 Behavioral disorders I N/A "$3,972.50 " N/A "$3,972.50 " N/A N/A N/A N/A "$3,773.88 " N/A "$3,813.60 " N/A N/A N/A N/A N/A "$5,084.80 " "$3,972.50 " N/A N/A N/A N/A "$4,091.68 " N/A N/A "$5,561.50 " "$14,386.12 " "$3,972.50 " "$5,362.88 " "$4,886.18 " N/A "$4,091.68 " N/A N/A N/A N/A N/A "$3,972.50 " "$12,633.85 " "$8,143.63 " "$3,972.50 " "$3,972.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$3,972.50 " "$4,568.38 " "$3,972.50 " N/A $739.00 "$14,386.12 " 330104 758 2 Behavioral disorders I N/A "$8,011.19 " N/A "$8,011.19 " N/A N/A N/A N/A "$7,610.63 " N/A "$7,690.74 " N/A N/A N/A N/A N/A "$10,254.32 " "$8,011.19 " N/A N/A N/A N/A "$8,251.52 " N/A N/A "$11,215.66 " "$30,240.27 " "$8,011.19 " "$10,815.10 " "$9,853.76 " N/A "$8,251.52 " N/A N/A N/A N/A N/A "$8,011.19 " "$26,556.92 " "$16,422.94 " "$8,011.19 " "$8,011.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$8,011.19 " "$9,212.87 " "$8,011.19 " N/A $739.00 "$30,240.27 " 330104 758 3 Behavioral disorders I N/A "$8,011.19 " N/A "$8,011.19 " N/A N/A N/A N/A "$7,610.63 " N/A "$7,690.74 " N/A N/A N/A N/A N/A "$10,254.32 " "$8,011.19 " N/A N/A N/A N/A "$8,251.52 " N/A N/A "$11,215.66 " "$30,240.27 " "$8,011.19 " "$10,815.10 " "$9,853.76 " N/A "$8,251.52 " N/A N/A N/A N/A N/A "$8,011.19 " "$26,556.92 " "$16,422.94 " "$8,011.19 " "$8,011.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$8,011.19 " "$9,212.87 " "$8,011.19 " N/A $739.00 "$30,240.27 " 330104 758 4 Behavioral disorders I N/A "$8,011.19 " N/A "$8,011.19 " N/A N/A N/A N/A "$7,610.63 " N/A "$7,690.74 " N/A N/A N/A N/A N/A "$10,254.32 " "$8,011.19 " N/A N/A N/A N/A "$8,251.52 " N/A N/A "$11,215.66 " "$30,240.27 " "$8,011.19 " "$10,815.10 " "$9,853.76 " N/A "$8,251.52 " N/A N/A N/A N/A N/A "$8,011.19 " "$26,556.92 " "$16,422.94 " "$8,011.19 " "$8,011.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$8,011.19 " "$9,212.87 " "$8,011.19 " N/A $739.00 "$30,240.27 " 330104 759 1 Eating disorders I N/A "$9,137.85 " N/A "$9,137.85 " N/A N/A N/A N/A "$8,680.96 " N/A "$8,772.34 " N/A N/A N/A N/A N/A "$11,696.45 " "$9,137.85 " N/A N/A N/A N/A "$9,411.99 " N/A N/A "$12,792.99 " "$34,663.06 " "$9,137.85 " "$12,336.10 " "$11,239.56 " N/A "$9,411.99 " N/A N/A N/A N/A N/A "$9,137.85 " "$30,441.01 " "$18,732.60 " "$9,137.85 " "$9,137.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$9,137.85 " "$10,508.53 " "$9,137.85 " N/A $739.00 "$34,663.06 " 330104 759 2 Eating disorders I N/A "$9,137.85 " N/A "$9,137.85 " N/A N/A N/A N/A "$8,680.96 " N/A "$8,772.34 " N/A N/A N/A N/A N/A "$11,696.45 " "$9,137.85 " N/A N/A N/A N/A "$9,411.99 " N/A N/A "$12,792.99 " "$34,663.06 " "$9,137.85 " "$12,336.10 " "$11,239.56 " N/A "$9,411.99 " N/A N/A N/A N/A N/A "$9,137.85 " "$30,441.01 " "$18,732.60 " "$9,137.85 " "$9,137.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$9,137.85 " "$10,508.53 " "$9,137.85 " N/A $739.00 "$34,663.06 " 330104 759 3 Eating disorders I N/A "$14,718.72 " N/A "$14,718.72 " N/A N/A N/A N/A "$13,982.78 " N/A "$14,129.97 " N/A N/A N/A N/A N/A "$18,839.96 " "$14,718.72 " N/A N/A N/A N/A "$15,160.28 " N/A N/A "$20,606.21 " "$56,571.14 " "$14,718.72 " "$19,870.27 " "$18,104.02 " N/A "$15,160.28 " N/A N/A N/A N/A N/A "$14,718.72 " "$49,680.63 " "$30,173.37 " "$14,718.72 " "$14,718.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$14,718.72 " "$16,926.53 " "$14,718.72 " N/A $739.00 "$56,571.14 " 330104 759 4 Eating disorders I N/A "$14,718.72 " N/A "$14,718.72 " N/A N/A N/A N/A "$13,982.78 " N/A "$14,129.97 " N/A N/A N/A N/A N/A "$18,839.96 " "$14,718.72 " N/A N/A N/A N/A "$15,160.28 " N/A N/A "$20,606.21 " "$56,571.14 " "$14,718.72 " "$19,870.27 " "$18,104.02 " N/A "$15,160.28 " N/A N/A N/A N/A N/A "$14,718.72 " "$49,680.63 " "$30,173.37 " "$14,718.72 " "$14,718.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$14,718.72 " "$16,926.53 " "$14,718.72 " N/A $739.00 "$56,571.14 " 330104 760 1 Other mental health disorders I N/A "$4,067.18 " N/A "$4,067.18 " N/A N/A N/A N/A "$3,863.83 " N/A "$3,904.50 " N/A N/A N/A N/A N/A "$5,206.00 " "$4,067.18 " N/A N/A N/A N/A "$4,189.20 " N/A N/A "$5,694.06 " "$14,757.81 " "$4,067.18 " "$5,490.70 " "$5,002.64 " N/A "$4,189.20 " N/A N/A N/A N/A N/A "$4,067.18 " "$12,960.27 " "$8,337.73 " "$4,067.18 " "$4,067.18 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,067.18 " "$4,067.18 " "$4,677.26 " "$4,067.18 " N/A "$3,863.83 " "$14,757.81 " 330104 760 2 Other mental health disorders I N/A "$5,847.78 " N/A "$5,847.78 " N/A N/A N/A N/A "$5,555.39 " N/A "$5,613.87 " N/A N/A N/A N/A N/A "$7,485.15 " "$5,847.78 " N/A N/A N/A N/A "$6,023.21 " N/A N/A "$8,186.89 " "$21,747.64 " "$5,847.78 " "$7,894.50 " "$7,192.76 " N/A "$6,023.21 " N/A N/A N/A N/A N/A "$5,847.78 " "$19,098.72 " "$11,987.94 " "$5,847.78 " "$5,847.78 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,847.78 " "$5,847.78 " "$6,724.94 " "$5,847.78 " N/A "$5,555.39 " "$21,747.64 " 330104 760 3 Other mental health disorders I N/A "$6,094.36 " N/A "$6,094.36 " N/A N/A N/A N/A "$5,789.64 " N/A "$5,850.59 " N/A N/A N/A N/A N/A "$7,800.78 " "$6,094.36 " N/A N/A N/A N/A "$6,277.19 " N/A N/A "$8,532.11 " "$22,715.63 " "$6,094.36 " "$8,227.39 " "$7,496.06 " N/A "$6,277.19 " N/A N/A N/A N/A N/A "$6,094.36 " "$19,948.81 " "$12,493.44 " "$6,094.36 " "$6,094.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,094.36 " "$6,094.36 " "$7,008.52 " "$6,094.36 " N/A "$5,789.64 " "$22,715.63 " 330104 760 4 Other mental health disorders I N/A "$6,094.36 " N/A "$6,094.36 " N/A N/A N/A N/A "$5,789.64 " N/A "$5,850.59 " N/A N/A N/A N/A N/A "$7,800.78 " "$6,094.36 " N/A N/A N/A N/A "$6,277.19 " N/A N/A "$8,532.11 " "$22,715.63 " "$6,094.36 " "$8,227.39 " "$7,496.06 " N/A "$6,277.19 " N/A N/A N/A N/A N/A "$6,094.36 " "$19,948.81 " "$12,493.44 " "$6,094.36 " "$6,094.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,094.36 " "$6,094.36 " "$7,008.52 " "$6,094.36 " N/A "$5,789.64 " "$22,715.63 " 330104 770 1 Drug & alcohol abuse or dependence left against medical advice I N/A "$2,344.49 " N/A "$2,344.49 " N/A N/A N/A N/A "$2,227.27 " N/A "$2,250.71 " N/A N/A N/A N/A N/A "$3,000.95 " "$2,344.49 " N/A N/A N/A N/A "$2,414.83 " N/A N/A "$3,282.29 " "$7,995.26 " "$2,344.49 " "$3,165.07 " "$2,883.73 " N/A "$2,414.83 " N/A N/A N/A N/A N/A "$2,344.49 " "$7,021.42 " "$4,806.21 " "$2,344.49 " "$2,344.49 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$2,344.49 " "$2,696.17 " "$2,344.49 " N/A $739.00 "$7,995.26 " 330104 770 2 Drug & alcohol abuse or dependence left against medical advice I N/A "$2,889.43 " N/A "$2,889.43 " N/A N/A N/A N/A "$2,744.96 " N/A "$2,773.86 " N/A N/A N/A N/A N/A "$3,698.47 " "$2,889.43 " N/A N/A N/A N/A "$2,976.12 " N/A N/A "$4,045.21 " "$10,134.46 " "$2,889.43 " "$3,900.73 " "$3,554.00 " N/A "$2,976.12 " N/A N/A N/A N/A N/A "$2,889.43 " "$8,900.06 " "$5,923.34 " "$2,889.43 " "$2,889.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$2,889.43 " "$3,322.85 " "$2,889.43 " N/A $739.00 "$10,134.46 " 330104 770 3 Drug & alcohol abuse or dependence left against medical advice I N/A "$5,667.26 " N/A "$5,667.26 " N/A N/A N/A N/A "$5,383.90 " N/A "$5,440.57 " N/A N/A N/A N/A N/A "$7,254.10 " "$5,667.26 " N/A N/A N/A N/A "$5,837.28 " N/A N/A "$7,934.17 " "$21,039.03 " "$5,667.26 " "$7,650.81 " "$6,970.74 " N/A "$5,837.28 " N/A N/A N/A N/A N/A "$5,667.26 " "$18,476.42 " "$11,617.89 " "$5,667.26 " "$5,667.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,667.26 " "$6,517.35 " "$5,667.26 " N/A $739.00 "$21,039.03 " 330104 770 4 Drug & alcohol abuse or dependence left against medical advice I N/A "$6,395.44 " N/A "$6,395.44 " N/A N/A N/A N/A "$6,075.67 " N/A "$6,139.62 " N/A N/A N/A N/A N/A "$8,186.16 " "$6,395.44 " N/A N/A N/A N/A "$6,587.30 " N/A N/A "$8,953.62 " "$23,897.54 " "$6,395.44 " "$8,633.85 " "$7,866.39 " N/A "$6,587.30 " N/A N/A N/A N/A N/A "$6,395.44 " "$20,986.76 " "$13,110.65 " "$6,395.44 " "$6,395.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$6,395.44 " "$7,354.76 " "$6,395.44 " N/A $739.00 "$23,897.54 " 330104 772 1 Alcohol & drug dependence w rehab or rehab/detox therapy I N/A "$7,052.09 " N/A "$7,052.09 " N/A N/A N/A N/A "$6,699.49 " N/A "$6,770.01 " N/A N/A N/A N/A N/A "$9,026.68 " "$7,052.09 " N/A N/A N/A N/A "$7,263.66 " N/A N/A "$9,872.93 " "$26,475.27 " "$7,052.09 " "$9,520.33 " "$8,674.08 " N/A "$7,263.66 " N/A N/A N/A N/A N/A "$7,052.09 " "$23,250.52 " "$14,456.79 " "$7,052.09 " "$7,052.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$7,052.09 " "$8,109.91 " "$7,052.09 " N/A $739.00 "$26,475.27 " 330104 772 2 Alcohol & drug dependence w rehab or rehab/detox therapy I N/A "$7,052.09 " N/A "$7,052.09 " N/A N/A N/A N/A "$6,699.49 " N/A "$6,770.01 " N/A N/A N/A N/A N/A "$9,026.68 " "$7,052.09 " N/A N/A N/A N/A "$7,263.66 " N/A N/A "$9,872.93 " "$26,475.27 " "$7,052.09 " "$9,520.33 " "$8,674.08 " N/A "$7,263.66 " N/A N/A N/A N/A N/A "$7,052.09 " "$23,250.52 " "$14,456.79 " "$7,052.09 " "$7,052.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$7,052.09 " "$8,109.91 " "$7,052.09 " N/A $739.00 "$26,475.27 " 330104 772 3 Alcohol & drug dependence w rehab or rehab/detox therapy I N/A "$7,052.09 " N/A "$7,052.09 " N/A N/A N/A N/A "$6,699.49 " N/A "$6,770.01 " N/A N/A N/A N/A N/A "$9,026.68 " "$7,052.09 " N/A N/A N/A N/A "$7,263.66 " N/A N/A "$9,872.93 " "$26,475.27 " "$7,052.09 " "$9,520.33 " "$8,674.08 " N/A "$7,263.66 " N/A N/A N/A N/A N/A "$7,052.09 " "$23,250.52 " "$14,456.79 " "$7,052.09 " "$7,052.09 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$7,052.09 " "$8,109.91 " "$7,052.09 " N/A $739.00 "$26,475.27 " 330104 772 4 Alcohol & drug dependence w rehab or rehab/detox therapy I N/A "$7,735.31 " N/A "$7,735.31 " N/A N/A N/A N/A "$7,348.55 " N/A "$7,425.90 " N/A N/A N/A N/A N/A "$9,901.20 " "$7,735.31 " N/A N/A N/A N/A "$7,967.37 " N/A N/A "$10,829.44 " "$29,157.30 " "$7,735.31 " "$10,442.67 " "$9,514.43 " N/A "$7,967.37 " N/A N/A N/A N/A N/A "$7,735.31 " "$25,605.86 " "$15,857.39 " "$7,735.31 " "$7,735.31 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$7,735.31 " "$8,895.61 " "$7,735.31 " N/A $739.00 "$29,157.30 " 330104 773 1 Opioid abuse & dependence I N/A "$2,803.61 " N/A "$2,803.61 " N/A N/A N/A N/A "$2,663.42 " N/A "$2,691.46 " N/A N/A N/A N/A N/A "$3,588.61 " "$2,803.61 " N/A N/A N/A N/A "$2,887.71 " N/A N/A "$3,925.05 " "$9,797.54 " "$2,803.61 " "$3,784.87 " "$3,448.43 " N/A "$2,887.71 " N/A N/A N/A N/A N/A "$2,803.61 " "$8,604.17 " "$5,747.39 " "$2,803.61 " "$2,803.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$2,803.61 " "$3,224.15 " "$2,803.61 " N/A $739.00 "$9,797.54 " 330104 773 2 Opioid abuse & dependence I N/A "$3,703.44 " N/A "$3,703.44 " N/A N/A N/A N/A "$3,518.27 " N/A "$3,555.30 " N/A N/A N/A N/A N/A "$4,740.40 " "$3,703.44 " N/A N/A N/A N/A "$3,814.54 " N/A N/A "$5,184.81 " "$13,329.89 " "$3,703.44 " "$4,999.64 " "$4,555.23 " N/A "$3,814.54 " N/A N/A N/A N/A N/A "$3,703.44 " "$11,706.28 " "$7,592.05 " "$3,703.44 " "$3,703.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$3,703.44 " "$4,258.95 " "$3,703.44 " N/A $739.00 "$13,329.89 " 330104 773 3 Opioid abuse & dependence I N/A "$8,023.45 " N/A "$8,023.45 " N/A N/A N/A N/A "$7,622.28 " N/A "$7,702.51 " N/A N/A N/A N/A N/A "$10,270.02 " "$8,023.45 " N/A N/A N/A N/A "$8,264.15 " N/A N/A "$11,232.83 " "$30,288.40 " "$8,023.45 " "$10,831.66 " "$9,868.84 " N/A "$8,264.15 " N/A N/A N/A N/A N/A "$8,023.45 " "$26,599.19 " "$16,448.07 " "$8,023.45 " "$8,023.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$8,023.45 " "$9,226.97 " "$8,023.45 " N/A $739.00 "$30,288.40 " 330104 773 4 Opioid abuse & dependence I N/A "$9,164.42 " N/A "$9,164.42 " N/A N/A N/A N/A "$8,706.20 " N/A "$8,797.84 " N/A N/A N/A N/A N/A "$11,730.45 " "$9,164.42 " N/A N/A N/A N/A "$9,439.35 " N/A N/A "$12,830.18 " "$34,767.35 " "$9,164.42 " "$12,371.96 " "$11,272.23 " N/A "$9,439.35 " N/A N/A N/A N/A N/A "$9,164.42 " "$30,532.60 " "$18,787.06 " "$9,164.42 " "$9,164.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$9,164.42 " "$10,539.08 " "$9,164.42 " N/A $739.00 "$34,767.35 " 330104 774 1 Cocaine abuse & dependence I N/A "$3,683.68 " N/A "$3,683.68 " N/A N/A N/A N/A "$3,499.50 " N/A "$3,536.34 " N/A N/A N/A N/A N/A "$4,715.11 " "$3,683.68 " N/A N/A N/A N/A "$3,794.19 " N/A N/A "$5,157.16 " "$13,252.34 " "$3,683.68 " "$4,972.97 " "$4,530.93 " N/A "$3,794.19 " N/A N/A N/A N/A N/A "$3,683.68 " "$11,638.17 " "$7,551.55 " "$3,683.68 " "$3,683.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$3,683.68 " "$4,236.24 " "$3,683.68 " N/A $739.00 "$13,252.34 " 330104 774 2 Cocaine abuse & dependence I N/A "$3,717.74 " N/A "$3,717.74 " N/A N/A N/A N/A "$3,531.85 " N/A "$3,569.03 " N/A N/A N/A N/A N/A "$4,758.71 " "$3,717.74 " N/A N/A N/A N/A "$3,829.27 " N/A N/A "$5,204.84 " "$13,386.04 " "$3,717.74 " "$5,018.95 " "$4,572.82 " N/A "$3,829.27 " N/A N/A N/A N/A N/A "$3,717.74 " "$11,755.59 " "$7,621.37 " "$3,717.74 " "$3,717.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$3,717.74 " "$4,275.40 " "$3,717.74 " N/A $739.00 "$13,386.04 " 330104 774 3 Cocaine abuse & dependence I N/A "$5,816.44 " N/A "$5,816.44 " N/A N/A N/A N/A "$5,525.62 " N/A "$5,583.78 " N/A N/A N/A N/A N/A "$7,445.05 " "$5,816.44 " N/A N/A N/A N/A "$5,990.94 " N/A N/A "$8,143.02 " "$21,624.64 " "$5,816.44 " "$7,852.20 " "$7,154.22 " N/A "$5,990.94 " N/A N/A N/A N/A N/A "$5,816.44 " "$18,990.70 " "$11,923.71 " "$5,816.44 " "$5,816.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$5,816.44 " "$6,688.91 " "$5,816.44 " N/A $739.00 "$21,624.64 " 330104 774 4 Cocaine abuse & dependence I N/A "$7,186.97 " N/A "$7,186.97 " N/A N/A N/A N/A "$6,827.62 " N/A "$6,899.49 " N/A N/A N/A N/A N/A "$9,199.32 " "$7,186.97 " N/A N/A N/A N/A "$7,402.58 " N/A N/A "$10,061.75 " "$27,004.73 " "$7,186.97 " "$9,702.40 " "$8,839.97 " N/A "$7,402.58 " N/A N/A N/A N/A N/A "$7,186.97 " "$23,715.48 " "$14,733.28 " "$7,186.97 " "$7,186.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$7,186.97 " "$8,265.01 " "$7,186.97 " N/A $739.00 "$27,004.73 " 330104 775 1 Alcohol abuse & dependence I N/A "$3,415.98 " N/A "$3,415.98 " N/A N/A N/A N/A "$3,245.18 " N/A "$3,279.34 " N/A N/A N/A N/A N/A "$4,372.46 " "$3,415.98 " N/A N/A N/A N/A "$3,518.46 " N/A N/A "$4,782.37 " "$12,201.46 " "$3,415.98 " "$4,611.58 " "$4,201.66 " N/A "$3,518.46 " N/A N/A N/A N/A N/A "$3,415.98 " "$10,715.29 " "$7,002.76 " "$3,415.98 " "$3,415.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$3,415.98 " "$3,928.38 " "$3,415.98 " N/A $739.00 "$12,201.46 " 330104 775 2 Alcohol abuse & dependence I N/A "$4,736.10 " N/A "$4,736.10 " N/A N/A N/A N/A "$4,499.29 " N/A "$4,546.65 " N/A N/A N/A N/A N/A "$6,062.21 " "$4,736.10 " N/A N/A N/A N/A "$4,878.18 " N/A N/A "$6,630.54 " "$17,383.67 " "$4,736.10 " "$6,393.73 " "$5,825.40 " N/A "$4,878.18 " N/A N/A N/A N/A N/A "$4,736.10 " "$15,266.30 " "$9,709.00 " "$4,736.10 " "$4,736.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$4,736.10 " "$5,446.51 " "$4,736.10 " N/A $739.00 "$17,383.67 " 330104 775 3 Alcohol abuse & dependence I N/A "$8,702.58 " N/A "$8,702.58 " N/A N/A N/A N/A "$8,267.45 " N/A "$8,354.48 " N/A N/A N/A N/A N/A "$11,139.30 " "$8,702.58 " N/A N/A N/A N/A "$8,963.66 " N/A N/A "$12,183.61 " "$32,954.38 " "$8,702.58 " "$11,748.48 " "$10,704.17 " N/A "$8,963.66 " N/A N/A N/A N/A N/A "$8,702.58 " "$28,940.45 " "$17,840.29 " "$8,702.58 " "$8,702.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$8,702.58 " "$10,007.97 " "$8,702.58 " N/A $739.00 "$32,954.38 " 330104 775 4 Alcohol abuse & dependence I N/A "$27,005.07 " N/A "$27,005.07 " N/A N/A N/A N/A "$25,654.82 " N/A "$25,924.87 " N/A N/A N/A N/A N/A "$34,566.49 " "$27,005.07 " N/A N/A N/A N/A "$27,815.22 " N/A N/A "$37,807.10 " "$104,802.08 " "$27,005.07 " "$36,456.85 " "$33,216.24 " N/A "$27,815.22 " N/A N/A N/A N/A N/A "$27,005.07 " "$92,036.92 " "$55,360.40 " "$27,005.07 " "$27,005.07 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$27,005.07 " "$31,055.83 " "$27,005.07 " N/A $739.00 "$104,802.08 " 330104 776 1 Other drug abuse & dependence I N/A "$3,870.33 " N/A "$3,870.33 " N/A N/A N/A N/A "$3,676.81 " N/A "$3,715.51 " N/A N/A N/A N/A N/A "$4,954.02 " "$3,870.33 " N/A N/A N/A N/A "$3,986.44 " N/A N/A "$5,418.46 " "$13,985.02 " "$3,870.33 " "$5,224.94 " "$4,760.50 " N/A "$3,986.44 " N/A N/A N/A N/A N/A "$3,870.33 " "$12,281.61 " "$7,934.17 " "$3,870.33 " "$3,870.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$3,870.33 " "$4,450.87 " "$3,870.33 " N/A $739.00 "$13,985.02 " 330104 776 2 Other drug abuse & dependence I N/A "$4,078.08 " N/A "$4,078.08 " N/A N/A N/A N/A "$3,874.18 " N/A "$3,914.96 " N/A N/A N/A N/A N/A "$5,219.95 " "$4,078.08 " N/A N/A N/A N/A "$4,200.43 " N/A N/A "$5,709.32 " "$14,800.59 " "$4,078.08 " "$5,505.41 " "$5,016.04 " N/A "$4,200.43 " N/A N/A N/A N/A N/A "$4,078.08 " "$12,997.84 " "$8,360.07 " "$4,078.08 " "$4,078.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$4,078.08 " "$4,689.80 " "$4,078.08 " N/A $739.00 "$14,800.59 " 330104 776 3 Other drug abuse & dependence I N/A "$4,532.43 " N/A "$4,532.43 " N/A N/A N/A N/A "$4,305.81 " N/A "$4,351.13 " N/A N/A N/A N/A N/A "$5,801.51 " "$4,532.43 " N/A N/A N/A N/A "$4,668.40 " N/A N/A "$6,345.40 " "$16,584.15 " "$4,532.43 " "$6,118.78 " "$5,574.89 " N/A "$4,668.40 " N/A N/A N/A N/A N/A "$4,532.43 " "$14,564.16 " "$9,291.48 " "$4,532.43 " "$4,532.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$4,532.43 " "$5,212.29 " "$4,532.43 " N/A $739.00 "$16,584.15 " 330104 776 4 Other drug abuse & dependence I N/A "$4,532.43 " N/A "$4,532.43 " N/A N/A N/A N/A "$4,305.81 " N/A "$4,351.13 " N/A N/A N/A N/A N/A "$5,801.51 " "$4,532.43 " N/A N/A N/A N/A "$4,668.40 " N/A N/A "$6,345.40 " "$16,584.15 " "$4,532.43 " "$6,118.78 " "$5,574.89 " N/A "$4,668.40 " N/A N/A N/A N/A N/A "$4,532.43 " "$14,564.16 " "$9,291.48 " "$4,532.43 " "$4,532.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A $739.00 "$4,532.43 " "$5,212.29 " "$4,532.43 " N/A $739.00 "$16,584.15 " 330104 791 1 O.R. procedure for other complications of treatment I N/A "$6,084.14 " N/A "$6,084.14 " N/A N/A N/A N/A "$5,779.94 " N/A "$5,840.78 " N/A N/A N/A N/A N/A "$7,787.70 " "$6,084.14 " N/A N/A N/A N/A "$6,266.67 " N/A N/A "$8,517.80 " "$22,675.52 " "$6,084.14 " "$8,213.59 " "$7,483.50 " N/A "$6,266.67 " N/A N/A N/A N/A N/A "$6,084.14 " "$19,913.58 " "$12,472.50 " "$6,084.14 " "$6,084.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,084.14 " "$6,084.14 " "$6,996.77 " "$6,084.14 " N/A "$5,779.94 " "$22,675.52 " 330104 791 2 O.R. procedure for other complications of treatment I N/A "$10,002.94 " N/A "$10,002.94 " N/A N/A N/A N/A "$9,502.80 " N/A "$9,602.83 " N/A N/A N/A N/A N/A "$12,803.77 " "$10,002.94 " N/A N/A N/A N/A "$10,303.03 " N/A N/A "$14,004.12 " "$38,059.04 " "$10,002.94 " "$13,503.97 " "$12,303.62 " N/A "$10,303.03 " N/A N/A N/A N/A N/A "$10,002.94 " "$33,423.35 " "$20,506.03 " "$10,002.94 " "$10,002.94 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,002.94 " "$10,002.94 " "$11,503.39 " "$10,002.94 " N/A "$9,502.80 " "$38,059.04 " 330104 791 3 O.R. procedure for other complications of treatment I N/A "$18,523.08 " N/A "$18,523.08 " N/A N/A N/A N/A "$17,596.93 " N/A "$17,782.16 " N/A N/A N/A N/A N/A "$23,709.54 " "$18,523.08 " N/A N/A N/A N/A "$19,078.77 " N/A N/A "$25,932.31 " "$71,505.43 " "$18,523.08 " "$25,006.16 " "$22,783.39 " N/A "$19,078.77 " N/A N/A N/A N/A N/A "$18,523.08 " "$62,795.89 " "$37,972.32 " "$18,523.08 " "$18,523.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,523.08 " "$18,523.08 " "$21,301.54 " "$18,523.08 " N/A "$17,596.93 " "$71,505.43 " 330104 791 4 O.R. procedure for other complications of treatment I N/A "$45,338.22 " N/A "$45,338.22 " N/A N/A N/A N/A "$43,071.30 " N/A "$43,524.69 " N/A N/A N/A N/A N/A "$58,032.92 " "$45,338.22 " N/A N/A N/A N/A "$46,698.36 " N/A N/A "$63,473.50 " "$176,770.12 " "$45,338.22 " "$61,206.59 " "$55,766.01 " N/A "$46,698.36 " N/A N/A N/A N/A N/A "$45,338.22 " "$155,239.07 " "$92,943.34 " "$45,338.22 " "$45,338.22 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$45,338.22 " "$45,338.22 " "$52,138.95 " "$45,338.22 " N/A "$43,071.30 " "$176,770.12 " 330104 811 1 Allergic reactions I N/A "$2,616.96 " N/A "$2,616.96 " N/A N/A N/A N/A "$2,486.12 " N/A "$2,512.28 " N/A N/A N/A N/A N/A "$3,349.71 " "$2,616.96 " N/A N/A N/A N/A "$2,695.47 " N/A N/A "$3,663.75 " "$9,064.86 " "$2,616.96 " "$3,532.90 " "$3,218.86 " N/A "$2,695.47 " N/A N/A N/A N/A N/A "$2,616.96 " "$7,960.74 " "$5,364.77 " "$2,616.96 " "$2,616.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,616.96 " "$2,616.96 " "$3,009.51 " "$2,616.96 " N/A "$2,486.12 " "$9,064.86 " 330104 811 2 Allergic reactions I N/A "$3,522.93 " N/A "$3,522.93 " N/A N/A N/A N/A "$3,346.78 " N/A "$3,382.01 " N/A N/A N/A N/A N/A "$4,509.35 " "$3,522.93 " N/A N/A N/A N/A "$3,628.61 " N/A N/A "$4,932.10 " "$12,621.28 " "$3,522.93 " "$4,755.95 " "$4,333.20 " N/A "$3,628.61 " N/A N/A N/A N/A N/A "$3,522.93 " "$11,083.98 " "$7,222.00 " "$3,522.93 " "$3,522.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,522.93 " "$3,522.93 " "$4,051.36 " "$3,522.93 " N/A "$3,346.78 " "$12,621.28 " 330104 811 3 Allergic reactions I N/A "$7,442.41 " N/A "$7,442.41 " N/A N/A N/A N/A "$7,070.29 " N/A "$7,144.71 " N/A N/A N/A N/A N/A "$9,526.28 " "$7,442.41 " N/A N/A N/A N/A "$7,665.68 " N/A N/A "$10,419.37 " "$28,007.48 " "$7,442.41 " "$10,047.25 " "$9,154.16 " N/A "$7,665.68 " N/A N/A N/A N/A N/A "$7,442.41 " "$24,596.09 " "$15,256.93 " "$7,442.41 " "$7,442.41 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,442.41 " "$7,442.41 " "$8,558.77 " "$7,442.41 " N/A "$7,070.29 " "$28,007.48 " 330104 811 4 Allergic reactions I N/A "$16,391.68 " N/A "$16,391.68 " N/A N/A N/A N/A "$15,572.10 " N/A "$15,736.02 " N/A N/A N/A N/A N/A "$20,981.36 " "$16,391.68 " N/A N/A N/A N/A "$16,883.43 " N/A N/A "$22,948.36 " "$63,138.49 " "$16,391.68 " "$22,128.77 " "$20,161.77 " N/A "$16,883.43 " N/A N/A N/A N/A N/A "$16,391.68 " "$55,448.06 " "$33,602.95 " "$16,391.68 " "$16,391.68 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,391.68 " "$16,391.68 " "$18,850.44 " "$16,391.68 " N/A "$15,572.10 " "$63,138.49 " 330104 812 1 Poisoning of medicinal agents I N/A "$3,097.19 " N/A "$3,097.19 " N/A N/A N/A N/A "$2,942.33 " N/A "$2,973.30 " N/A N/A N/A N/A N/A "$3,964.41 " "$3,097.19 " N/A N/A N/A N/A "$3,190.11 " N/A N/A "$4,336.07 " "$10,950.03 " "$3,097.19 " "$4,181.21 " "$3,809.55 " N/A "$3,190.11 " N/A N/A N/A N/A N/A "$3,097.19 " "$9,616.29 " "$6,349.24 " "$3,097.19 " "$3,097.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,097.19 " "$3,097.19 " "$3,561.77 " "$3,097.19 " N/A "$2,942.33 " "$10,950.03 " 330104 812 2 Poisoning of medicinal agents I N/A "$4,001.79 " N/A "$4,001.79 " N/A N/A N/A N/A "$3,801.70 " N/A "$3,841.72 " N/A N/A N/A N/A N/A "$5,122.29 " "$4,001.79 " N/A N/A N/A N/A "$4,121.85 " N/A N/A "$5,602.51 " "$14,501.10 " "$4,001.79 " "$5,402.42 " "$4,922.20 " N/A "$4,121.85 " N/A N/A N/A N/A N/A "$4,001.79 " "$12,734.83 " "$8,203.67 " "$4,001.79 " "$4,001.79 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,001.79 " "$4,001.79 " "$4,602.06 " "$4,001.79 " N/A "$3,801.70 " "$14,501.10 " 330104 812 3 Poisoning of medicinal agents I N/A "$6,574.59 " N/A "$6,574.59 " N/A N/A N/A N/A "$6,245.86 " N/A "$6,311.61 " N/A N/A N/A N/A N/A "$8,415.48 " "$6,574.59 " N/A N/A N/A N/A "$6,771.83 " N/A N/A "$9,204.43 " "$24,600.80 " "$6,574.59 " "$8,875.70 " "$8,086.75 " N/A "$6,771.83 " N/A N/A N/A N/A N/A "$6,574.59 " "$21,604.36 " "$13,477.91 " "$6,574.59 " "$6,574.59 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,574.59 " "$6,574.59 " "$7,560.78 " "$6,574.59 " N/A "$6,245.86 " "$24,600.80 " 330104 812 4 Poisoning of medicinal agents I N/A "$15,200.99 " N/A "$15,200.99 " N/A N/A N/A N/A "$14,440.94 " N/A "$14,592.95 " N/A N/A N/A N/A N/A "$19,457.27 " "$15,200.99 " N/A N/A N/A N/A "$15,657.02 " N/A N/A "$21,281.39 " "$58,464.34 " "$15,200.99 " "$20,521.34 " "$18,697.22 " N/A "$15,657.02 " N/A N/A N/A N/A N/A "$15,200.99 " "$51,343.23 " "$31,162.03 " "$15,200.99 " "$15,200.99 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,200.99 " "$15,200.99 " "$17,481.14 " "$15,200.99 " N/A "$14,440.94 " "$58,464.34 " 330104 813 1 Other complications of treatment I N/A "$3,696.63 " N/A "$3,696.63 " N/A N/A N/A N/A "$3,511.79 " N/A "$3,548.76 " N/A N/A N/A N/A N/A "$4,731.68 " "$3,696.63 " N/A N/A N/A N/A "$3,807.52 " N/A N/A "$5,175.28 " "$13,303.15 " "$3,696.63 " "$4,990.44 " "$4,546.85 " N/A "$3,807.52 " N/A N/A N/A N/A N/A "$3,696.63 " "$11,682.79 " "$7,578.08 " "$3,696.63 " "$3,696.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,696.63 " "$3,696.63 " "$4,251.12 " "$3,696.63 " N/A "$3,511.79 " "$13,303.15 " 330104 813 2 Other complications of treatment I N/A "$4,988.13 " N/A "$4,988.13 " N/A N/A N/A N/A "$4,738.73 " N/A "$4,788.61 " N/A N/A N/A N/A N/A "$6,384.81 " "$4,988.13 " N/A N/A N/A N/A "$5,137.78 " N/A N/A "$6,983.39 " "$18,373.05 " "$4,988.13 " "$6,733.98 " "$6,135.40 " N/A "$5,137.78 " N/A N/A N/A N/A N/A "$4,988.13 " "$16,135.17 " "$10,225.67 " "$4,988.13 " "$4,988.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,988.13 " "$4,988.13 " "$5,736.35 " "$4,988.13 " N/A "$4,738.73 " "$18,373.05 " 330104 813 3 Other complications of treatment I N/A "$8,060.23 " N/A "$8,060.23 " N/A N/A N/A N/A "$7,657.22 " N/A "$7,737.82 " N/A N/A N/A N/A N/A "$10,317.10 " "$8,060.23 " N/A N/A N/A N/A "$8,302.04 " N/A N/A "$11,284.33 " "$30,432.79 " "$8,060.23 " "$10,881.31 " "$9,914.09 " N/A "$8,302.04 " N/A N/A N/A N/A N/A "$8,060.23 " "$26,726.00 " "$16,523.48 " "$8,060.23 " "$8,060.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,060.23 " "$8,060.23 " "$9,269.27 " "$8,060.23 " N/A "$7,657.22 " "$30,432.79 " 330104 813 4 Other complications of treatment I N/A "$18,110.97 " N/A "$18,110.97 " N/A N/A N/A N/A "$17,205.42 " N/A "$17,386.53 " N/A N/A N/A N/A N/A "$23,182.04 " "$18,110.97 " N/A N/A N/A N/A "$18,654.30 " N/A N/A "$25,355.36 " "$69,887.66 " "$18,110.97 " "$24,449.81 " "$22,276.49 " N/A "$18,654.30 " N/A N/A N/A N/A N/A "$18,110.97 " "$61,375.17 " "$37,127.49 " "$18,110.97 " "$18,110.97 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,110.97 " "$18,110.97 " "$20,827.62 " "$18,110.97 " N/A "$17,205.42 " "$69,887.66 " 330104 815 1 Other injury poisoning & toxic effect diagnoses I N/A "$2,768.87 " N/A "$2,768.87 " N/A N/A N/A N/A "$2,630.42 " N/A "$2,658.11 " N/A N/A N/A N/A N/A "$3,544.15 " "$2,768.87 " N/A N/A N/A N/A "$2,851.93 " N/A N/A "$3,876.41 " "$9,661.16 " "$2,768.87 " "$3,737.97 " "$3,405.70 " N/A "$2,851.93 " N/A N/A N/A N/A N/A "$2,768.87 " "$8,484.41 " "$5,676.17 " "$2,768.87 " "$2,768.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$2,768.87 " "$2,768.87 " "$3,184.20 " "$2,768.87 " N/A "$2,630.42 " "$9,661.16 " 330104 815 2 Other injury poisoning & toxic effect diagnoses I N/A "$4,517.44 " N/A "$4,517.44 " N/A N/A N/A N/A "$4,291.57 " N/A "$4,336.74 " N/A N/A N/A N/A N/A "$5,782.33 " "$4,517.44 " N/A N/A N/A N/A "$4,652.96 " N/A N/A "$6,324.42 " "$16,525.32 " "$4,517.44 " "$6,098.55 " "$5,556.45 " N/A "$4,652.96 " N/A N/A N/A N/A N/A "$4,517.44 " "$14,512.49 " "$9,260.76 " "$4,517.44 " "$4,517.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,517.44 " "$4,517.44 " "$5,195.06 " "$4,517.44 " N/A "$4,291.57 " "$16,525.32 " 330104 815 3 Other injury poisoning & toxic effect diagnoses I N/A "$7,491.45 " N/A "$7,491.45 " N/A N/A N/A N/A "$7,116.88 " N/A "$7,191.79 " N/A N/A N/A N/A N/A "$9,589.06 " "$7,491.45 " N/A N/A N/A N/A "$7,716.20 " N/A N/A "$10,488.03 " "$28,200.00 " "$7,491.45 " "$10,113.46 " "$9,214.49 " N/A "$7,716.20 " N/A N/A N/A N/A N/A "$7,491.45 " "$24,765.17 " "$15,357.48 " "$7,491.45 " "$7,491.45 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,491.45 " "$7,491.45 " "$8,615.17 " "$7,491.45 " N/A "$7,116.88 " "$28,200.00 " 330104 815 4 Other injury poisoning & toxic effect diagnoses I N/A "$18,730.16 " N/A "$18,730.16 " N/A N/A N/A N/A "$17,793.65 " N/A "$17,980.95 " N/A N/A N/A N/A N/A "$23,974.60 " "$18,730.16 " N/A N/A N/A N/A "$19,292.06 " N/A N/A "$26,222.22 " "$72,318.33 " "$18,730.16 " "$25,285.71 " "$23,038.09 " N/A "$19,292.06 " N/A N/A N/A N/A N/A "$18,730.16 " "$63,509.77 " "$38,396.82 " "$18,730.16 " "$18,730.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,730.16 " "$18,730.16 " "$21,539.68 " "$18,730.16 " N/A "$17,793.65 " "$72,318.33 " 330104 816 1 Toxic effects of non-medicinal substances I N/A "$3,359.44 " N/A "$3,359.44 " N/A N/A N/A N/A "$3,191.47 " N/A "$3,225.07 " N/A N/A N/A N/A N/A "$4,300.09 " "$3,359.44 " N/A N/A N/A N/A "$3,460.23 " N/A N/A "$4,703.22 " "$11,979.52 " "$3,359.44 " "$4,535.25 " "$4,132.12 " N/A "$3,460.23 " N/A N/A N/A N/A N/A "$3,359.44 " "$10,520.38 " "$6,886.86 " "$3,359.44 " "$3,359.44 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,359.44 " "$3,359.44 " "$3,863.36 " "$3,359.44 " N/A "$3,191.47 " "$11,979.52 " 330104 816 2 Toxic effects of non-medicinal substances I N/A "$4,165.96 " N/A "$4,165.96 " N/A N/A N/A N/A "$3,957.66 " N/A "$3,999.32 " N/A N/A N/A N/A N/A "$5,332.42 " "$4,165.96 " N/A N/A N/A N/A "$4,290.93 " N/A N/A "$5,832.34 " "$15,145.54 " "$4,165.96 " "$5,624.04 " "$5,124.12 " N/A "$4,290.93 " N/A N/A N/A N/A N/A "$4,165.96 " "$13,300.77 " "$8,540.21 " "$4,165.96 " "$4,165.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,165.96 " "$4,165.96 " "$4,790.85 " "$4,165.96 " N/A "$3,957.66 " "$15,145.54 " 330104 816 3 Toxic effects of non-medicinal substances I N/A "$6,309.61 " N/A "$6,309.61 " N/A N/A N/A N/A "$5,994.13 " N/A "$6,057.23 " N/A N/A N/A N/A N/A "$8,076.30 " "$6,309.61 " N/A N/A N/A N/A "$6,498.90 " N/A N/A "$8,833.46 " "$23,560.61 " "$6,309.61 " "$8,517.98 " "$7,760.82 " N/A "$6,498.90 " N/A N/A N/A N/A N/A "$6,309.61 " "$20,690.87 " "$12,934.71 " "$6,309.61 " "$6,309.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,309.61 " "$6,309.61 " "$7,256.05 " "$6,309.61 " N/A "$5,994.13 " "$23,560.61 " 330104 816 4 Toxic effects of non-medicinal substances I N/A "$14,571.58 " N/A "$14,571.58 " N/A N/A N/A N/A "$13,843.01 " N/A "$13,988.72 " N/A N/A N/A N/A N/A "$18,651.63 " "$14,571.58 " N/A N/A N/A N/A "$15,008.73 " N/A N/A "$20,400.22 " "$55,993.56 " "$14,571.58 " "$19,671.64 " "$17,923.05 " N/A "$15,008.73 " N/A N/A N/A N/A N/A "$14,571.58 " "$49,173.40 " "$29,871.75 " "$14,571.58 " "$14,571.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,571.58 " "$14,571.58 " "$16,757.32 " "$14,571.58 " N/A "$13,843.01 " "$55,993.56 " 330104 841 1 Extensive 3rd degree burns w skin graft I N/A "$36,865.08 " N/A "$36,865.08 " N/A N/A N/A N/A "$35,021.83 " N/A "$35,390.48 " N/A N/A N/A N/A N/A "$47,187.30 " "$36,865.08 " N/A N/A N/A N/A "$37,971.03 " N/A N/A "$51,611.11 " "$143,508.23 " "$36,865.08 " "$49,767.86 " "$45,344.05 " N/A "$37,971.03 " N/A N/A N/A N/A N/A "$36,865.08 " "$126,028.56 " "$75,573.41 " "$36,865.08 " "$36,865.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$36,865.08 " "$36,865.08 " "$42,394.84 " "$36,865.08 " N/A "$35,021.83 " "$143,508.23 " 330104 841 2 Extensive 3rd degree burns w skin graft I N/A "$48,547.91 " N/A "$48,547.91 " N/A N/A N/A N/A "$46,120.52 " N/A "$46,606.00 " N/A N/A N/A N/A N/A "$62,141.33 " "$48,547.91 " N/A N/A N/A N/A "$50,004.35 " N/A N/A "$67,967.08 " "$189,370.01 " "$48,547.91 " "$65,539.68 " "$59,713.93 " N/A "$50,004.35 " N/A N/A N/A N/A N/A "$48,547.91 " "$166,304.26 " "$99,523.22 " "$48,547.91 " "$48,547.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$48,547.91 " "$48,547.91 " "$55,830.10 " "$48,547.91 " N/A "$46,120.52 " "$189,370.01 " 330104 841 3 Extensive 3rd degree burns w skin graft I N/A "$100,051.55 " N/A "$100,051.55 " N/A N/A N/A N/A "$95,048.98 " N/A "$96,049.49 " N/A N/A N/A N/A N/A "$128,065.99 " "$100,051.55 " N/A N/A N/A N/A "$103,053.10 " N/A N/A "$140,072.18 " "$391,551.15 " "$100,051.55 " "$135,069.60 " "$123,063.41 " N/A "$103,053.10 " N/A N/A N/A N/A N/A "$100,051.55 " "$343,859.22 " "$205,105.69 " "$100,051.55 " "$100,051.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$100,051.55 " "$100,051.55 " "$115,059.29 " "$100,051.55 " N/A "$95,048.98 " "$391,551.15 " 330104 841 4 Extensive 3rd degree burns w skin graft I N/A "$127,949.08 " N/A "$127,949.08 " N/A N/A N/A N/A "$121,551.62 " N/A "$122,831.11 " N/A N/A N/A N/A N/A "$163,774.82 " "$127,949.08 " N/A N/A N/A N/A "$131,787.55 " N/A N/A "$179,128.71 " "$501,064.82 " "$127,949.08 " "$172,731.25 " "$157,377.36 " N/A "$131,787.55 " N/A N/A N/A N/A N/A "$127,949.08 " "$440,033.85 " "$262,295.61 " "$127,949.08 " "$127,949.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$127,949.08 " "$127,949.08 " "$147,141.44 " "$127,949.08 " N/A "$121,551.62 " "$501,064.82 " 330104 842 1 Burns with skin graft except extensive 3rd degree burns I N/A "$14,988.46 " N/A "$14,988.46 " N/A N/A N/A N/A "$14,239.04 " N/A "$14,388.93 " N/A N/A N/A N/A N/A "$19,185.23 " "$14,988.46 " N/A N/A N/A N/A "$15,438.12 " N/A N/A "$20,983.85 " "$57,630.05 " "$14,988.46 " "$20,234.43 " "$18,435.81 " N/A "$15,438.12 " N/A N/A N/A N/A N/A "$14,988.46 " "$50,610.56 " "$30,726.35 " "$14,988.46 " "$14,988.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,988.46 " "$14,988.46 " "$17,236.73 " "$14,988.46 " N/A "$14,239.04 " "$57,630.05 " 330104 842 2 Burns with skin graft except extensive 3rd degree burns I N/A "$19,615.00 " N/A "$19,615.00 " N/A N/A N/A N/A "$18,634.25 " N/A "$18,830.40 " N/A N/A N/A N/A N/A "$25,107.21 " "$19,615.00 " N/A N/A N/A N/A "$20,203.45 " N/A N/A "$27,461.01 " "$75,791.86 " "$19,615.00 " "$26,480.26 " "$24,126.46 " N/A "$20,203.45 " N/A N/A N/A N/A N/A "$19,615.00 " "$66,560.22 " "$40,210.76 " "$19,615.00 " "$19,615.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$19,615.00 " "$19,615.00 " "$22,557.25 " "$19,615.00 " N/A "$18,634.25 " "$75,791.86 " 330104 842 3 Burns with skin graft except extensive 3rd degree burns I N/A "$30,030.85 " N/A "$30,030.85 " N/A N/A N/A N/A "$28,529.31 " N/A "$28,829.62 " N/A N/A N/A N/A N/A "$38,439.49 " "$30,030.85 " N/A N/A N/A N/A "$30,931.78 " N/A N/A "$42,043.19 " "$116,679.99 " "$30,030.85 " "$40,541.65 " "$36,937.95 " N/A "$30,931.78 " N/A N/A N/A N/A N/A "$30,030.85 " "$102,468.07 " "$61,563.24 " "$30,030.85 " "$30,030.85 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$30,030.85 " "$30,030.85 " "$34,535.48 " "$30,030.85 " N/A "$28,529.31 " "$116,679.99 " 330104 842 4 Burns with skin graft except extensive 3rd degree burns I N/A "$59,145.63 " N/A "$59,145.63 " N/A N/A N/A N/A "$56,188.35 " N/A "$56,779.81 " N/A N/A N/A N/A N/A "$75,706.41 " "$59,145.63 " N/A N/A N/A N/A "$60,920.00 " N/A N/A "$82,803.89 " "$230,972.10 " "$59,145.63 " "$79,846.60 " "$72,749.13 " N/A "$60,920.00 " N/A N/A N/A N/A N/A "$59,145.63 " "$202,839.11 " "$121,248.55 " "$59,145.63 " "$59,145.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$59,145.63 " "$59,145.63 " "$68,017.48 " "$59,145.63 " N/A "$56,188.35 " "$230,972.10 " 330104 843 1 Extensive 3rd degree or full thickness burns w/o skin graft I N/A "$13,736.46 " N/A "$13,736.46 " N/A N/A N/A N/A "$13,049.64 " N/A "$13,187.01 " N/A N/A N/A N/A N/A "$17,582.67 " "$13,736.46 " N/A N/A N/A N/A "$14,148.56 " N/A N/A "$19,231.05 " "$52,715.24 " "$13,736.46 " "$18,544.23 " "$16,895.85 " N/A "$14,148.56 " N/A N/A N/A N/A N/A "$13,736.46 " "$46,294.39 " "$28,159.75 " "$13,736.46 " "$13,736.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,736.46 " "$13,736.46 " "$15,796.93 " "$13,736.46 " N/A "$13,049.64 " "$52,715.24 " 330104 843 2 Extensive 3rd degree or full thickness burns w/o skin graft I N/A "$13,736.46 " N/A "$13,736.46 " N/A N/A N/A N/A "$13,049.64 " N/A "$13,187.01 " N/A N/A N/A N/A N/A "$17,582.67 " "$13,736.46 " N/A N/A N/A N/A "$14,148.56 " N/A N/A "$19,231.05 " "$52,715.24 " "$13,736.46 " "$18,544.23 " "$16,895.85 " N/A "$14,148.56 " N/A N/A N/A N/A N/A "$13,736.46 " "$46,294.39 " "$28,159.75 " "$13,736.46 " "$13,736.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,736.46 " "$13,736.46 " "$15,796.93 " "$13,736.46 " N/A "$13,049.64 " "$52,715.24 " 330104 843 3 Extensive 3rd degree or full thickness burns w/o skin graft I N/A "$13,736.46 " N/A "$13,736.46 " N/A N/A N/A N/A "$13,049.64 " N/A "$13,187.01 " N/A N/A N/A N/A N/A "$17,582.67 " "$13,736.46 " N/A N/A N/A N/A "$14,148.56 " N/A N/A "$19,231.05 " "$52,715.24 " "$13,736.46 " "$18,544.23 " "$16,895.85 " N/A "$14,148.56 " N/A N/A N/A N/A N/A "$13,736.46 " "$46,294.39 " "$28,159.75 " "$13,736.46 " "$13,736.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,736.46 " "$13,736.46 " "$15,796.93 " "$13,736.46 " N/A "$13,049.64 " "$52,715.24 " 330104 843 4 Extensive 3rd degree or full thickness burns w/o skin graft I N/A "$13,736.46 " N/A "$13,736.46 " N/A N/A N/A N/A "$13,049.64 " N/A "$13,187.01 " N/A N/A N/A N/A N/A "$17,582.67 " "$13,736.46 " N/A N/A N/A N/A "$14,148.56 " N/A N/A "$19,231.05 " "$52,715.24 " "$13,736.46 " "$18,544.23 " "$16,895.85 " N/A "$14,148.56 " N/A N/A N/A N/A N/A "$13,736.46 " "$46,294.39 " "$28,159.75 " "$13,736.46 " "$13,736.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,736.46 " "$13,736.46 " "$15,796.93 " "$13,736.46 " N/A "$13,049.64 " "$52,715.24 " 330104 844 1 Partial thickness burns without skin graft I N/A "$4,730.65 " N/A "$4,730.65 " N/A N/A N/A N/A "$4,494.12 " N/A "$4,541.42 " N/A N/A N/A N/A N/A "$6,055.23 " "$4,730.65 " N/A N/A N/A N/A "$4,872.57 " N/A N/A "$6,622.91 " "$17,362.28 " "$4,730.65 " "$6,386.38 " "$5,818.70 " N/A "$4,872.57 " N/A N/A N/A N/A N/A "$4,730.65 " "$15,247.51 " "$9,697.83 " "$4,730.65 " "$4,730.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,730.65 " "$4,730.65 " "$5,440.25 " "$4,730.65 " N/A "$4,494.12 " "$17,362.28 " 330104 844 2 Partial thickness burns without skin graft I N/A "$7,552.76 " N/A "$7,552.76 " N/A N/A N/A N/A "$7,175.12 " N/A "$7,250.65 " N/A N/A N/A N/A N/A "$9,667.53 " "$7,552.76 " N/A N/A N/A N/A "$7,779.34 " N/A N/A "$10,573.86 " "$28,440.66 " "$7,552.76 " "$10,196.22 " "$9,289.89 " N/A "$7,779.34 " N/A N/A N/A N/A N/A "$7,552.76 " "$24,976.52 " "$15,483.15 " "$7,552.76 " "$7,552.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,552.76 " "$7,552.76 " "$8,685.67 " "$7,552.76 " N/A "$7,175.12 " "$28,440.66 " 330104 844 3 Partial thickness burns without skin graft I N/A "$13,128.17 " N/A "$13,128.17 " N/A N/A N/A N/A "$12,471.77 " N/A "$12,603.05 " N/A N/A N/A N/A N/A "$16,804.06 " "$13,128.17 " N/A N/A N/A N/A "$13,522.02 " N/A N/A "$18,379.44 " "$50,327.35 " "$13,128.17 " "$17,723.04 " "$16,147.65 " N/A "$13,522.02 " N/A N/A N/A N/A N/A "$13,128.17 " "$44,197.35 " "$26,912.76 " "$13,128.17 " "$13,128.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,128.17 " "$13,128.17 " "$15,097.40 " "$13,128.17 " N/A "$12,471.77 " "$50,327.35 " 330104 844 4 Partial thickness burns without skin graft I N/A "$34,909.43 " N/A "$34,909.43 " N/A N/A N/A N/A "$33,163.96 " N/A "$33,513.05 " N/A N/A N/A N/A N/A "$44,684.07 " "$34,909.43 " N/A N/A N/A N/A "$35,956.71 " N/A N/A "$48,873.20 " "$135,831.18 " "$34,909.43 " "$47,127.73 " "$42,938.59 " N/A "$35,956.71 " N/A N/A N/A N/A N/A "$34,909.43 " "$119,286.60 " "$71,564.32 " "$34,909.43 " "$34,909.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$34,909.43 " "$34,909.43 " "$40,145.84 " "$34,909.43 " N/A "$33,163.96 " "$135,831.18 " 330104 850 1 Procedure w diag of rehab aftercare or oth contact w health service I N/A "$8,216.90 " N/A "$8,216.90 " N/A N/A N/A N/A "$7,806.06 " N/A "$7,888.23 " N/A N/A N/A N/A N/A "$10,517.64 " "$8,216.90 " N/A N/A N/A N/A "$8,463.41 " N/A N/A "$11,503.66 " "$31,047.81 " "$8,216.90 " "$11,092.82 " "$10,106.79 " N/A "$8,463.41 " N/A N/A N/A N/A N/A "$8,216.90 " "$27,266.11 " "$16,844.65 " "$8,216.90 " "$8,216.90 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,216.90 " "$8,216.90 " "$9,449.44 " "$8,216.90 " N/A "$7,806.06 " "$31,047.81 " 330104 850 2 Procedure w diag of rehab aftercare or oth contact w health service I N/A "$11,600.30 " N/A "$11,600.30 " N/A N/A N/A N/A "$11,020.28 " N/A "$11,136.29 " N/A N/A N/A N/A N/A "$14,848.38 " "$11,600.30 " N/A N/A N/A N/A "$11,948.31 " N/A N/A "$16,240.42 " "$44,329.57 " "$11,600.30 " "$15,660.40 " "$14,268.37 " N/A "$11,948.31 " N/A N/A N/A N/A N/A "$11,600.30 " "$38,930.12 " "$23,780.61 " "$11,600.30 " "$11,600.30 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,600.30 " "$11,600.30 " "$13,340.34 " "$11,600.30 " N/A "$11,020.28 " "$44,329.57 " 330104 850 3 Procedure w diag of rehab aftercare or oth contact w health service I N/A "$22,359.46 " N/A "$22,359.46 " N/A N/A N/A N/A "$21,241.49 " N/A "$21,465.08 " N/A N/A N/A N/A N/A "$28,620.11 " "$22,359.46 " N/A N/A N/A N/A "$23,030.24 " N/A N/A "$31,303.24 " "$86,565.40 " "$22,359.46 " "$30,185.27 " "$27,502.13 " N/A "$23,030.24 " N/A N/A N/A N/A N/A "$22,359.46 " "$76,021.52 " "$45,836.89 " "$22,359.46 " "$22,359.46 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$22,359.46 " "$22,359.46 " "$25,713.38 " "$22,359.46 " N/A "$21,241.49 " "$86,565.40 " 330104 850 4 Procedure w diag of rehab aftercare or oth contact w health service I N/A "$52,258.95 " N/A "$52,258.95 " N/A N/A N/A N/A "$49,646.01 " N/A "$50,168.60 " N/A N/A N/A N/A N/A "$66,891.46 " "$52,258.95 " N/A N/A N/A N/A "$53,826.72 " N/A N/A "$73,162.54 " "$203,937.96 " "$52,258.95 " "$70,549.59 " "$64,278.51 " N/A "$53,826.72 " N/A N/A N/A N/A N/A "$52,258.95 " "$179,097.80 " "$107,130.86 " "$52,258.95 " "$52,258.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$52,258.95 " "$52,258.95 " "$60,097.80 " "$52,258.95 " N/A "$49,646.01 " "$203,937.96 " 330104 860 1 Rehabilitation I N/A "$10,745.42 " N/A "$10,745.42 " N/A N/A N/A N/A "$10,208.15 " N/A "$10,315.61 " N/A N/A N/A N/A N/A "$13,754.14 " "$10,745.42 " N/A N/A N/A N/A "$11,067.79 " N/A N/A "$15,043.59 " "$40,973.70 " "$10,745.42 " "$14,506.32 " "$13,216.87 " N/A "$11,067.79 " N/A N/A N/A N/A N/A "$10,745.42 " "$35,983.00 " "$22,028.12 " "$10,745.42 " "$10,745.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,745.42 " "$10,745.42 " "$12,357.24 " "$10,745.42 " N/A "$10,208.15 " "$40,973.70 " 330104 860 2 Rehabilitation I N/A "$12,527.38 " N/A "$12,527.38 " N/A N/A N/A N/A "$11,901.01 " N/A "$12,026.28 " N/A N/A N/A N/A N/A "$16,035.04 " "$12,527.38 " N/A N/A N/A N/A "$12,903.20 " N/A N/A "$17,538.33 " "$47,968.89 " "$12,527.38 " "$16,911.96 " "$15,408.68 " N/A "$12,903.20 " N/A N/A N/A N/A N/A "$12,527.38 " "$42,126.15 " "$25,681.13 " "$12,527.38 " "$12,527.38 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$12,527.38 " "$12,527.38 " "$14,406.49 " "$12,527.38 " N/A "$11,901.01 " "$47,968.89 " 330104 860 3 Rehabilitation I N/A "$16,466.61 " N/A "$16,466.61 " N/A N/A N/A N/A "$15,643.28 " N/A "$15,807.95 " N/A N/A N/A N/A N/A "$21,077.27 " "$16,466.61 " N/A N/A N/A N/A "$16,960.61 " N/A N/A "$23,053.26 " "$63,432.63 " "$16,466.61 " "$22,229.93 " "$20,253.93 " N/A "$16,960.61 " N/A N/A N/A N/A N/A "$16,466.61 " "$55,706.37 " "$33,756.56 " "$16,466.61 " "$16,466.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,466.61 " "$16,466.61 " "$18,936.61 " "$16,466.61 " N/A "$15,643.28 " "$63,432.63 " 330104 860 4 Rehabilitation I N/A "$16,466.61 " N/A "$16,466.61 " N/A N/A N/A N/A "$15,643.28 " N/A "$15,807.95 " N/A N/A N/A N/A N/A "$21,077.27 " "$16,466.61 " N/A N/A N/A N/A "$16,960.61 " N/A N/A "$23,053.26 " "$63,432.63 " "$16,466.61 " "$22,229.93 " "$20,253.93 " N/A "$16,960.61 " N/A N/A N/A N/A N/A "$16,466.61 " "$55,706.37 " "$33,756.56 " "$16,466.61 " "$16,466.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,466.61 " "$16,466.61 " "$18,936.61 " "$16,466.61 " N/A "$15,643.28 " "$63,432.63 " 330104 861 1 Signs symptoms & other factors influencing health status I N/A "$3,374.43 " N/A "$3,374.43 " N/A N/A N/A N/A "$3,205.71 " N/A "$3,239.45 " N/A N/A N/A N/A N/A "$4,319.27 " "$3,374.43 " N/A N/A N/A N/A "$3,475.66 " N/A N/A "$4,724.20 " "$12,038.35 " "$3,374.43 " "$4,555.48 " "$4,150.55 " N/A "$3,475.66 " N/A N/A N/A N/A N/A "$3,374.43 " "$10,572.05 " "$6,917.58 " "$3,374.43 " "$3,374.43 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,374.43 " "$3,374.43 " "$3,880.59 " "$3,374.43 " N/A "$3,205.71 " "$12,038.35 " 330104 861 2 Signs symptoms & other factors influencing health status I N/A "$4,601.23 " N/A "$4,601.23 " N/A N/A N/A N/A "$4,371.16 " N/A "$4,417.18 " N/A N/A N/A N/A N/A "$5,889.57 " "$4,601.23 " N/A N/A N/A N/A "$4,739.26 " N/A N/A "$6,441.72 " "$16,854.22 " "$4,601.23 " "$6,211.66 " "$5,659.51 " N/A "$4,739.26 " N/A N/A N/A N/A N/A "$4,601.23 " "$14,801.33 " "$9,432.51 " "$4,601.23 " "$4,601.23 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,601.23 " "$4,601.23 " "$5,291.41 " "$4,601.23 " N/A "$4,371.16 " "$16,854.22 " 330104 861 3 Signs symptoms & other factors influencing health status I N/A "$7,513.25 " N/A "$7,513.25 " N/A N/A N/A N/A "$7,137.59 " N/A "$7,212.72 " N/A N/A N/A N/A N/A "$9,616.96 " "$7,513.25 " N/A N/A N/A N/A "$7,738.65 " N/A N/A "$10,518.55 " "$28,285.57 " "$7,513.25 " "$10,142.89 " "$9,241.30 " N/A "$7,738.65 " N/A N/A N/A N/A N/A "$7,513.25 " "$24,840.32 " "$15,402.16 " "$7,513.25 " "$7,513.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,513.25 " "$7,513.25 " "$8,640.24 " "$7,513.25 " N/A "$7,137.59 " "$28,285.57 " 330104 861 4 Signs symptoms & other factors influencing health status I N/A "$14,545.70 " N/A "$14,545.70 " N/A N/A N/A N/A "$13,818.41 " N/A "$13,963.87 " N/A N/A N/A N/A N/A "$18,618.50 " "$14,545.70 " N/A N/A N/A N/A "$14,982.07 " N/A N/A "$20,363.98 " "$55,891.95 " "$14,545.70 " "$19,636.69 " "$17,891.21 " N/A "$14,982.07 " N/A N/A N/A N/A N/A "$14,545.70 " "$49,084.17 " "$29,818.68 " "$14,545.70 " "$14,545.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,545.70 " "$14,545.70 " "$16,727.55 " "$14,545.70 " N/A "$13,818.41 " "$55,891.95 " 330104 862 1 Other aftercare & convalescence I N/A "$3,796.08 " N/A "$3,796.08 " N/A N/A N/A N/A "$3,606.27 " N/A "$3,644.23 " N/A N/A N/A N/A N/A "$4,858.98 " "$3,796.08 " N/A N/A N/A N/A "$3,909.96 " N/A N/A "$5,314.51 " "$13,693.55 " "$3,796.08 " "$5,124.70 " "$4,669.17 " N/A "$3,909.96 " N/A N/A N/A N/A N/A "$3,796.08 " "$12,025.64 " "$7,781.96 " "$3,796.08 " "$3,796.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$3,796.08 " "$3,796.08 " "$4,365.49 " "$3,796.08 " N/A "$3,606.27 " "$13,693.55 " 330104 862 2 Other aftercare & convalescence I N/A "$5,304.88 " N/A "$5,304.88 " N/A N/A N/A N/A "$5,039.64 " N/A "$5,092.68 " N/A N/A N/A N/A N/A "$6,790.25 " "$5,304.88 " N/A N/A N/A N/A "$5,464.03 " N/A N/A "$7,426.83 " "$19,616.46 " "$5,304.88 " "$7,161.59 " "$6,525.00 " N/A "$5,464.03 " N/A N/A N/A N/A N/A "$5,304.88 " "$17,227.13 " "$10,875.00 " "$5,304.88 " "$5,304.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,304.88 " "$5,304.88 " "$6,100.61 " "$5,304.88 " N/A "$5,039.64 " "$19,616.46 " 330104 862 3 Other aftercare & convalescence I N/A "$8,674.65 " N/A "$8,674.65 " N/A N/A N/A N/A "$8,240.92 " N/A "$8,327.67 " N/A N/A N/A N/A N/A "$11,103.56 " "$8,674.65 " N/A N/A N/A N/A "$8,934.89 " N/A N/A "$12,144.51 " "$32,844.74 " "$8,674.65 " "$11,710.78 " "$10,669.82 " N/A "$8,934.89 " N/A N/A N/A N/A N/A "$8,674.65 " "$28,844.17 " "$17,783.04 " "$8,674.65 " "$8,674.65 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,674.65 " "$8,674.65 " "$9,975.85 " "$8,674.65 " N/A "$8,240.92 " "$32,844.74 " 330104 862 4 Other aftercare & convalescence I N/A "$14,901.95 " N/A "$14,901.95 " N/A N/A N/A N/A "$14,156.86 " N/A "$14,305.88 " N/A N/A N/A N/A N/A "$19,074.50 " "$14,901.95 " N/A N/A N/A N/A "$15,349.01 " N/A N/A "$20,862.74 " "$57,290.45 " "$14,901.95 " "$20,117.64 " "$18,329.40 " N/A "$15,349.01 " N/A N/A N/A N/A N/A "$14,901.95 " "$50,312.33 " "$30,549.01 " "$14,901.95 " "$14,901.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$14,901.95 " "$14,901.95 " "$17,137.25 " "$14,901.95 " N/A "$14,156.86 " "$57,290.45 " 330104 863 1 Neonatal aftercare I N/A "$6,509.88 " N/A "$6,509.88 " N/A N/A N/A N/A "$6,184.38 " N/A "$6,249.48 " N/A N/A N/A N/A N/A "$8,332.64 " "$6,509.88 " N/A N/A N/A N/A "$6,705.17 " N/A N/A "$9,113.83 " "$24,346.77 " "$6,509.88 " "$8,788.34 " "$8,007.15 " N/A "$6,705.17 " N/A N/A N/A N/A N/A "$6,509.88 " "$21,381.27 " "$13,345.25 " "$6,509.88 " "$6,509.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,509.88 " "$6,509.88 " "$7,486.36 " "$6,509.88 " N/A "$6,184.38 " "$24,346.77 " 330104 863 2 Neonatal aftercare I N/A "$15,220.06 " N/A "$15,220.06 " N/A N/A N/A N/A "$14,459.06 " N/A "$14,611.26 " N/A N/A N/A N/A N/A "$19,481.68 " "$15,220.06 " N/A N/A N/A N/A "$15,676.66 " N/A N/A "$21,308.09 " "$58,539.21 " "$15,220.06 " "$20,547.09 " "$18,720.68 " N/A "$15,676.66 " N/A N/A N/A N/A N/A "$15,220.06 " "$51,408.98 " "$31,201.13 " "$15,220.06 " "$15,220.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,220.06 " "$15,220.06 " "$17,503.07 " "$15,220.06 " N/A "$14,459.06 " "$58,539.21 " 330104 863 3 Neonatal aftercare I N/A "$28,586.76 " N/A "$28,586.76 " N/A N/A N/A N/A "$27,157.42 " N/A "$27,443.29 " N/A N/A N/A N/A N/A "$36,591.05 " "$28,586.76 " N/A N/A N/A N/A "$29,444.36 " N/A N/A "$40,021.46 " "$111,011.11 " "$28,586.76 " "$38,592.13 " "$35,161.71 " N/A "$29,444.36 " N/A N/A N/A N/A N/A "$28,586.76 " "$97,489.67 " "$58,602.86 " "$28,586.76 " "$28,586.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$28,586.76 " "$28,586.76 " "$32,874.77 " "$28,586.76 " N/A "$27,157.42 " "$111,011.11 " 330104 863 4 Neonatal aftercare I N/A "$36,403.24 " N/A "$36,403.24 " N/A N/A N/A N/A "$34,583.08 " N/A "$34,947.11 " N/A N/A N/A N/A N/A "$46,596.15 " "$36,403.24 " N/A N/A N/A N/A "$37,495.34 " N/A N/A "$50,964.54 " "$141,695.26 " "$36,403.24 " "$49,144.38 " "$44,775.99 " N/A "$37,495.34 " N/A N/A N/A N/A N/A "$36,403.24 " "$124,436.42 " "$74,626.65 " "$36,403.24 " "$36,403.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$36,403.24 " "$36,403.24 " "$41,863.73 " "$36,403.24 " N/A "$34,583.08 " "$141,695.26 " 330104 890 1 HIV w multiple major HIV related conditions I N/A "$7,892.66 " N/A "$7,892.66 " N/A N/A N/A N/A "$7,498.03 " N/A "$7,576.96 " N/A N/A N/A N/A N/A "$10,102.61 " "$7,892.66 " N/A N/A N/A N/A "$8,129.44 " N/A N/A "$11,049.73 " "$29,774.99 " "$7,892.66 " "$10,655.10 " "$9,707.98 " N/A "$8,129.44 " N/A N/A N/A N/A N/A "$7,892.66 " "$26,148.32 " "$16,179.96 " "$7,892.66 " "$7,892.66 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,892.66 " "$7,892.66 " "$9,076.56 " "$7,892.66 " N/A "$7,498.03 " "$29,774.99 " 330104 890 2 HIV w multiple major HIV related conditions I N/A "$7,903.56 " N/A "$7,903.56 " N/A N/A N/A N/A "$7,508.38 " N/A "$7,587.42 " N/A N/A N/A N/A N/A "$10,116.56 " "$7,903.56 " N/A N/A N/A N/A "$8,140.67 " N/A N/A "$11,064.99 " "$29,817.77 " "$7,903.56 " "$10,669.81 " "$9,721.38 " N/A "$8,140.67 " N/A N/A N/A N/A N/A "$7,903.56 " "$26,185.89 " "$16,202.30 " "$7,903.56 " "$7,903.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$7,903.56 " "$7,903.56 " "$9,089.10 " "$7,903.56 " N/A "$7,508.38 " "$29,817.77 " 330104 890 3 HIV w multiple major HIV related conditions I N/A "$13,427.21 " N/A "$13,427.21 " N/A N/A N/A N/A "$12,755.85 " N/A "$12,890.12 " N/A N/A N/A N/A N/A "$17,186.83 " "$13,427.21 " N/A N/A N/A N/A "$13,830.03 " N/A N/A "$18,798.09 " "$51,501.24 " "$13,427.21 " "$18,126.73 " "$16,515.47 " N/A "$13,830.03 " N/A N/A N/A N/A N/A "$13,427.21 " "$45,228.26 " "$27,525.78 " "$13,427.21 " "$13,427.21 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,427.21 " "$13,427.21 " "$15,441.29 " "$13,427.21 " N/A "$12,755.85 " "$51,501.24 " 330104 890 4 HIV w multiple major HIV related conditions I N/A "$26,100.47 " N/A "$26,100.47 " N/A N/A N/A N/A "$24,795.45 " N/A "$25,056.45 " N/A N/A N/A N/A N/A "$33,408.60 " "$26,100.47 " N/A N/A N/A N/A "$26,883.49 " N/A N/A "$36,540.66 " "$101,251.01 " "$26,100.47 " "$35,235.64 " "$32,103.58 " N/A "$26,883.49 " N/A N/A N/A N/A N/A "$26,100.47 " "$88,918.38 " "$53,505.97 " "$26,100.47 " "$26,100.47 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,100.47 " "$26,100.47 " "$30,015.54 " "$26,100.47 " N/A "$24,795.45 " "$101,251.01 " 330104 892 1 HIV w major HIV related condition I N/A "$5,212.92 " N/A "$5,212.92 " N/A N/A N/A N/A "$4,952.28 " N/A "$5,004.40 " N/A N/A N/A N/A N/A "$6,672.54 " "$5,212.92 " N/A N/A N/A N/A "$5,369.31 " N/A N/A "$7,298.09 " "$19,255.47 " "$5,212.92 " "$7,037.44 " "$6,411.89 " N/A "$5,369.31 " N/A N/A N/A N/A N/A "$5,212.92 " "$16,910.11 " "$10,686.49 " "$5,212.92 " "$5,212.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,212.92 " "$5,212.92 " "$5,994.86 " "$5,212.92 " N/A "$4,952.28 " "$19,255.47 " 330104 892 2 HIV w major HIV related condition I N/A "$6,663.82 " N/A "$6,663.82 " N/A N/A N/A N/A "$6,330.63 " N/A "$6,397.27 " N/A N/A N/A N/A N/A "$8,529.69 " "$6,663.82 " N/A N/A N/A N/A "$6,863.74 " N/A N/A "$9,329.35 " "$24,951.09 " "$6,663.82 " "$8,996.16 " "$8,196.50 " N/A "$6,863.74 " N/A N/A N/A N/A N/A "$6,663.82 " "$21,911.99 " "$13,660.84 " "$6,663.82 " "$6,663.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,663.82 " "$6,663.82 " "$7,663.40 " "$6,663.82 " N/A "$6,330.63 " "$24,951.09 " 330104 892 3 HIV w major HIV related condition I N/A "$9,227.77 " N/A "$9,227.77 " N/A N/A N/A N/A "$8,766.38 " N/A "$8,858.66 " N/A N/A N/A N/A N/A "$11,811.54 " "$9,227.77 " N/A N/A N/A N/A "$9,504.60 " N/A N/A "$12,918.87 " "$35,016.03 " "$9,227.77 " "$12,457.48 " "$11,350.15 " N/A "$9,504.60 " N/A N/A N/A N/A N/A "$9,227.77 " "$30,750.99 " "$18,916.92 " "$9,227.77 " "$9,227.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,227.77 " "$9,227.77 " "$10,611.93 " "$9,227.77 " N/A "$8,766.38 " "$35,016.03 " 330104 892 4 HIV w major HIV related condition I N/A "$16,209.81 " N/A "$16,209.81 " N/A N/A N/A N/A "$15,399.32 " N/A "$15,561.42 " N/A N/A N/A N/A N/A "$20,748.56 " "$16,209.81 " N/A N/A N/A N/A "$16,696.10 " N/A N/A "$22,693.73 " "$62,424.53 " "$16,209.81 " "$21,883.24 " "$19,938.07 " N/A "$16,696.10 " N/A N/A N/A N/A N/A "$16,209.81 " "$54,821.06 " "$33,230.11 " "$16,209.81 " "$16,209.81 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,209.81 " "$16,209.81 " "$18,641.28 " "$16,209.81 " N/A "$15,399.32 " "$62,424.53 " 330104 893 1 HIV w multiple significant HIV related conditions I N/A "$5,636.61 " N/A "$5,636.61 " N/A N/A N/A N/A "$5,354.78 " N/A "$5,411.15 " N/A N/A N/A N/A N/A "$7,214.86 " "$5,636.61 " N/A N/A N/A N/A "$5,805.71 " N/A N/A "$7,891.26 " "$20,918.70 " "$5,636.61 " "$7,609.43 " "$6,933.03 " N/A "$5,805.71 " N/A N/A N/A N/A N/A "$5,636.61 " "$18,370.75 " "$11,555.05 " "$5,636.61 " "$5,636.61 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,636.61 " "$5,636.61 " "$6,482.10 " "$5,636.61 " N/A "$5,354.78 " "$20,918.70 " 330104 893 2 HIV w multiple significant HIV related conditions I N/A "$6,605.24 " N/A "$6,605.24 " N/A N/A N/A N/A "$6,274.98 " N/A "$6,341.03 " N/A N/A N/A N/A N/A "$8,454.71 " "$6,605.24 " N/A N/A N/A N/A "$6,803.40 " N/A N/A "$9,247.34 " "$24,721.13 " "$6,605.24 " "$8,917.08 " "$8,124.45 " N/A "$6,803.40 " N/A N/A N/A N/A N/A "$6,605.24 " "$21,710.03 " "$13,540.75 " "$6,605.24 " "$6,605.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,605.24 " "$6,605.24 " "$7,596.03 " "$6,605.24 " N/A "$6,274.98 " "$24,721.13 " 330104 893 3 HIV w multiple significant HIV related conditions I N/A "$10,201.17 " N/A "$10,201.17 " N/A N/A N/A N/A "$9,691.11 " N/A "$9,793.12 " N/A N/A N/A N/A N/A "$13,057.49 " "$10,201.17 " N/A N/A N/A N/A "$10,507.20 " N/A N/A "$14,281.63 " "$38,837.18 " "$10,201.17 " "$13,771.57 " "$12,547.43 " N/A "$10,507.20 " N/A N/A N/A N/A N/A "$10,201.17 " "$34,106.71 " "$20,912.39 " "$10,201.17 " "$10,201.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,201.17 " "$10,201.17 " "$11,731.34 " "$10,201.17 " N/A "$9,691.11 " "$38,837.18 " 330104 893 4 HIV w multiple significant HIV related conditions I N/A "$10,398.71 " N/A "$10,398.71 " N/A N/A N/A N/A "$9,878.77 " N/A "$9,982.76 " N/A N/A N/A N/A N/A "$13,310.34 " "$10,398.71 " N/A N/A N/A N/A "$10,710.67 " N/A N/A "$14,558.19 " "$39,612.64 " "$10,398.71 " "$14,038.25 " "$12,790.41 " N/A "$10,710.67 " N/A N/A N/A N/A N/A "$10,398.71 " "$34,787.72 " "$21,317.35 " "$10,398.71 " "$10,398.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$10,398.71 " "$10,398.71 " "$11,958.51 " "$10,398.71 " N/A "$9,878.77 " "$39,612.64 " 330104 894 1 HIV w one signif HIV cond or w/o signif related cond I N/A "$4,488.83 " N/A "$4,488.83 " N/A N/A N/A N/A "$4,264.39 " N/A "$4,309.28 " N/A N/A N/A N/A N/A "$5,745.71 " "$4,488.83 " N/A N/A N/A N/A "$4,623.50 " N/A N/A "$6,284.37 " "$16,413.01 " "$4,488.83 " "$6,059.92 " "$5,521.26 " N/A "$4,623.50 " N/A N/A N/A N/A N/A "$4,488.83 " "$14,413.87 " "$9,202.11 " "$4,488.83 " "$4,488.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$4,488.83 " "$4,488.83 " "$5,162.16 " "$4,488.83 " N/A "$4,264.39 " "$16,413.01 " 330104 894 2 HIV w one signif HIV cond or w/o signif related cond I N/A "$5,498.33 " N/A "$5,498.33 " N/A N/A N/A N/A "$5,223.42 " N/A "$5,278.40 " N/A N/A N/A N/A N/A "$7,037.87 " "$5,498.33 " N/A N/A N/A N/A "$5,663.28 " N/A N/A "$7,697.67 " "$20,375.88 " "$5,498.33 " "$7,422.75 " "$6,762.95 " N/A "$5,663.28 " N/A N/A N/A N/A N/A "$5,498.33 " "$17,894.05 " "$11,271.58 " "$5,498.33 " "$5,498.33 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,498.33 " "$5,498.33 " "$6,323.08 " "$5,498.33 " N/A "$5,223.42 " "$20,375.88 " 330104 894 3 HIV w one signif HIV cond or w/o signif related cond I N/A "$8,203.96 " N/A "$8,203.96 " N/A N/A N/A N/A "$7,793.76 " N/A "$7,875.80 " N/A N/A N/A N/A N/A "$10,501.07 " "$8,203.96 " N/A N/A N/A N/A "$8,450.08 " N/A N/A "$11,485.54 " "$30,997.01 " "$8,203.96 " "$11,075.35 " "$10,090.87 " N/A "$8,450.08 " N/A N/A N/A N/A N/A "$8,203.96 " "$27,221.49 " "$16,818.12 " "$8,203.96 " "$8,203.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,203.96 " "$8,203.96 " "$9,434.55 " "$8,203.96 " N/A "$7,793.76 " "$30,997.01 " 330104 894 4 HIV w one signif HIV cond or w/o signif related cond I N/A "$8,203.96 " N/A "$8,203.96 " N/A N/A N/A N/A "$7,793.76 " N/A "$7,875.80 " N/A N/A N/A N/A N/A "$10,501.07 " "$8,203.96 " N/A N/A N/A N/A "$8,450.08 " N/A N/A "$11,485.54 " "$30,997.01 " "$8,203.96 " "$11,075.35 " "$10,090.87 " N/A "$8,450.08 " N/A N/A N/A N/A N/A "$8,203.96 " "$27,221.49 " "$16,818.12 " "$8,203.96 " "$8,203.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,203.96 " "$8,203.96 " "$9,434.55 " "$8,203.96 " N/A "$7,793.76 " "$30,997.01 " 330104 910 1 Craniotomy for multiple significant trauma I N/A "$25,915.87 " N/A "$25,915.87 " N/A N/A N/A N/A "$24,620.08 " N/A "$24,879.24 " N/A N/A N/A N/A N/A "$33,172.32 " "$25,915.87 " N/A N/A N/A N/A "$26,693.35 " N/A N/A "$36,282.22 " "$100,526.36 " "$25,915.87 " "$34,986.43 " "$31,876.52 " N/A "$26,693.35 " N/A N/A N/A N/A N/A "$25,915.87 " "$88,281.99 " "$53,127.54 " "$25,915.87 " "$25,915.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,915.87 " "$25,915.87 " "$29,803.25 " "$25,915.87 " N/A "$24,620.08 " "$100,526.36 " 330104 910 2 Craniotomy for multiple significant trauma I N/A "$25,915.87 " N/A "$25,915.87 " N/A N/A N/A N/A "$24,620.08 " N/A "$24,879.24 " N/A N/A N/A N/A N/A "$33,172.32 " "$25,915.87 " N/A N/A N/A N/A "$26,693.35 " N/A N/A "$36,282.22 " "$100,526.36 " "$25,915.87 " "$34,986.43 " "$31,876.52 " N/A "$26,693.35 " N/A N/A N/A N/A N/A "$25,915.87 " "$88,281.99 " "$53,127.54 " "$25,915.87 " "$25,915.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,915.87 " "$25,915.87 " "$29,803.25 " "$25,915.87 " N/A "$24,620.08 " "$100,526.36 " 330104 910 3 Craniotomy for multiple significant trauma I N/A "$26,717.62 " N/A "$26,717.62 " N/A N/A N/A N/A "$25,381.74 " N/A "$25,648.91 " N/A N/A N/A N/A N/A "$34,198.55 " "$26,717.62 " N/A N/A N/A N/A "$27,519.14 " N/A N/A "$37,404.66 " "$103,673.65 " "$26,717.62 " "$36,068.78 " "$32,862.67 " N/A "$27,519.14 " N/A N/A N/A N/A N/A "$26,717.62 " "$91,045.94 " "$54,771.11 " "$26,717.62 " "$26,717.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$26,717.62 " "$26,717.62 " "$30,725.26 " "$26,717.62 " N/A "$25,381.74 " "$103,673.65 " 330104 910 4 Craniotomy for multiple significant trauma I N/A "$49,233.17 " N/A "$49,233.17 " N/A N/A N/A N/A "$46,771.52 " N/A "$47,263.85 " N/A N/A N/A N/A N/A "$63,018.46 " "$49,233.17 " N/A N/A N/A N/A "$50,710.17 " N/A N/A "$68,926.44 " "$192,060.05 " "$49,233.17 " "$66,464.79 " "$60,556.80 " N/A "$50,710.17 " N/A N/A N/A N/A N/A "$49,233.17 " "$168,666.65 " "$100,928.01 " "$49,233.17 " "$49,233.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$49,233.17 " "$49,233.17 " "$56,618.15 " "$49,233.17 " N/A "$46,771.52 " "$192,060.05 " 330104 911 1 Extensive abdominal/thoracic procedures for mult significant trauma I N/A "$13,055.29 " N/A "$13,055.29 " N/A N/A N/A N/A "$12,402.52 " N/A "$12,533.08 " N/A N/A N/A N/A N/A "$16,710.77 " "$13,055.29 " N/A N/A N/A N/A "$13,446.95 " N/A N/A "$18,277.40 " "$50,041.24 " "$13,055.29 " "$17,624.64 " "$16,058.01 " N/A "$13,446.95 " N/A N/A N/A N/A N/A "$13,055.29 " "$43,946.09 " "$26,763.34 " "$13,055.29 " "$13,055.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,055.29 " "$13,055.29 " "$15,013.58 " "$13,055.29 " N/A "$12,402.52 " "$50,041.24 " 330104 911 2 Extensive abdominal/thoracic procedures for mult significant trauma I N/A "$13,055.29 " N/A "$13,055.29 " N/A N/A N/A N/A "$12,402.52 " N/A "$12,533.08 " N/A N/A N/A N/A N/A "$16,710.77 " "$13,055.29 " N/A N/A N/A N/A "$13,446.95 " N/A N/A "$18,277.40 " "$50,041.24 " "$13,055.29 " "$17,624.64 " "$16,058.01 " N/A "$13,446.95 " N/A N/A N/A N/A N/A "$13,055.29 " "$43,946.09 " "$26,763.34 " "$13,055.29 " "$13,055.29 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$13,055.29 " "$13,055.29 " "$15,013.58 " "$13,055.29 " N/A "$12,402.52 " "$50,041.24 " 330104 911 3 Extensive abdominal/thoracic procedures for mult significant trauma I N/A "$17,766.98 " N/A "$17,766.98 " N/A N/A N/A N/A "$16,878.63 " N/A "$17,056.30 " N/A N/A N/A N/A N/A "$22,741.73 " "$17,766.98 " N/A N/A N/A N/A "$18,299.99 " N/A N/A "$24,873.77 " "$68,537.29 " "$17,766.98 " "$23,985.42 " "$21,853.38 " N/A "$18,299.99 " N/A N/A N/A N/A N/A "$17,766.98 " "$60,189.28 " "$36,422.30 " "$17,766.98 " "$17,766.98 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$17,766.98 " "$17,766.98 " "$20,432.02 " "$17,766.98 " N/A "$16,878.63 " "$68,537.29 " 330104 911 4 Extensive abdominal/thoracic procedures for mult significant trauma I N/A "$44,518.08 " N/A "$44,518.08 " N/A N/A N/A N/A "$42,292.18 " N/A "$42,737.36 " N/A N/A N/A N/A N/A "$56,983.14 " "$44,518.08 " N/A N/A N/A N/A "$45,853.62 " N/A N/A "$62,325.31 " "$173,550.62 " "$44,518.08 " "$60,099.41 " "$54,757.24 " N/A "$45,853.62 " N/A N/A N/A N/A N/A "$44,518.08 " "$152,411.71 " "$91,262.07 " "$44,518.08 " "$44,518.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$44,518.08 " "$44,518.08 " "$51,195.79 " "$44,518.08 " N/A "$42,292.18 " "$173,550.62 " 330104 912 1 Musculoskeletal & other procedures for multiple significant trauma I N/A "$16,410.76 " N/A "$16,410.76 " N/A N/A N/A N/A "$15,590.22 " N/A "$15,754.33 " N/A N/A N/A N/A N/A "$21,005.77 " "$16,410.76 " N/A N/A N/A N/A "$16,903.08 " N/A N/A "$22,975.06 " "$63,213.36 " "$16,410.76 " "$22,154.52 " "$20,185.23 " N/A "$16,903.08 " N/A N/A N/A N/A N/A "$16,410.76 " "$55,513.81 " "$33,642.05 " "$16,410.76 " "$16,410.76 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,410.76 " "$16,410.76 " "$18,872.37 " "$16,410.76 " N/A "$15,590.22 " "$63,213.36 " 330104 912 2 Musculoskeletal & other procedures for multiple significant trauma I N/A "$16,423.02 " N/A "$16,423.02 " N/A N/A N/A N/A "$15,601.87 " N/A "$15,766.10 " N/A N/A N/A N/A N/A "$21,021.46 " "$16,423.02 " N/A N/A N/A N/A "$16,915.71 " N/A N/A "$22,992.23 " "$63,261.49 " "$16,423.02 " "$22,171.07 " "$20,200.31 " N/A "$16,915.71 " N/A N/A N/A N/A N/A "$16,423.02 " "$55,556.08 " "$33,667.19 " "$16,423.02 " "$16,423.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,423.02 " "$16,423.02 " "$18,886.47 " "$16,423.02 " N/A "$15,601.87 " "$63,261.49 " 330104 912 3 Musculoskeletal & other procedures for multiple significant trauma I N/A "$27,115.42 " N/A "$27,115.42 " N/A N/A N/A N/A "$25,759.65 " N/A "$26,030.81 " N/A N/A N/A N/A N/A "$34,707.74 " "$27,115.42 " N/A N/A N/A N/A "$27,928.88 " N/A N/A "$37,961.59 " "$105,235.27 " "$27,115.42 " "$36,605.82 " "$33,351.97 " N/A "$27,928.88 " N/A N/A N/A N/A N/A "$27,115.42 " "$92,417.35 " "$55,586.62 " "$27,115.42 " "$27,115.42 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,115.42 " "$27,115.42 " "$31,182.74 " "$27,115.42 " N/A "$25,759.65 " "$105,235.27 " 330104 912 4 Musculoskeletal & other procedures for multiple significant trauma I N/A "$51,917.69 " N/A "$51,917.69 " N/A N/A N/A N/A "$49,321.80 " N/A "$49,840.98 " N/A N/A N/A N/A N/A "$66,454.64 " "$51,917.69 " N/A N/A N/A N/A "$53,475.22 " N/A N/A "$72,684.76 " "$202,598.28 " "$51,917.69 " "$70,088.87 " "$63,858.75 " N/A "$53,475.22 " N/A N/A N/A N/A N/A "$51,917.69 " "$177,921.30 " "$106,431.25 " "$51,917.69 " "$51,917.69 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$51,917.69 " "$51,917.69 " "$59,705.34 " "$51,917.69 " N/A "$49,321.80 " "$202,598.28 " 330104 930 1 Multiple significant trauma w/o O.R. procedure I N/A "$6,315.06 " N/A "$6,315.06 " N/A N/A N/A N/A "$5,999.31 " N/A "$6,062.46 " N/A N/A N/A N/A N/A "$8,083.28 " "$6,315.06 " N/A N/A N/A N/A "$6,504.51 " N/A N/A "$8,841.09 " "$23,582.01 " "$6,315.06 " "$8,525.33 " "$7,767.53 " N/A "$6,504.51 " N/A N/A N/A N/A N/A "$6,315.06 " "$20,709.66 " "$12,945.88 " "$6,315.06 " "$6,315.06 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,315.06 " "$6,315.06 " "$7,262.32 " "$6,315.06 " N/A "$5,999.31 " "$23,582.01 " 330104 930 2 Multiple significant trauma w/o O.R. procedure I N/A "$6,346.40 " N/A "$6,346.40 " N/A N/A N/A N/A "$6,029.08 " N/A "$6,092.54 " N/A N/A N/A N/A N/A "$8,123.39 " "$6,346.40 " N/A N/A N/A N/A "$6,536.79 " N/A N/A "$8,884.95 " "$23,705.01 " "$6,346.40 " "$8,567.64 " "$7,806.07 " N/A "$6,536.79 " N/A N/A N/A N/A N/A "$6,346.40 " "$20,817.68 " "$13,010.11 " "$6,346.40 " "$6,346.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,346.40 " "$6,346.40 " "$7,298.36 " "$6,346.40 " N/A "$6,029.08 " "$23,705.01 " 330104 930 3 Multiple significant trauma w/o O.R. procedure I N/A "$11,088.74 " N/A "$11,088.74 " N/A N/A N/A N/A "$10,534.30 " N/A "$10,645.19 " N/A N/A N/A N/A N/A "$14,193.58 " "$11,088.74 " N/A N/A N/A N/A "$11,421.40 " N/A N/A "$15,524.23 " "$42,321.40 " "$11,088.74 " "$14,969.79 " "$13,639.15 " N/A "$11,421.40 " N/A N/A N/A N/A N/A "$11,088.74 " "$37,166.54 " "$22,731.91 " "$11,088.74 " "$11,088.74 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$11,088.74 " "$11,088.74 " "$12,752.05 " "$11,088.74 " N/A "$10,534.30 " "$42,321.40 " 330104 930 4 Multiple significant trauma w/o O.R. procedure I N/A "$25,197.91 " N/A "$25,197.91 " N/A N/A N/A N/A "$23,938.02 " N/A "$24,190.00 " N/A N/A N/A N/A N/A "$32,253.33 " "$25,197.91 " N/A N/A N/A N/A "$25,953.85 " N/A N/A "$35,277.08 " "$97,707.96 " "$25,197.91 " "$34,017.18 " "$30,993.43 " N/A "$25,953.85 " N/A N/A N/A N/A N/A "$25,197.91 " "$85,806.88 " "$51,655.72 " "$25,197.91 " "$25,197.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$25,197.91 " "$25,197.91 " "$28,977.60 " "$25,197.91 " N/A "$23,938.02 " "$97,707.96 " 330104 950 1 Extensive procedure unrelated to principal diagnosis I N/A "$9,588.11 " N/A "$9,588.11 " N/A N/A N/A N/A "$9,108.70 " N/A "$9,204.58 " N/A N/A N/A N/A N/A "$12,272.78 " "$9,588.11 " N/A N/A N/A N/A "$9,875.75 " N/A N/A "$13,423.35 " "$36,430.58 " "$9,588.11 " "$12,943.95 " "$11,793.37 " N/A "$9,875.75 " N/A N/A N/A N/A N/A "$9,588.11 " "$31,993.24 " "$19,655.62 " "$9,588.11 " "$9,588.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,588.11 " "$9,588.11 " "$11,026.32 " "$9,588.11 " N/A "$9,108.70 " "$36,430.58 " 330104 950 2 Extensive procedure unrelated to principal diagnosis I N/A "$15,014.35 " N/A "$15,014.35 " N/A N/A N/A N/A "$14,263.63 " N/A "$14,413.77 " N/A N/A N/A N/A N/A "$19,218.37 " "$15,014.35 " N/A N/A N/A N/A "$15,464.78 " N/A N/A "$21,020.09 " "$57,731.66 " "$15,014.35 " "$20,269.37 " "$18,467.65 " N/A "$15,464.78 " N/A N/A N/A N/A N/A "$15,014.35 " "$50,699.80 " "$30,779.41 " "$15,014.35 " "$15,014.35 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$15,014.35 " "$15,014.35 " "$17,266.50 " "$15,014.35 " N/A "$14,263.63 " "$57,731.66 " 330104 950 3 Extensive procedure unrelated to principal diagnosis I N/A "$27,516.63 " N/A "$27,516.63 " N/A N/A N/A N/A "$26,140.80 " N/A "$26,415.97 " N/A N/A N/A N/A N/A "$35,221.29 " "$27,516.63 " N/A N/A N/A N/A "$28,342.13 " N/A N/A "$38,523.29 " "$106,810.26 " "$27,516.63 " "$37,147.46 " "$33,845.46 " N/A "$28,342.13 " N/A N/A N/A N/A N/A "$27,516.63 " "$93,800.50 " "$56,409.10 " "$27,516.63 " "$27,516.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$27,516.63 " "$27,516.63 " "$31,644.13 " "$27,516.63 " N/A "$26,140.80 " "$106,810.26 " 330104 950 4 Extensive procedure unrelated to principal diagnosis I N/A "$55,580.36 " N/A "$55,580.36 " N/A N/A N/A N/A "$52,801.34 " N/A "$53,357.15 " N/A N/A N/A N/A N/A "$71,142.86 " "$55,580.36 " N/A N/A N/A N/A "$57,247.77 " N/A N/A "$77,812.51 " "$216,976.38 " "$55,580.36 " "$75,033.49 " "$68,363.85 " N/A "$57,247.77 " N/A N/A N/A N/A N/A "$55,580.36 " "$190,548.11 " "$113,939.74 " "$55,580.36 " "$55,580.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$55,580.36 " "$55,580.36 " "$63,917.42 " "$55,580.36 " N/A "$52,801.34 " "$216,976.38 " 330104 951 1 Moderately extensive procedure unrelated to principal diagnosis I N/A "$6,582.08 " N/A "$6,582.08 " N/A N/A N/A N/A "$6,252.98 " N/A "$6,318.80 " N/A N/A N/A N/A N/A "$8,425.07 " "$6,582.08 " N/A N/A N/A N/A "$6,779.55 " N/A N/A "$9,214.92 " "$24,630.21 " "$6,582.08 " "$8,885.81 " "$8,095.96 " N/A "$6,779.55 " N/A N/A N/A N/A N/A "$6,582.08 " "$21,630.19 " "$13,493.27 " "$6,582.08 " "$6,582.08 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$6,582.08 " "$6,582.08 " "$7,569.40 " "$6,582.08 " N/A "$6,252.98 " "$24,630.21 " 330104 951 2 Moderately extensive procedure unrelated to principal diagnosis I N/A "$9,780.20 " N/A "$9,780.20 " N/A N/A N/A N/A "$9,291.19 " N/A "$9,388.99 " N/A N/A N/A N/A N/A "$12,518.66 " "$9,780.20 " N/A N/A N/A N/A "$10,073.61 " N/A N/A "$13,692.28 " "$37,184.64 " "$9,780.20 " "$13,203.27 " "$12,029.65 " N/A "$10,073.61 " N/A N/A N/A N/A N/A "$9,780.20 " "$32,655.46 " "$20,049.41 " "$9,780.20 " "$9,780.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$9,780.20 " "$9,780.20 " "$11,247.23 " "$9,780.20 " N/A "$9,291.19 " "$37,184.64 " 330104 951 3 Moderately extensive procedure unrelated to principal diagnosis I N/A "$18,779.88 " N/A "$18,779.88 " N/A N/A N/A N/A "$17,840.89 " N/A "$18,028.69 " N/A N/A N/A N/A N/A "$24,038.25 " "$18,779.88 " N/A N/A N/A N/A "$19,343.28 " N/A N/A "$26,291.84 " "$72,513.53 " "$18,779.88 " "$25,352.84 " "$23,099.26 " N/A "$19,343.28 " N/A N/A N/A N/A N/A "$18,779.88 " "$63,681.20 " "$38,498.76 " "$18,779.88 " "$18,779.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$18,779.88 " "$18,779.88 " "$21,596.87 " "$18,779.88 " N/A "$17,840.89 " "$72,513.53 " 330104 951 4 Moderately extensive procedure unrelated to principal diagnosis I N/A "$43,052.19 " N/A "$43,052.19 " N/A N/A N/A N/A "$40,899.58 " N/A "$41,330.10 " N/A N/A N/A N/A N/A "$55,106.81 " "$43,052.19 " N/A N/A N/A N/A "$44,343.76 " N/A N/A "$60,273.07 " "$167,796.17 " "$43,052.19 " "$58,120.46 " "$52,954.20 " N/A "$44,343.76 " N/A N/A N/A N/A N/A "$43,052.19 " "$147,358.17 " "$88,256.99 " "$43,052.19 " "$43,052.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$43,052.19 " "$43,052.19 " "$49,510.02 " "$43,052.19 " N/A "$40,899.58 " "$167,796.17 " 330104 952 1 Nonextensive procedure unrelated to principal diagnosis I N/A "$5,654.32 " N/A "$5,654.32 " N/A N/A N/A N/A "$5,371.61 " N/A "$5,428.15 " N/A N/A N/A N/A N/A "$7,237.53 " "$5,654.32 " N/A N/A N/A N/A "$5,823.95 " N/A N/A "$7,916.05 " "$20,988.23 " "$5,654.32 " "$7,633.34 " "$6,954.82 " N/A "$5,823.95 " N/A N/A N/A N/A N/A "$5,654.32 " "$18,431.81 " "$11,591.36 " "$5,654.32 " "$5,654.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$5,654.32 " "$5,654.32 " "$6,502.47 " "$5,654.32 " N/A "$5,371.61 " "$20,988.23 " 330104 952 2 Nonextensive procedure unrelated to principal diagnosis I N/A "$8,456.00 " N/A "$8,456.00 " N/A N/A N/A N/A "$8,033.20 " N/A "$8,117.76 " N/A N/A N/A N/A N/A "$10,823.67 " "$8,456.00 " N/A N/A N/A N/A "$8,709.68 " N/A N/A "$11,838.39 " "$31,986.39 " "$8,456.00 " "$11,415.59 " "$10,400.87 " N/A "$8,709.68 " N/A N/A N/A N/A N/A "$8,456.00 " "$28,090.36 " "$17,334.79 " "$8,456.00 " "$8,456.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$8,456.00 " "$8,456.00 " "$9,724.39 " "$8,456.00 " N/A "$8,033.20 " "$31,986.39 " 330104 952 3 Nonextensive procedure unrelated to principal diagnosis I N/A "$16,955.02 " N/A "$16,955.02 " N/A N/A N/A N/A "$16,107.27 " N/A "$16,276.82 " N/A N/A N/A N/A N/A "$21,702.42 " "$16,955.02 " N/A N/A N/A N/A "$17,463.67 " N/A N/A "$23,737.02 " "$65,349.89 " "$16,955.02 " "$22,889.27 " "$20,854.67 " N/A "$17,463.67 " N/A N/A N/A N/A N/A "$16,955.02 " "$57,390.10 " "$34,757.78 " "$16,955.02 " "$16,955.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$16,955.02 " "$16,955.02 " "$19,498.27 " "$16,955.02 " N/A "$16,107.27 " "$65,349.89 " 330104 952 4 Nonextensive procedure unrelated to principal diagnosis I N/A "$40,712.36 " N/A "$40,712.36 " N/A N/A N/A N/A "$38,676.74 " N/A "$39,083.86 " N/A N/A N/A N/A N/A "$52,111.82 " "$40,712.36 " N/A N/A N/A N/A "$41,933.73 " N/A N/A "$56,997.30 " "$158,610.98 " "$40,712.36 " "$54,961.68 " "$50,076.20 " N/A "$41,933.73 " N/A N/A N/A N/A N/A "$40,712.36 " "$139,291.76 " "$83,460.33 " "$40,712.36 " "$40,712.36 " N/A N/A N/A N/A N/A N/A N/A N/A N/A "$40,712.36 " "$40,712.36 " "$46,819.21 " "$40,712.36 " N/A "$38,676.74 " "$158,610.98 "